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Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis
Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis Vanessa Sousa Víctor Beltrán Nikos Mardas Lochana Nanayakkara Nikolaos Donos Dental Update 2024 50:11, 707-709.
Clinical Lecturer and Honorary Consultant in Periodontology, Periodontology Unit, Centre for Host–Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's and St Thomas' NHS Foundation Trust; Specialist Practitioner, Private Practice, London
Associate Professor in Periodontology and Implant Dentistry, Postgraduate Academic Dean, Director of Clinical Investigation and Dental Innovation Center, Institute of Dentistry, Universidad de La Frontera, Temuco, Chile; Specialist Practitioner, Private Practice, Temuco, Chile
Clinical Reader and Honorary Consultant in Periodontology, Undergraduate Periodontology Lead, Centre for Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London; Specialist Practitioner, Private Practice, London
Consultant in Restorative Dentistry, Director of Dental Education, Royal London Hospital, Barts Health NHS Trust; Honorary Senior Lecturer, Co-Lead for DClinDent Programme in Prosthodontics, Institute of Dentistry, Queen Mary University of London; Specialist Practitioner, Private Practice, London
Professor of Periodontology and Implant Dentistry, Honorary Consultant in Periodontology, Director of Research, Director of Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London; Royal London Hospital, Barts Health NHS Trust; Specialist Practitioner, Private Practice, London
Treatment protocols for peri-implantitis include various decontamination procedures of the exposed implant surface, and their application is dependent on the stage of implant therapy, involving both non-surgical and surgical interventions, as appropriate. These implant surface decontamination procedures may be delivered using different approaches, such as mechanical/physical, chemical, photo/mechanical, adjuncts, or combinations thereof. In Part 1 of this two-part series, we reviewed the available evidence for the non-surgical and surgical management of peri-implantitis. In Part 2, we discuss different approaches for implant surface decontamination.
CPD/Clinical Relevance: The pre-operative risk identification and management at both patient and site level, early diagnosis and regular supportive peri-implant care are fundamental for long term implant success and survival.
Article
Peri-implantitis therapy starts with a non-surgical step, followed by re-evaluation and, depending on the outcomes, progress to the surgical step or to supportive peri-implant care (SPIC).1 An important part of the peri-implantitis treatment pathway is the decontamination of the implant surface.1,2,3 In terms of clinical outcomes and histological observations, preclinical and clinical studies have reported that no surface decontamination method (e.g. titanium (Ti) curettes, plastic curettes, Ti brushes, air-polishing abrasives, laser application or chemotherapeutic approaches) appears to yield superior outcomes to any other.4,5,6,7 No significant long-term differences have been found, for instance, between the use of a gauze soaked in saline and other decontamination techniques, such as employing rotating brushes, H2O2, air powder abrasives, or citric acid.8 However, although no decontamination technique has been found to be the most effective,9,10 the objective of this article is to present a summary of the evidence for different methods and to try to understand why these techniques might be failing to achieve medium-to long-term (≥3 years) improvement (Table 1). Importantly, current European Federation of Periodontology (EFP) S3 Level Clinical Practice Guidelines (CPG) recommend that implant-supported prostheses, which hinder self-performed oral hygiene, be adjusted prior to the surgical therapy of peri-implantitis. Furthermore, it is suggested that implant-supported prostheses, where feasible, be removed in conjunction with the surgical treatment of peri-implantitis to facilitate access and peri-implant tissue healing.1
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