Clinical and Biochemical Evaluation of the Efficacy of Non-Surgical Treatment Approaches in the Treatment of Peri-implantitis

Study Overview
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Brief Summary
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Peri-implantitis is a pathological condition associated with plaque that develops around dental implants, characterized by inflammation and progressive bone loss in the peri-implant area. Bleeding on probing, suppuration, increased pathological pocket depths and/or mucosal recessions are seen with radiographic bone loss in peri-implantitis. When evaluated histologically, the lesion extends to the apical part of the pocket epithelium and contains a large amount of plasma cells, macrophages and neutrophils. In the Peri-implant crevicular fluid analysis, which is one of the most important parameters that enable the biochemical and immunological evaluation of the inflammatory state in the peri-implant region, information about the current inflammatory situation can be obtained by evaluating the content of an osmotic inflammatory exudate originating from the vessels in the gingival plexus. Many surgical and non-surgical methods have been proposed for the treatment of peri-implantitis. Mechanical surface debridement, laser application and air abrasives are a part of non-surgical treatment of peri-implantitis. In this study, we examined the effectiveness of diode laser in addition to mechanical debridement with titanium curettes. In our study, we aimed to compare these two treatments biochemically by determining the changes in interleukin-1β, Interleukin-10, Interleukin-17, RANKL, osteoprotegerin, TWEAK and sclerostin biomarkers in Peri-implant crevicular fluid and clinically.

Detailed Description
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Primary outcome measures (probing depth as clinical parameter) and secondary outcome measures ( collection of gingival crevicular fluid, gingival bleeding time index, gingival index, plaque index and clinical attachment level) asre recorded in baseline, third and sixth month. The change between these parameters is observed.

Official Title
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Clinical and Biochemical Evaluation of the Efficacy of Non-Surgical Treatment Approaches in the Treatment of Peri-implantitis

Conditions
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Peri-Implantitis

Intervention / Treatment
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* Device: Diode laser
* Device: Titanium curettes


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Presence of 5mm or more peri-implant pockets Not having periodontal treatment in the last 3 months, The informed consent form must be approved, At least 18 years old. Exclusion Criteria: Presence of systemic disease, Smoking, Regular use of non-steroidal anti inflammatory drugs, Having been treated with antibiotics in the last 3 months, Individuals in need of pre-treatment antibiotic prophylaxis, Pregnancy and lactation, Not approving the informed consent form, Patients with known allergies.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Diode Laser<br>At baseline, diode laser is applied to one group. | Device: Diode laser<br>* Diode Laser is applied to one group as an adjunctive therapy.<br>Device: Titanium curettes<br>* Non-surgical treatment with titanium curettes were administrated to both groups.<br>|
| Active Comparator: Titanium curettes<br>At baseline, titanium curettes are used to both of the groups | Device: Titanium curettes<br>* Non-surgical treatment with titanium curettes were administrated to both groups.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical parameter probing depth | The primary outcome of the study was the control examination performed 3 months after the first examination. Probing depth was measured with a periodontal probe by the distance between gingival margin and the base of the pocket. The change between these time frames are recorded. | Baseline, 3 months and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Another outcome of the study is the collection of gingival crevicular fluid samples in the 3rd month. | Samples are obtained by means of paper strips placed gently in the gingival groove. These samples are stored at -20 ° C for later analysis by ELISA method. The change between these time frames are recorded. | Baseline, 3 months and 6 months | 
| Gingival bleeding time index | Bleeding on probing according to the time is recorded. The change between these time frames are recorded. | Baseline, 3 months and 6 months | 
| Gingival index | The gingival index is graded as follows: 0 = Normal gingiva Mild inflammation, slight change in color, slight oedema. No bleeding on probing Moderate inflammation redness, oedema and glazing. Bleeding on probing Severe inflammation marked redness and oedema. Ulceration. Tendency to spontaneous bleeding. | Baseline, 3 months and 6 months | 
| Plaque index | 0 = No plaque in the gingival area. A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may only be recognized by running a probe across the tooth surface. Moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. Abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface. | Baseline, 3 months and 6 months | 
| Clinical attachment level | The distance in millimeters from the cemento-enamel junction to the bottom of the pocket. | Baseline, 3 months and 6 months |