A retrospective analysis of the management of ailing and failing endosseous dental implants.

Very little has been presented in the scientific literature regarding the ability of practitioners to salvage the ailing dental implant once bone loss has occurred. The purpose of this study was to follow patients who had bone loss and increased probing depths associated with their dental implants after initial integration and restoration. All patients either were referred for the treatment of these implant problems or were patients on supportive periodontal therapy in this periodontal practice. Forty-two ailing/failing implants in 21 consecutive patients (ages 22-87) all having signs of excessive bone loss and bleeding on probing (most having suppuration) were treated either resectively or via hard or soft tissue augmentation and were followed for 42 to 84 months (average 54 months) in this retrospective study.

Chemotherapeutics in implant dentistry.

Adjunctive treatment with various chemotherapeutic regimens in implant dentistry are reviewed along with the indications for specific approaches. The use of systemic antibiotics, topical antimicrobials, and various mechanical modalities are discussed in relation to patient maintenance and the repair of ailing implants.

Detoxification of endotoxin-contaminated titanium and hydroxyapatite-coated surfaces utilizing various chemotherapeutic and mechanical modalities.

The surgical repair of the ailing implant may be complicated by the surface effects of pathogenic bacteria and their products. This study evaluated the ability of various chemotherapeutic modalities to detoxify endotoxin-contaminated titanium alloy and hydroxyapatite-coated test strips. Grit-blasted titanium alloy and hydroxyapatite-coated test strips were contaminated with purified outer membranes of Escherichia coli labeled with radioactive 14C. The titanium alloy strips were treated with citric acid, stannous fluoride, tetracycline HCl, chlorhexidine gluconate, hydrogen peroxide, chloramine T, sterile water, a plastic sonic scaler tip, and an air-powder abrasive unit. Hydroxyapatite-coated strips were treated with chloramine T, citric acid, or burnished with sterile water on cotton pellets. Residual lipopolysaccharide levels were measured by liquid scintillation spectrometry. The air-powder abrasive unit removed significantly greater amounts of lipopolysaccharide than all other treatment modalities on titanium samples (P < 0.05). A 60-second burnish with sterile water was able to remove significant amounts of lipopolysaccharide when compared with untreated controls (P < 0.05). Citric acid was superior in the removal of lipopolysaccharide from hydroxyapatite-coated surfaces when compared with the controls or chloramine T (P < 0.01). Detoxification of an implant infected surface may be beneficial when surgical repair of the ailing implant is indicated.

Fibroblastic growth and attachment on hydroxyapatite-coated titanium surfaces following the use of various detoxification modalities. Part I: Noncontaminated hydroxyapatite.

Hydroxyapatite-coated titanium alloy test strips were treated with chlorhexidine gluconate, stannous fluoride, citric acid, tetracycline HCl, polymyxin B, hydrogen peroxide, and a plastic Cavitron tip: untreated sterile strips served as controls. The strips were incubated with cultured human gingival and periodontal ligament fibroblasts. Image analysis of three photomicrographs of each test strip (original magnification x350) indicated that the tetracycline HCl treatment resulted in significantly greater cellular surface area coverage compared with the other treatments. Citric acid and the plastic Cavitron tip also stimulated cell attachment, although the results from the Cavitron tip were not significantly different from citric acid or the other treatment groups. The remainder of the modalities and the untreated cellular controls experienced similar cellular coverage.

Fibroblastic growth and attachment on hydroxyapatite-coated titanium surfaces following the use of various detoxification modalities. Part II: Contaminated hydroxyapatite.

This study evaluated the ability of various chemotherapeutic and mechanical modalities to detoxify endotoxin-contaminated hydroxyapatite-coated dental implant surfaces as determined by the early attachment and growth of human gingival fibroblasts. Hydroxyapatite-coated test strips were contaminated with purified outer membranes of Escherichia coli and treated with citric acid, hydrogen peroxide, stannous fluoride, chlorhexidine gluconate, tetracycline HCl, polymyxin B, a plastic sonic scaler tip, or left untreated (contaminated and sterile controls). Human gingival fibroblasts were then seeded onto the test strips and incubated for 48 hours. The citric acid-treated strips showed greater cell growth than the other treatments. The plastic sonic scaler tip and the polymyxin B-treated samples exhibited greater cell coverage than the sterile control specimens. The use of citric acid and/or a modified plastic sonic scaler tip may be a valuable adjunct when surgical repair of an ailing hydroxyapatite-coated dental implant is contemplated.

Hydroxyapatite coatings in implant dentistry.

Hydroxyapatite coatings have shown promise due to the enhanced integration of osseous tissues to coated implant surfaces. When compared with healing around commercially pure or titanium alloy implant surfaces, hydroxyapatite-coated implants appear to be superior in sites which are compromised in either quantity or quality of bone. In spite of these encouraging findings, the long-term stability of the hydroxyapatite/bone interface has been challenged. Microbiologically, the hydroxyapatite-coated implant surface may be at an increased risk to bacterial plaque. However, after 8 years of clinical utilization, the hydroxyapatite-coated implant surface has not been shown to be predisposed to increased long-term failure. Available research as it pertains to this controversial area of implant dentistry is reviewed.

Implant maintenance using a modified ultrasonic instrument.

With the increasing number of implants in place, oral hygiene and maintenance are imperative because implants are susceptible to plaque accumulation and calculus formation. This case study evaluated a modification of the common ultrasonic tip to remove calcified deposits on implant abutments and prostheses, and also evaluated ultrastructural changes on polished titanium. A modified "plastic" ultrasonic instrument was found to be clinically effective and efficient. This instrument, unlike a metal ultrasonic tip on an ultrastructural level, produced no irreversible changes on the evaluated commercially pure titanium test strip. The preliminary results of this modification of an ultrasonic instrument show promise for its use as an implant maintenance modality.