Evaluation of Photodynamic Therapy in Treatment of Peri-implantitis
Condition: Peri-Implantitis
MeSH terms: Peri-Implantitis
Study type: Interventional

Summary: 
      Photodynamic therapy (PDT) is suggested as an adjuvant treatment method to the surgery in
      peri-implantitis treatment. The primary goal of peri-implantitis therapy is the removal of
      the causative bacteria from the implant surface and surrounding tissues in order to improve
      the process of re-osseointegration and achieve long term implant stability. Accordingly, the
      aims of the study were to evaluate clinical, immunological and microbiological outcomes after
      surgical therapy of peri-implantitis following PDT.
    

Detailed description: 
      Treatment procedure

      After clinical parameters were recorded and samples were taken, all patients underwent a
      single episode of non-surgical therapy. It implied a mechanical method for debridement of
      implants and remaining dentition in order to reduce signs of inflammation. Instructions for
      oral hygiene were proposed in the same visit.

      Peri-implantitis surgical treatment was conducted by one experienced surgeon two weeks after
      non-surgical therapy. After granulation tissue removal and mechanical implant surface
      cleaning with graphite curettes (Straumann Dental Implant System Straumann AG, Basel,
      Switzerland), decontamination of implant surface was conducted. In the study group, for the
      decontamination of implant surfaces and peri-implant tissues photodynamic therapy was
      performed (HELBO, Photodynamic Systems GmbH, Wels, Austria), while in the control group,
      after removal of granulation tissue, 1% gel of chlorhexidine (Chlorhexamed® - Direkt) was put
      on the implant surface. One minute after exposing the implant surface with CHX, it was
      irrigated for 1 min by saline. Bone augmentation and bio-resorbable membrane were applied in
      peri-implant defects using the bovine bone substitute and collagen membrane (Bio-Oss and Bio
      Gide, GeistlichPharma; Dembone). The mucoperiosteal flaps were repositioned and sutured [17,
      19].

      Patients were prescribed antibiotics (Amoxicillin, 500 mg, three per day, 5 days). It was
      recommended that patients don't use mouthwash during the postoperative period.

      Clinical, immunological and microbiological parameters were measured and assessed baseline,
      three, six, 12 and 24 months postoperatively. Immunological parameters (IL-17, IL-1β, IL-6)
      were analysed by ELISA while microbiological samples were collected before the therapy,
      during the surgery, and at follow-up periods.

      Assessment of implant macro- and micro- design were additionally assessed.
    

Intervention name(s): Photodynamic (PDT) group; Chlorhexidine (CHX) group
Intervention type(s): Procedure; Procedure
Intervention description(s): Mucoperiostal buccal and lingual incisions were made using a surgical blade under local anaesthesia. Full-thickness mucoperiosteal flaps were elevated buccally and lingually. In the photodynamic (PDT) group, after careful removal of granulation tissue and mechanical debridement of the implant surface, decontamination of implant surfaces and peri-implant tissues was performed using the photodynamic therapy, PDT (HELBO, Photodynamic Systems GmbH, Wels, Austria). The implant surface and the surrounding tissue were exposed to the laser light by means of fibres (HELBO ® TheraLite Laser HELBO ® 2D Spot Probe; bredent medical GmbH & Co KG) for the 30s/spot, which operates on the wavelength of 660 nm and irradiance of 100 Mw. Bone augmentation and bio-resorbable membrane were applied in peri-implant defects using the bovine bone substitute and collagen membrane (Bio -Oss and Bio Guide, GeistlichPharma; Dembone). The mucoperiosteal flaps were repositioned and sutured.; Mucoperiostal buccal and lingual incisions were made using a surgical blade under local anaesthesia. Full-thickness mucoperiosteal flaps were elevated buccally and lingually. In the chlorhexidine (CHX) group, after careful removal of granulation tissue and mechanical debridement of the implant surface 1% gel of chlorhexidine (Chlorhexamed® - Direkt) was applied on the implant surface for one minute and irrigated for 1 min by saline. Bone augmentation and bio-resorbable membrane were applied in peri-implant defects using the bovine bone substitute and collagen membrane (Bio -Oss and Bio Guide, GeistlichPharma; Dembone). The mucoperiosteal flaps were repositioned and sutured.
Intervention MeSH terms: Chlorhexidine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Peri-Implantitis, Photodynamic therapy, Surgery