Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial

Mario Romandini, Andreina Laforí, Ignacio Pedrinaci, Giacomo Baima, Francesco Ferrarotti, Cristina Lima, Lucrezia Paternó Holtzman, Mario Aimetti, Luca Cordaro, Mariano Sanz, Mario Romandini, Andreina Laforí, Ignacio Pedrinaci, Giacomo Baima, Francesco Ferrarotti, Cristina Lima, Lucrezia Paternó Holtzman, Mario Aimetti, Luca Cordaro, Mariano Sanz

Abstract

Aim: The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis.

Materials and methods: Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial.

Results: At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups.

Conclusions: The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).

Keywords: clinical trial; disease resolution; non-surgical treatment; peri-implantitis.

Conflict of interest statement

The authors declare no conflicts of interest related to this study.

© 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
CONSORT 2010 participant flow diagram of the trial

References

    1. Berglundh, J. , Romandini, M. , Derks, J. , Sanz, M. , & Berglundh, T. (2021). Clinical findings and history of bone loss at implant sites. Clinical Oral Implants Research, 32(3), 314–323. 10.1111/clr.13701
    1. Berglundh, T., Wennström, J. L., & Lindhe, J. (2018). Long‐term outcome of surgical treatment of peri‐implantitis. A 2‐11‐year retrospective study. Observational Study, 29(4), 404–410. 10.1111/clr.13138
    1. Carcuac, O. , Derks, J. , Charalampakis, G. , Abrahamsson, I. , Wennstrom, J. , & Berglundh, T. (2016). Adjunctive systemic and local antimicrobial therapy in the surgical treatment of peri‐implantitis: A randomized controlled clinical trial. Journal of Dental Research, 95(1), 50–57. 10.1177/0022034515601961
    1. Carcuac, O., Derks, J., Abrahamsson, I., Wennström, J. L., & Berglundh, T. (2020). Risk for recurrence of disease following surgical therapy of peri‐implantitis‐A prospective longitudinal study. Clinical Oral Implants Research, 31(11), 1072–1077. 10.1111/clr.13653
    1. Cha, J. K. , Lee, J. S. , & Kim, C. S. (2019). Surgical therapy of peri‐implantitis with local minocycline: A 6‐month randomized controlled clinical trial. Journal of Dental Research, 98(3), 288–295. 10.1177/0022034518818479
    1. de Tapia, B. , Valles, C. , Ribeiro‐Amaral, T. , Mor, C. , Herrera, D. , Sanz, M. , & Nart, J. (2019). The adjunctive effect of a titanium brush in implant surface decontamination at peri‐implantitis surgical regenerative interventions: A randomized controlled clinical trial. Journal of Clinical Periodontology, 46(5), 586–596. 10.1111/jcpe.13095
    1. de Waal, Y. C. M. , Vangsted, T. E. , & van Winkelhoff, A. J. (2021). Systemic antibiotic therapy as an adjunct to non‐surgical peri‐implantitis treatment: A single‐blind RCT. Journal of Clinical Periodontology, 48, 996–1006. 10.1111/jcpe.13464
    1. Derks, J. , Ortiz‐Vigón, A. , Guerrero, A. , Donati, M. , Bressan, E. , Ghensi, P. , Schaller, D. , Tomasi, C. , Karlsson, K. , Abrahamsson, I. , Ichioka, Y. , Dionigi, C. , Regidor, E. , & Berglundh, T. (2022). Reconstructive surgical therapy of peri‐implantitis: A multicenter randomized controlled clinical trial. Clinical Oral Implants Research. 10.1111/clr.13972
    1. Derks, J. , Schaller, D. , Håkansson, J. , Wennström, J. L. , Tomasi, C. , & Berglundh, T. (2016a). Effectiveness of implant therapy analyzed in a Swedish population: Prevalence of peri‐implantitis. Journal of Dental Research, 95(1), 43–49. 10.1177/0022034515608832
    1. Derks, J. , Schaller, D. , Håkansson, J. , Wennström, J. L. , Tomasi, C. , & Berglundh, T. (2016b). Peri‐implantitis – Onset and pattern of progression. Journal of Clinical Periodontology, 43(4), 383–388. 10.1111/jcpe.12535
    1. Figuero, E. , Graziani, F. , Sanz, I. , Herrera, D. , & Sanz, M. (2014). Management of peri‐implant mucositis and peri‐implantitis. Periodontology 2000, 66(1), 255–273. 10.1111/prd.12049
    1. Hallström, H. , Persson, G. R. , Lindgren, S. , & Renvert, S. (2017). Open flap debridement of peri‐implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial. Journal of Clinical Periodontology, 44, 1285–1293. 10.1111/jcpe.12805
    1. Hentenaar, D. F. M. , de Waal, Y. C. M. , Stewart, R. E. , van Winkelhoff, A. J. , Meijer, H. J. A. , & Raghoebar, G. M. (2021). Erythritol airpolishing in the non‐surgical treatment of peri‐implantitis: A randomized controlled trial. Clinical Oral Implants Research, 32, 840–852. 10.1111/clr.13757
    1. Isehed, C. , Holmlund, A. , Renvert, S. , Svenson, B. , Johansson, I. , & Lundberg, P. (2016). Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri‐implantitis. A randomized controlled trial. Journal of Clinical Periodontology, 43(10), 863–873. 10.1111/jcpe.12583
    1. Jepsen, K. , Jepsen, S. , Laine, M. L. , Anssari Moin, D. , Pilloni, A. , Zeza, B. , Sanz, M. , Ortiz‐Vigon, A. , Roos‐Jansåker, A. M. , & Renvert, S. (2016). Reconstruction of peri‐implant osseous defects: A multicenter randomized trial. Journal of Dental Research, 95(1), 58–66. 10.1177/0022034515610056
    1. Karlsson, K. , Derks, J. , Håkansson, J. , Wennström, J. L. , Petzold, M. , & Berglundh, T. (2019). Interventions for peri‐implantitis and their effects on further bone loss: A retrospective analysis of a registry‐based cohort. Journal of Clinical Periodontology, 46(8), 872–879. 10.1111/jcpe.13129
    1. Merli, M. , Bernardelli, F. , Giulianelli, E. , Carinci, F. , Mariotti, G. , Merli, M. , Pini‐Prato, G. , & Nieri, M. (2020). Short‐term comparison of two non‐surgical treatment modalities of peri‐implantitis: Clinical and microbiological outcomes in a two‐factorial randomized controlled trial. Journal of Clinical Periodontology, 47(10), 1268–1280. 10.1111/jcpe.13345
    1. Moher, D. , Hopewell, S. , Schulz, K. F. , Montori, V. , Gotzsche, P. C. , Devereaux, P. J. , Elbourne, D. , Egger, M. , & Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. British Medical Journal (Clinical Research Ed.), 340, c869. 10.1136/bmj.c869
    1. Mombelli, A. , Van Oosten, M. A. C. , Schürch, E. , & Lang, N. P. (1987). The microbiota associated with successful or failing osseointegrated titanium implants. Molecular Oral Microbiology, 2, 145–151. 10.1111/j.1399-302X.1987.tb00298.x
    1. Polymeri, A. , Anssari‐Moin, D. , van der Horst, J. , Wismeijer, D. , Laine, M. L. , & Loos, B. G. (2020). Surgical treatment of peri‐implantitis defects with two different xenograft granules: A randomized clinical pilot study. Clinical Oral Implants Research, 31, 1047–1060. 10.1111/clr.13651
    1. Renvert, S. , Giovannoli, J. , Roos‐Jansåker, A. , & Rinke, S. (2021). Surgical treatment of peri‐implantitis with or without a deproteinized bovine bone mineral and a native bilayer collagen membrane: A randomized clinical trial. Journal of Clinical Periodontology, 48, 1312–1321. 10.1111/jcpe.13513
    1. Renvert, S. , Rutger Persson, G. , Pirih, F. Q. , & Camargo, P. M. (2018). Peri‐implant health, peri‐implant mucositis, and peri‐implantitis: Case definitions and diagnostic considerations. Journal of Clinical Periodontology, 45(Suppl. 20), S278–S285. 10.1111/jcpe.12956
    1. Romandini, M. , Berglundh, J. , Derks, J. , Sanz, M. , & Berglundh, T. (2021). Diagnosis of peri‐implantitis in the absence of baseline data: A diagnostic accuracy study. Clinical Oral Implants Research, 32(3), 297–313. 10.1111/clr.13700
    1. Romandini, M. , Cordaro, M. , Donno, S. , & Cordaro, L. (2019). Discrepancy between patient satisfaction and biologic complication rate in patients rehabilitated with overdentures and not participating in a structured maintenance program after 7 to 12 years of loading. The International Journal of Oral & Maxillofacial Implants, 34(5), 1143–1151. 10.11607/jomi.7465
    1. Romandini, M. , Lima, C. , Pedrinaci, I. , Araoz, A. , Costanza Soldini, M. , & Sanz, M. (2021a). Clinical signs, symptoms, perceptions, and impact on quality of life in patients suffering from peri‐implant diseases: A university‐representative cross‐sectional study. Clinical Oral Implants Research, 32(1), 100–111. 10.1111/clr.13683
    1. Romandini, M. , Lima, C. , Pedrinaci, I. , Araoz, A. , Costanza Soldini, M. , & Sanz, M. (2021b). Prevalence and risk/protective indicators of peri‐implant diseases: A university‐representative cross‐sectional study. Clinical Oral Implants Research, 32(1), 112–122. 10.1111/clr.13684
    1. Romandini, M. , Pedrinaci, I. , Lima, C. , Costanza Soldini, M. C. , Araoz, A. , & Sanz, M. (2021). Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants. Journal of Clinical Periodontology, 95(9), 995–999. 10.1111/jcpe.13417
    1. Sanz, M. , Herrera, D. , Kebschull, M. , Chapple, I. , Jepsen, S. , Beglundh, T. , Sculean, A. , Tonetti, M. S. , & EFP Workshop Participants and Methodological Consultants . (2020). Treatment of stage I‐III periodontitis‐the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(Suppl. 22), 4–60. 10.1111/jcpe.13290
    1. Schirmer, C. , Otero Dos Santos, G. , Franciele Rost, J. , Cardoso Ferreira, M. B. , & Weidlich, P. (2018). Factors associated with pain and analgesic consumption following non‐surgical periodontal therapy under local anaesthesia and carried out by dental students. Journal of Clinical Periodontology, 45(1), 68–77. 10.1111/jcpe.12833
    1. Schwarz, F. , Jepsen, S. , Obreja, K. , Galarraga‐Vinueza, M. E. , & Ramanauskaite, A. (2022). Surgical therapy of peri‐implantitis. Periodontology, 2000(88), 145–181. 10.1111/prd.12417
    1. Schwarz, F. , Sahm, N. , Iglhaut, G. , & Becker, J. (2011). Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri‐implantitis: A randomized controlled clinical study. Journal of Clinical Periodontology, 38(3), 276–284. 10.1111/j.1600-051X.2010.01690.x
    1. Suvan, J. , Leira, Y. , Moreno Sancho, F. M. , Graziani, F. , Derks, J. , & Tomasi, C. (2020). Subgingival instrumentation for treatment of periodontitis. A systematic review. Journal of Clinical Periodontology, 47(Suppl. 22), 155–175. 10.1111/jcpe.13245
    1. Vignoletti, F. , Di Domenico, G. L. , Di Martino, M. , Montero, E. , & De Sanctis, M. (2019). Prevalence and risk indicators of peri‐implantitis in a sample of university‐based dental patients in Italy: A cross‐sectional study. Journal of Clinical Periodontology, 46(5), 597–605. 10.1111/jcpe.13111

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner