Dental News - Surgical treatment of circumferential and semicircumferential defects due to periimplantitis: A prospective case series cohort study

Dr. Luigi Canullo et al.

Mon. 16. January 2017

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Different surgical treatment strategies for periimplantitis using graft material and membranes have been suggested. However, in these, the microbiological aspects of the periimplant environment were underestimated. The present preliminary study was aimed at analyzing a new clinical approach based on disinfection of the implant connection and of the implant surface, as well as the use of only a self-stabilizing graft material in the treatment of circumferential and semicircumferential bony defects resulting from periimplantitis.

Materials and methods
Ten consecutive patients were selected for the present study. After removal of factors that may potentially have influenced the periimplant pathology, the prosthesis was removed and a full-thickness flap was elevated to allow access to the periimplant defect and the exposed implant surface. Once the defect had been degranulated and the implant surface cleaned, bone powder was used to cover the surface. A resorbable, self-stabilizing material (GUIDOR easy-graft CLASSIC, Sunstar Suisse, Étoy, Switzerland) composed of calcium phosphate particles coated with a thin layer of PLGA was used to fill the defect. No membranes were used and the flaps were closed for a submerged healing. Two months thereafter, a new reopening procedure was performed and the cleaned superstructures and crowns were repositioned. The patients were followed for 12 months thereafter and recalled for customized oral hygiene every three months. Radiographic and periodontal analysis were performed preoperatively and every six months postoperatively. Microbiological analysis was performed preoperatively and at the last follow-up. Three types of sites in each patient were analyzed: (a) the periimplant sulcus of each implant; (b) the gingival sulci of the neighboring teeth; and (c) the connection’s inside and the abutment surface of each implant. The presence of ten common periodontal pathogens was measured.

Results
The procedure studied was associated with a pronounced increase in mucosal recession and clinical attachment level with stable periimplant conditions at six and 12 months. Plaque index, bleeding on probing and probing depth values were significantly reduced at six and 12 months. Radiographic analysis demonstrated a complete or semicomplete filling of the defect in all of the cases, with a significant bone gain at six and 12 months. Microbiological analysis, in terms of total bacterial count and single pathogens, demonstrated a significant decrease of microbiological contamination in all of the test sites between baseline and the 12 months follow-up: at the sulcus, the neighboring teeth and the connection.

Conclusion
Within the limitations of the present preliminary study, the proposed technique, in combination with a self-stabilizing graft material, offers promising results for the treatment of circumferential and semicircumferential bone defects around implants affected by periimplantitis, without the use of a membrane.

Editorial note: The full article was published in the 4/2016 issue of the Journal of Oral Science and Rehabilitation. It can be access free of charge at www.dtscience.com.

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