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29 January 2020

Perimplantitis: how to decontaminate implant surface

Giulia Palandrani


Treatments using dental implants to replace missing teeth are effective and predictable. However, with the ever-growing popularity of implant treatments and the increasing number performed in recent years, the incidence of short and long-term complications has increased. One of these complications is peri-implantitis. The literature shows evidence of periimplantitis’s microbial etiology, with a microbiota that is very similar to advanced periodontitis, A systematic review of research published before January 2008 identified much evidence that poor oral hygiene, a history of periodontitis and/or of smoking are indicators of peri-implantitis risk. The therapies proposed for treating peri-implantitis are based on the evidence available for the treatment of periodontitis, and are aimed at reducing the bacterial load within peri-implant pockets and decontaminating implant surfaces. The objective of this review was to evaluate the information available in the literature as to the efficacy of different mechanisms for decontaminating implant surfaces.  

MATERIAL AND METHODS  
Of the 135 articles identified in the Internet search using Pubmed database, only 36 ful- filled the quality criteria. Studies in which the main topic was regenerative treatment of peri-implant defects were excluded. All literature reviewed analyzed the diverse methods of implant surface decontamination which were classified in:
- Physical Decontamination Methods: principally mechanical, such as implantoplasty, sandblasting systems, bicarbonate air-powder abrasion systems. Its objective is the elimination of toxins from the implant surface in order to produce a surface compatible with health, to promote reosseointegration.
-Decontamiation using laser: is based on its thermal effect, which denatures proteins and causes cellular necrosis.
-Chemical Decontamination and Antibiotic Therapy: involves the localized use of anti-microbial solutions such as topical chlorhexidine, tetracycline or minocycline, citric acid, hydrogen per- oxide or 35% phosphoric acid gel, in combination with mechanical debridement for eliminating hard and soft deposits  

RESULTS 
In non-surgical treatment of peri-implantitis, mechanical therapy on its own would appear to be insufficient. Used in combination with chlorhexidine, it improves the clinical and microbiological parameters slightly, and the addition of local or systemic administration of antibiotics reduces bleeding on probing and probing depth. For this reason, non-surgical treatment should limit itself to the treatment of mucositis, as it will not resolve inflammatory lesions in cases of bone loss. For peri-implantitis treatment, surgical access is recommended in order to achieve complete removal of granulation tissue and to obtain access for the decontamination of the implant surface. In fact there would appear to be sufficient consensus that, for the treatment of peri-implant infections, the removal of the biofilm from the implant surface should be supplemented by chemical decontamination.

CONCLUSIONS
Due to the great heterogeneity of studies, which have used empirical combinations of different decontamination methods, and the variablility of the implant surfaces treated, it is impossible to establish a single protocol for implant decontamination for peri-implatitis treatment. 

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