Clinical efficacy of photodynamic therapy as an adjunct to mechanical debridement in the treatment of per-implantitis with abscess.

AIM: The aim of the present clinical trial was to evaluate the efficacy of photodynamic therapy (PDT) as an adjunct to mechanical debridement (MD) in the treatment of severe peri-implantitis (PI) with abscess. MATERIALS AND METHODS: Selected individuals with severe PI were divided into two groups: Group A: received methylene blue mediated (PDT) using diode laser as an adjunct to MD, whereas, Group B received thrice daily application of 500 mg amoxicillin and 400 mg metronidazole with adjunctive MD. Peri-implant plaque scores (PS), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) were reported. Microbial counts of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia were analyzed using polymerase chain reaction. The assessment of pain was done with the help of numeric pain rating scale (NPRS). All assessments were done at baseline and repeated at 6 and 12 months, respectively. RESULTS: A total of 40 individuals completed the clinical trial. Both Group A and Group B comprised of 20 patients respectively. A significant improvement was observed in BOP in Group A at 12 months compared to Group B. No statistically significant changes were seen for NPRS scores between both groups (p > 0.05). Statistically significant differences were observed in values for P. gingivalis, T. denticola and T. forsythia at 6 months follow-up period in comparison to baseline for both Group A and Group B (p < 0.05). Whereas, the values observed at 6 months follow-up period for Porphyromonas gingivalis also reported a statistically significant difference in between the groups (p < 0.05). CONCLUSION: PDT was equally effective in reducing severe peri-implant symptoms compared to antimicrobial therapy as an adjunct to mechanical debridement.

Assessment of advanced glycation end products in the peri-implant sulcular fluid among moderate cigarette-smokers and nonsmokers with peri-implantitis.

BACKGROUND: It is hypothesized that the levels of advanced glycation end products (AGEs) are higher in the peri-implant sulcular fluid (PISF) of cigarette-smokers than nonsmokers with peri-implantitis. PURPOSE: The purpose was to compare the levels of AGEs in the PISF among moderate cigarette-smokers and nonsmokers with peri-implantitis. MATERIALS AND METHODS: Cigarette-smokers and nonsmokers with peri-implantitis and nonsmokers without peri-implantitis were included. A questionnaire was used to gather information related to smoking habit, duration of implants in function and demographic traits. In all groups, peri-implant plaque index (PI), gingival index (GI), crestal bone loss (CBL) and probing depth (PD). The PISF was collected and levels of AGEs were measured. Group comparisons were performed and P < .01 was nominated as pointer of statistical significance. RESULTS: Fourteen smokers with peri-implantitis (12 males and 2 females), 15 nonsmokers with peri-implantitis (14 males and 1 female) and 15 nonsmokers without peri-implantitis (13 males and 2 females) were included. Smokers with peri-implantitis had a smoking history of 22.7 ± 0.3 pack years. The mesial and distal CBL, PI, and PD were significantly higher in smokers with peri-implantitis than nonsmokers with (P < .01) and without peri-implantitis (P < .01). The GI was significantly higher in smokers (P < .01) and nonsmokers with peri-implantitis (P < .01) compared with nonsmokers without peri-implantitis. The levels of AGEs were significantly higher among smokers with peri-implantitis (552.8 ± 87.2 pg/mL) (P < .01) compared with nonsmokers with (141.6 ± 64.9 pg/mL) and without (88.1 ± 27.3 pg/mL) peri-implantitis. The levels of AGEs were significantly higher among nonsmokers with (141.6 ± 64.9 pg/mL) (P < .01) than without (88.1 ± 27.3 pg/mL) peri-implantitis. CONCLUSION: The levels of AGEs expressed in the PISF are higher among moderate cigarette-smokers than nonsmokers with peri-implantitis.

Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation.

AIM: To compare the effectiveness of two protocols in the treatment of peri-implant mucositis (p-iM) among cigarette smokers. MATERIALS AND METHODS: Three groups were randomized into (i) single session of antimicrobial photodynamic therapy (aPDT) with mechanical debridement (MD) (Group-A), (ii) systemic AB with MD (Group-B), and (iii) MD alone (Group-C). Clinical peri-implant parameters including plaque scores (PS), bleeding on probing (BOP) and probing depth (PD) were measured at baseline, 6 weeks and 12 weeks. Microbiological parameters included the assessment of percentage level of Pseudomonas aeruginosa and Staphylococcus aureus at baseline and 12 weeks. All parameters were analyzed using Friedman test and multiple comparisons performed using Bonferroni tests. P-value less than 0.05 were considered statistically significant. RESULTS: At 6 weeks of follow-up, there was a statistically significant reduction in PS (p < 0.001), BOP (p < 0.01), and PD (p < 0.05) among patients in groups A and B on intragroup comparison. At 12 weeks of follow-up, there was a further significant reduction in PS (p < 0.001) and BOP (p < 0.01) among patients in groups A and B on intragroup comparison but this reduction was comparable with 6-week follow-up. On inter-group comparison, only Group-A showed statistically significant reduction in BOP compared to Group-B and C at 6 weeks (p < 0.05). The levels of both P. aeruginosa and S. aureus in Group-A and Group-B showed statistically significant reductions at 12 weeks compared with baseline (p < 0.01). On inter-group comparison, Group-A and B showed no significant differences at follow-up (p > 0.05). CONCLUSION: This short term clinical study suggests that aPDT as an adjunct to MD is as efficacious as adjunctive antibiotic therapy. However, additional benefits in the reduction of bleeding scores were observed for aPDT in peri-implant inflammation among cigarette smokers.

Relationship between self-rated pain and peri-implant clinical, radiographic and whole salivary inflammatory markers among patients with and without peri-implantitis.

BACKGROUND: There are no studies that have evaluated the correlation between self-rated pain, peri-implant clinical and radiographic parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], and crestal bone loss [CBL]) and whole salivary interleukin (IL)-1ß, IL-6, and tumor necrosis factor-alpha (TNF-α) levels among patients with and without peri-implantitis. PURPOSE: The objective was to evaluate the correlation between self-evaluated pain, peri-implant clinical and radiographic parameters and whole salivary IL-1ß, IL-6, and TNF-α levels among patients with and without peri-implantitis. MATERIALS AND METHODS: Included in this study were patients with and without peri-implantitis. Data regarding age, gender, duration of implants in function, and self-perceived pain were recorded using a question. Self-rated pain was assessed using the numeric pain rating scale. Peri-implant PD, PI, BOP, and CBL were recorded and samples of unstimulated whole saliva samples were obtained. Whole salivary IL-1ß, IL-6, and TNF-α were measured. Sample-size was approximated and group comparisons were completed. P-values <.05 were regarded as statistically significant. RESULTS: Forty-six male individuals (21 with and 25 without peri-implantitis) were included. The mean age of individuals with and without PiD was 53.71 ± 5.45 and 50.92 ± 6.26 years, respectively. The mean self-rated pain score in patients with and without PiD was 3 ± 2 and zero, respectively. There was no significant difference in the SFR among patients with and without peri-implantitis. Levels of IL-1ß (P < .01), IL-6 (P < .01), and TNF-α (P < .01) were significantly elevated in subjects with than without peri-implantitis. Regression analysis-based results reflected no significant association between increasing self-rated pain and whole salivary IL-1ß, IL-6, and TNF-α levels. CONCLUSION: Proinflammatory cytokines (IL-1ß, IL-6, and TNF-α) are more often expressed in the UWS of patients with than without peri-implantitis. However, the correlation between self-rated pain and whole salivary proinflammatory cytokine profile in patients with peri-implantitis remains unclear.