Non Surgical Protocol for Treatment of Mucositis
Condition: Peri-implant Mucositis
MeSH terms: Mucositis
Study type: Interventional

Summary: 
      Peri-implant mucositis is an important disease entity as a result of its high prevalence and
      the lack of a standard mode of therapy.

      Non-surgical therapy of peri-implant mucositis appears to be partially effective in resolving
      the disease. In several cases, however, only limited improvements have been reported in the
      main clinical parameters (bleeding partial resolution and presence of pocket at follow-up
      visits) and there is a clear tendency to relapse of the disease.

      In these cases it is therefore recommended to consider adjunctive therapies. Numerous
      approaches have been used for implant surface decontamination including mechanical, chemical
      and treatments by means of air-powder or laser.

      The aim of the present randomized controlled clinical trial will be to assess the efficacy in
      improving clinical parameters of two further methods of implant surface decontamination
      (Er:YAG laser or air-abrasive device) after mechanical cleaning during non surgical treatment
      of peri-implant mucositis.
    

Detailed description: 
      Peri-implant mucositis, defined as an inflammatory lesion of the surrounding peri-implant
      tissues without loss of supporting bone, is an important disease entity as a result of its
      high prevalence and the lack of a standard mode of therapy. Although the current
      epidemiological data are limited, peri-implant mucositis affects 43% of the subjects.

      Numerous approaches have been used for implant surface decontamination, including mechanical,
      chemical and laser treatments. Using conventional mechanical means, eradication of pathogens
      on implant surfaces with threads and often with rough surface structures is difficult.
      Treatment models, such as debridement, effectively used to treat teeth with periodontitis,
      cannot be used in the same way on rough threaded implant surfaces. The implant rough surface
      structure also provides the bacteria with ''protected areas'', inaccessible to conventional
      mechanical removal.

      A treatment protocol that may offer an advantage over traditional mechanical treatment
      includes the use of laser therapy. Data have shown that treatments with Er:YAG lasers have a
      bactericidal effect. Er:YAG laser treatment can debride the implant surface effectively and
      safely. Slightly better clinical results in terms of bleeding on probing and clinical
      attachment level have been reported by Er:YAG laser treatment as compared with traditional
      non-surgical mechanical debridement with curettes and chlorhexidine.

      The air abrasive method for the removal of bacterial plaque on tooth surfaces has also been
      used in the treatment of mucositis, demonstrating no relevant adverse effects. Until
      recently, air-polishing devices have used a slurry of water and sodium bicarbonate (NaHCO3)
      and pressurized air/water. A less abrasive method using an aminoacid glycine has been proven
      to be effective in removing bacterial biofilm structures in deep periodontal pockets and safe
      by not causing emphysema. Moreover the use of a glycine-based powder does not seem to cause
      titanium implant surface changes.

      The aim of the present randomized controlled clinical trial will be to assess the efficacy in
      improving clinical parameters of two further methods of implant surface decontamination
      (Er:YAG laser or air-abrasive device) after mechanical cleaning during non surgical treatment
      of mucositis.
    

Intervention name(s): Mechanical debridement with curettes; Er:YAG laser; Air Powder
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): mechanical debridement: Inflammatory tissue, excess cement or plaque deposits will be removed using hand instruments; mechanical debridement: Inflammatory tissue, excess cement or plaque deposits will be removed using hand instruments. Furthermore, an Er:YAG laser will be used for the implant surface decontamination.; mechanical debridement: Inflammatory tissue, excess cement or plaque deposits will be removed using hand instruments. Furthermore, an Air-Powder treatment will be provided on the implant/abutment surface.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: peri-implant mucositis; non surgical therapy; laser; air powder