Peri-implantitis is an inflammatory condition in which bone loss develops as a result of a bone-related implant. Because implants have the potential to last a patient’s entire life, peri-implantitis can lead to disintegration and early loss of implants and their supported prostheses. About one out of every 10 implants are thought to result in peri-implantitis. Despite such a high frequency, treatment options for peri-implantitis have not been well investigated.
Once peri-implantitis develops, conservative or non-surgical therapy appears to be ineffective. Non-surgical treatment of peri-implantitis using laser or air abrasive systems have generally shown poor results. The only treatment that appears effective at resolving peri-implantitis is surgical therapy. But surgical resective therapy is only partially effective. The most successful strategy may involve a combination of surgery and regenerative procedures.
Multiple studies have evaluated the efficacy of the different surface treatments for this condition. Two recent reports, both out of King Saud University in Riyadh, Saudi Arabia, suggest that photodynamic therapy, or PDT, could play an important role. In the first of these studies, scientists within the Department of Prosthetic Dental Sciences sought to assess whether or not mechanical debridement with antimicrobial PDT was effective for the management of peri-implant diseases. The central question was as follows: “Is mechanical debridement with adjunct aPDT more effective in treating peri-implant diseases as compared to when mechanical debridement is used alone?”
Four out of a total of 12 studies reported mechanical debridement with adjunct PDT to be effective in the treatment of peri-implant diseases; however, these benefits were comparable with conventional treatments. Two studies reported that PDT reduced the bacterial load more than when the laser and the photosensitizer were applied alone. In two other studies, chemical disinfection and PDT showed comparable outcomes in terms of bacterial disinfection.
PDT was also shown in experiemental studies to improve bone to implant contact and re-osseointegration. Given these mixed findings, the investigators concluded that the “efficacy of mechanical debridement with adjunctive antimicrobial PDT for the management of peri-implant diseases remains debatable, as reported ahead-of-print in the 13 June 2014 issue of Photochemical and Photobiological Sciences.
Researchers from King Saud University also recently reviewed studies focusing on the use of antibiotics in the treatment of peri-implantitis. They identified three studies in which systemic antibiotics were administered and six studies in which locally delivered antibiotics were used for treatment. As with antimicrobial PDT, the findings regarding the efficacy of adjunctive antibiotic therapy in the treatment of peri-implantitis were mixed, as reported in the August 2013 issue of the International Journal of Dentistry. Given the growing global problem of antibiotic resistance, future research should focus on the use of PDT is worth exploring as a more viable adjunctive strategy in the long term.
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Vohra F, Al-Rifaiy MQ, Lillywhite G, Abu Hassan MI, Javed F. Efficacy of mechanical debridement with adjunct antimicrobial photodynamic therapy for the management of peri-implant diseases: a systematic review. Photochem Photobiol Sci. 2014 Jun 13. [Epub ahead of print]
Javed F, Alghamdi AS, Ahmed A, Mikami T, Ahmed HB, Tenenbaum HC. Clinical efficacy of antibiotics in the treatment of peri-implantitis. Int Dent J. 2013 Aug;63(4):169-76.
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