Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis
Identifieur interne : 002995 ( Pmc/Corpus ); précédent : 002994; suivant : 002996Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis
Auteurs : Giorgio Lombardo ; Giovanni Corrocher ; Angela Rovera ; Jacopo Pighi ; Mauro Marincola ; Jeffrey Lehrberg ; Pier Francesco NociniSource :
- Case Reports in Dentistry [ 2090-6447 ] ; 2015.
Abstract
Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis.
Url:
DOI: 10.1155/2015/474839
PubMed: 26000178
PubMed Central: 4427007
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PMC:4427007Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis</title><author><name sortKey="Lombardo, Giorgio" sort="Lombardo, Giorgio" uniqKey="Lombardo G" first="Giorgio" last="Lombardo">Giorgio Lombardo</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Corrocher, Giovanni" sort="Corrocher, Giovanni" uniqKey="Corrocher G" first="Giovanni" last="Corrocher">Giovanni Corrocher</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Rovera, Angela" sort="Rovera, Angela" uniqKey="Rovera A" first="Angela" last="Rovera">Angela Rovera</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Pighi, Jacopo" sort="Pighi, Jacopo" uniqKey="Pighi J" first="Jacopo" last="Pighi">Jacopo Pighi</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Marincola, Mauro" sort="Marincola, Mauro" uniqKey="Marincola M" first="Mauro" last="Marincola">Mauro Marincola</name><affiliation><nlm:aff id="I2">Department of Dental Medicine, University of Cartagena, Avenida del Consulado # Calle 30 No. 48–152, Cartagena, Bolívar 130011, Colombia</nlm:aff></affiliation></author><author><name sortKey="Lehrberg, Jeffrey" sort="Lehrberg, Jeffrey" uniqKey="Lehrberg J" first="Jeffrey" last="Lehrberg">Jeffrey Lehrberg</name><affiliation><nlm:aff id="I3">Department of Biomaterials, Implant Dentistry Centre, 501 Arborway, Jamaica Plain, Boston, MA 02130, USA</nlm:aff></affiliation></author><author><name sortKey="Nocini, Pier Francesco" sort="Nocini, Pier Francesco" uniqKey="Nocini P" first="Pier Francesco" last="Nocini">Pier Francesco Nocini</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26000178</idno><idno type="pmc">4427007</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427007</idno><idno type="RBID">PMC:4427007</idno><idno type="doi">10.1155/2015/474839</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002995</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002995</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis</title><author><name sortKey="Lombardo, Giorgio" sort="Lombardo, Giorgio" uniqKey="Lombardo G" first="Giorgio" last="Lombardo">Giorgio Lombardo</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Corrocher, Giovanni" sort="Corrocher, Giovanni" uniqKey="Corrocher G" first="Giovanni" last="Corrocher">Giovanni Corrocher</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Rovera, Angela" sort="Rovera, Angela" uniqKey="Rovera A" first="Angela" last="Rovera">Angela Rovera</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Pighi, Jacopo" sort="Pighi, Jacopo" uniqKey="Pighi J" first="Jacopo" last="Pighi">Jacopo Pighi</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Marincola, Mauro" sort="Marincola, Mauro" uniqKey="Marincola M" first="Mauro" last="Marincola">Mauro Marincola</name><affiliation><nlm:aff id="I2">Department of Dental Medicine, University of Cartagena, Avenida del Consulado # Calle 30 No. 48–152, Cartagena, Bolívar 130011, Colombia</nlm:aff></affiliation></author><author><name sortKey="Lehrberg, Jeffrey" sort="Lehrberg, Jeffrey" uniqKey="Lehrberg J" first="Jeffrey" last="Lehrberg">Jeffrey Lehrberg</name><affiliation><nlm:aff id="I3">Department of Biomaterials, Implant Dentistry Centre, 501 Arborway, Jamaica Plain, Boston, MA 02130, USA</nlm:aff></affiliation></author><author><name sortKey="Nocini, Pier Francesco" sort="Nocini, Pier Francesco" uniqKey="Nocini P" first="Pier Francesco" last="Nocini">Pier Francesco Nocini</name><affiliation><nlm:aff id="I1">Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</nlm:aff></affiliation></author></analytic><series><title level="j">Case Reports in Dentistry</title><idno type="ISSN">2090-6447</idno><idno type="eISSN">2090-6455</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id><journal-id journal-id-type="publisher-id">CRID</journal-id><journal-title-group><journal-title>Case Reports in Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2090-6447</issn><issn pub-type="epub">2090-6455</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26000178</article-id><article-id pub-id-type="pmc">4427007</article-id><article-id pub-id-type="doi">10.1155/2015/474839</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lombardo</surname><given-names>Giorgio</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Corrocher</surname><given-names>Giovanni</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rovera</surname><given-names>Angela</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pighi</surname><given-names>Jacopo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marincola</surname><given-names>Mauro</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lehrberg</surname><given-names>Jeffrey</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nocini</surname><given-names>Pier Francesco</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Clinic of Dentistry and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy</aff><aff id="I2"><sup>2</sup>Department of Dental Medicine, University of Cartagena, Avenida del Consulado # Calle 30 No. 48–152, Cartagena, Bolívar 130011, Colombia</aff><aff id="I3"><sup>3</sup>Department of Biomaterials, Implant Dentistry Centre, 501 Arborway, Jamaica Plain, Boston, MA 02130, USA</aff><author-notes><corresp id="cor1">*Giorgio Lombardo: <email>giorgio.lombardo@univr.it</email></corresp><fn fn-type="other"><p>Academic Editor: Jamil A. Shibli</p></fn></author-notes><pub-date pub-type="ppub"><year>2015</year></pub-date><pub-date pub-type="epub"><day>27</day><month>4</month><year>2015</year></pub-date><volume>2015</volume><elocation-id>474839</elocation-id><history><date date-type="received"><day>2</day><month>2</month><year>2015</year></date><date date-type="rev-recd"><day>31</day><month>3</month><year>2015</year></date><date date-type="accepted"><day>15</day><month>4</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2015 Giorgio Lombardo et al.</copyright-statement><copyright-year>2015</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>Peri-implantitis is a condition that affects the mucosa and bone surrounding dental implants and is characterized by crestal bone loss [<xref rid="B1" ref-type="bibr">1</xref>, <xref rid="B2" ref-type="bibr">2</xref>]. Depending on the qualification criteria, the incidence of peri-implantitis ranges from 18.8% to 51.9% [<xref rid="B3" ref-type="bibr">3</xref>–<xref rid="B5" ref-type="bibr">5</xref>]. It is generally accepted that the colonization of deleterious bacteria in the peri-implant microenvironment plays a major role in the etiology of peri-implantitis [<xref rid="B1" ref-type="bibr">1</xref>, <xref rid="B6" ref-type="bibr">6</xref>–<xref rid="B8" ref-type="bibr">8</xref>]. Polymicrobial communities that colonize different microhabitats within the mouth are referred to as a biofilm [<xref rid="B9" ref-type="bibr">9</xref>, <xref rid="B10" ref-type="bibr">10</xref>]. Similar to periodontitis, treatment modalities aimed at correcting peri-implantitis include the reduction or elimination of deleterious bacteria within the biofilms that coat the oral surfaces [<xref rid="B11" ref-type="bibr">11</xref>, <xref rid="B12" ref-type="bibr">12</xref>].</p><p>Removal of oral biofilms, or the decontamination of the peri-implant microenvironment in patients suffering from peri-implantitis, can be achieved through both surgical and nonsurgical means [<xref rid="B11" ref-type="bibr">11</xref>, <xref rid="B12" ref-type="bibr">12</xref>]. Proposed treatments for the decontamination of microenvironments during peri-implantitis include antibiotic and antiseptic treatment (both local and systemic), mechanical debridement, and laser treatment [<xref rid="B13" ref-type="bibr">13</xref>]. Surgical techniques are also used in the treatment of peri-implantitis, with the rationale that surgery grants increased access to the spaces inhabited by deleterious bacteria [<xref rid="B13" ref-type="bibr">13</xref>, <xref rid="B14" ref-type="bibr">14</xref>]. However, strong evidence supporting any particular therapy in the treatment of peri-implantitis has yet to be established [<xref rid="B13" ref-type="bibr">13</xref>, <xref rid="B14" ref-type="bibr">14</xref>]. In light of this, we attempted to treat a case of peri-implantitis using a topical desiccant (HYBENX Oral Tissue Decontaminant, EPIEN Medical, Inc.) as an adjunct to air powder abrasion (Airflow, EMS), followed by the application of an inorganic bone composite comprised of a mixture of bovine bone material (Bio-Oss, Geistlich Biomaterials) mixed with biphasic calcium sulfate (BondBone, MIS Implants Technologies Ltd.). HYBENX is an extremely hygroscopic solution that theoretically functions by denaturing the attachment proteins used by bacteria to adhere to the implant surface. This allows the more efficient subsequent removal of biofilm microbes. To our knowledge, no study using a topical desiccant as an adjunct to air powder abrasives has been published to date.</p><p>Here we report the treatment protocol and two-year follow-up of a 62-year-old patient who was treated using our novel surgical protocol for peri-implantitis. Based on the successful outcome our patient exhibited, we conclude that the use of a HYBENX as an adjunct to air powder abrasion, followed by composite bone grafting using inorganic bovine bone mixed with biphasic calcium sulfate, represents a possible future treatment for peri-implantitis that warrants further consideration and study.</p></sec><sec id="sec2"><title>2. Case Report</title><p>A 62-year-old man reported discomfort and bleeding that occurred while brushing around his two single crown implants (upper left premolars: tooth numbers 12 and 13). Periapical radiographs revealed a large apical lesion adjacent to the neighboring molar and a bone loss pattern suggestive of peri-implantitis around the indicated implants (<xref ref-type="fig" rid="fig1">Figure 1</xref>). Probing pocket depths ranged from 7 to 9 mm (<xref ref-type="fig" rid="fig2">Figure 2</xref>). Initial treatment included the nonsurgical mechanical debridement of implants using ultrasonic devices and reinstruction in oral hygiene techniques. This initial treatment unfortunately resulted in insignificant reductions of pocket depths and inflammation.</p><p>Following the initial nonsurgical treatment, the option of removing the prosthesis to allow submerged healing was presented to and declined by the patient. After discussing the inherent risks involved, the patient gave written consent and agreed to proceed with open debridement and decontamination, followed by guided bone regeneration using bone composite [<xref rid="B15" ref-type="bibr">15</xref>].</p><p>In order to minimize clinical signs of inflammation, a single course of low abrasive air powder (Airflow) was implemented two weeks before surgery.</p><p>The surgical procedure is described as follows: briefly, after local infiltration of a 2% lidocaine solution with 1 mcg/mL epinephrine, sulcular incisions were made on the buccal and lingual/palatal side in an effort to preserve soft tissue. Full thickness flaps were then elevated with a periosteal release to allow for adequate flap mobilization and coronal advancement at the time of closure.</p><p>Interproximal tissue was then removed and—after a thorough degranulation of the osseous defects—surgical exposure of the coronal portion of the implants was provided. Smoothening of buccally and supracrestally exposed implant parts was performed with the use of rotating burs (i.e., implantoplasty) (Figures <xref ref-type="fig" rid="fig3">3</xref> and <xref ref-type="fig" rid="fig4">4</xref>) [<xref rid="B16" ref-type="bibr">16</xref>, <xref rid="B17" ref-type="bibr">17</xref>]. The surface decontamination procedure consisted of a 3-step protocol that was repeated twice:<list list-type="order"><list-item><p>Application of HYBENX to the defect and implant surface, with 60-second incubation period (<xref ref-type="fig" rid="fig5">Figure 5</xref>).</p></list-item><list-item><p>Abundant irrigation of the defect with saline solution.</p></list-item><list-item><p>Administration of sodium bicarbonate-based abrasive air powder treatment (Airflow) to all contaminated and exposed parts of the implant surface for 60 seconds (<xref ref-type="fig" rid="fig6">Figure 6</xref>).</p></list-item></list>After the second round of surface decontamination had concluded, bone defects were filled with a composite graft that was created by mixing the inorganic portion of bovine bone (Bio-Oss) with a synthetic biphasic calcium sulfate material (BondBone). Bio-Oss (0.5 mg) and BondBone (0.5 g) were combined with Rifampicin (1 vial, Sanofi-Aventis) to produce the composite. Because the composite bone graft possesses the ability to harden in the presence of blood and saliva, we decided to forgo the use of graft retaining membranes (Figures <xref ref-type="fig" rid="fig7">7</xref> and <xref ref-type="fig" rid="fig8">8</xref>). The flap was then mobilized and advanced in order to obtain a primary tension-free closure (Figures <xref ref-type="fig" rid="fig9">9</xref> and <xref ref-type="fig" rid="fig10">10</xref>). Following the procedure, postoperative radiographs were taken to evaluate the level of the defect filling (<xref ref-type="fig" rid="fig11">Figure 11</xref>).</p><p>Postoperative care included a 0.12% chlorhexidine + 0.05% cetylpyridinium chloride (CPC) rinse (GUM Paroex, Sunstar Suisse S.A.) twice daily for 2 weeks, 1 g of amoxicillin every 12 hours for 7 days, and 800 mg of ibuprofen as needed for pain. Following the procedure the patient was instructed to abstain from brushing for two weeks and flossing for one month.</p><p>The patient was evaluated one week following the procedure. At two weeks, the patient was reevaluated and the sutures were removed. Four weeks after procedure the patient underwent surgical area debridement and home oral hygiene techniques were reinforced. The patient was placed on an 8–12 week recall schedule until the completion of treatment (2 years), during which time periapical radiographs were taken every 6 months.</p></sec><sec id="sec3"><title>3. Results</title><p>Measurements derived from clinical observations are summarized in <xref ref-type="table" rid="tab1">Table 1</xref> and represent the mean of four sampling sites surrounding each implant (i.e. buccal, lingual/palatal, mesial, and distal) both immediately before surgery (baseline) and at the 2-year time point.</p><p>Bone level changes and percentage of bone fill were measured using scanning intraoral radiographs with parallel technique, using Rinn centering devices (Rinn XCP Posterior Aiming Ring-Yellow, Dentsply, Elgin, IL). First bone-to-implant contact changes were assessed as described by Urdaneta et al. (2010) [<xref rid="B36" ref-type="bibr">18</xref>]. Implant measurements taken from radiographs were calibrated to actual implant lengths by using ImageJ to calculate the pixel/mm ratio of radiographs taken at baseline and after 2 years.</p><p>After an uneventful healing period of one year, clinical evaluations revealed healthy peri-implant hard and soft tissues (Figures <xref ref-type="fig" rid="fig12">12</xref> and <xref ref-type="fig" rid="fig13">13</xref>). Two years after procedure, a complete absence of bleeding upon probing along with physiological probing was observed (Figures <xref ref-type="fig" rid="fig14">14</xref> and <xref ref-type="fig" rid="fig15">15</xref>). A slight recession of the soft tissues without a change in the height of keratinized tissue was also observed (<xref ref-type="table" rid="tab1">Table 1</xref>).</p><p>Radiograph measurements reflecting bone level changes and the percentage of bone fill are summarized in <xref ref-type="table" rid="tab2">Table 2</xref>. Radiographs revealed that the initial bony defect had been almost completely regenerated (<xref ref-type="fig" rid="fig16">Figure 16</xref>), and increases in radiographic first bone-to-implant contact were observed at both the mesial (2.9 mm and 6.7 mm at numbers 12 and 13, resp.) and distal regions (8.0 mm and 5.6 mm at numbers 12 and 13, resp.).</p></sec><sec id="sec4"><title>4. Discussion</title><p>Peri-implantitis is responsible for the majority of implant failures [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B14" ref-type="bibr">14</xref>, <xref rid="B17" ref-type="bibr">17</xref>]. Defined as an irreversible condition with a relatively high—and possibly underreported—incidence rate, the prevention and treatment of peri-implantitis should be of the utmost concern to every clinician [<xref rid="B3" ref-type="bibr">3</xref>–<xref rid="B5" ref-type="bibr">5</xref>, <xref rid="B13" ref-type="bibr">13</xref>].</p><p>Many factors come into play when choosing an appropriate treatment for peri-implantitis. Overall patient health, location of the defect, and progression of the disease are all factors that should be considered. When probing depths exceed 5 mm, bleeding on probing occurs, and conventional nonsurgical options have been exhausted; then surgical intervention involving open debridement with resective or regenerative therapy should be performed [<xref rid="B18" ref-type="bibr">19</xref>–<xref rid="B20" ref-type="bibr">21</xref>].</p><p>We chose to pursue a novel course of treatment that utilized a topical desiccant and air powder abrasion to decontaminate the afflicted site, followed by grafting a mixture of biphasic calcium sulfate and inorganic bovine bone. The use of air powder abrasion during open flap surgical procedures has been shown to be an efficient decontamination measure both<italic> in vitro</italic> and<italic> in vivo</italic> [<xref rid="B21" ref-type="bibr">22</xref>–<xref rid="B27" ref-type="bibr">28</xref>]. And surfaces treated with air powder abrasives do not significantly affect the viability of human gingival fibroblasts and osteosarcoma cells,<italic> in vitro</italic> [<xref rid="B28" ref-type="bibr">29</xref>, <xref rid="B29" ref-type="bibr">30</xref>]. Despite the efficacious nature of air powder abrasion as highlighted in the relevant literature, defect and implant morphology can potentially diminish its effectiveness (especially in cases of narrow defects and around implant threads) [<xref rid="B21" ref-type="bibr">22</xref>–<xref rid="B27" ref-type="bibr">28</xref>, <xref rid="B30" ref-type="bibr">31</xref>]. In addition, the use of adjunctive antibiotics or antiseptics to air powder abrasion has yielded favorable outcomes [<xref rid="B31" ref-type="bibr">32</xref>]. Bearing this in mind, we chose to use the desiccating agent HYBENX as an adjunct to air powder abrasion.</p><p>HYBENX—an extremely hygroscopic solution comprised of hydroxymethoxybenzenesulfonic and hydroxybenzenesulfonic acid isomers, sulfuric acid, and water—has been used in the treatment of recurrent aphthous stomatitis [<xref rid="B32" ref-type="bibr">33</xref>]. The use of HYBENX was pursued in an attempt to boost the efficacy of our decontamination procedure, by denaturing adherence proteins used by bacteria in narrow defects and on implant threads, allowing them to be more easily rinsed away [<xref rid="B30" ref-type="bibr">31</xref>].</p><p>Subsequent to decontamination, we grafted a combination of inorganic bovine bone with biphasic calcium sulfate, in the absence of a membrane. Membranes (in the context of implant surgeries) serve as scaffolds to guide bone growth as well as barriers to soft tissue invasion [<xref rid="B33" ref-type="bibr">34</xref>, <xref rid="B34" ref-type="bibr">35</xref>]. Owing to the fact that the novel composite we used possesses the ability to harden in the presence of saliva and blood (and in light of a report indicating no significant difference between bone fill levels when comparing resorbable membranes to bone substitute alone), we decided to forgo the use of membranes [<xref rid="B35" ref-type="bibr">36</xref>].</p></sec><sec id="sec5"><title>5. Conclusion</title><p>The absence of morbidity and remarkably uneventful healing period our patient exhibited suggest that the technique described here may represent a successful procedure in the treatment of peri-implantitis. Clinical and radiographic evidence presented here corroborate the efficacy of this procedure. 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P.</given-names></name></person-group><article-title>Clinical use of resorbable polymeric membranes in the treatment of bone defects</article-title><source><italic>Orthopedic Clinics of North America</italic></source><year>2010</year><volume>41</volume><issue>1</issue><fpage>39</fpage><lpage>47</lpage><pub-id pub-id-type="other">2-s2.0-70449729534</pub-id><pub-id pub-id-type="doi">10.1016/j.ocl.2009.07.012</pub-id><pub-id pub-id-type="pmid">19931051</pub-id></element-citation></ref><ref id="B35"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Roos-Jansåker</surname><given-names>A.-M.</given-names></name><name><surname>Lindahl</surname><given-names>C.</given-names></name><name><surname>Persson</surname><given-names>G. R.</given-names></name><name><surname>Renvert</surname><given-names>S.</given-names></name></person-group><article-title>Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over 3 years</article-title><source><italic>Journal of Clinical Periodontology</italic></source><year>2011</year><volume>38</volume><issue>6</issue><fpage>590</fpage><lpage>597</lpage><pub-id pub-id-type="doi">10.1111/j.1600-051x.2011.01729.x</pub-id><pub-id pub-id-type="other">2-s2.0-79955906122</pub-id><pub-id pub-id-type="pmid">21488935</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>The baseline periapical radiograph indicated a deep interproximal peri-implant bone lesion.</p></caption><graphic xlink:href="CRID2015-474839.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Initial probing revealed a deep peri-implant pocket between 2 short, single-crown locking taper implants, in positions 12 and 13.</p></caption><graphic xlink:href="CRID2015-474839.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>After elevation of the vestibular and palatal full thickness flaps, a crater-like defect characterized by interproximal bone loss was observed around the implants.</p></caption><graphic xlink:href="CRID2015-474839.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>After elevation of the vestibular and palatal full thickness flaps, a crater-like defect characterized by interproximal bone loss was observed around the implants.</p></caption><graphic xlink:href="CRID2015-474839.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>HYBENX was administered on the implant surface for 60 seconds and then thoroughly rinsed away with saline.</p></caption><graphic xlink:href="CRID2015-474839.005"></graphic></fig><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Debridement of the implant surfaces using air powder abrasion for 60 seconds.</p></caption><graphic xlink:href="CRID2015-474839.006"></graphic></fig><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>Following decontamination of the implant surface, a mixture of biphasic calcium sulfate and inorganic bovine bone were applied to defect at the buccal and palatal location (without a membrane).</p></caption><graphic xlink:href="CRID2015-474839.007"></graphic></fig><fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>Following decontamination of the implant surface, a mixture of biphasic calcium sulfate and inorganic bovine bone were applied to defect at the buccal and palatal location (without a membrane).</p></caption><graphic xlink:href="CRID2015-474839.008"></graphic></fig><fig id="fig9" orientation="portrait" position="float"><label>Figure 9</label><caption><p>The mucoperiosteal flap was repositioned to ensure transmucosal healing and proper wound closure.</p></caption><graphic xlink:href="CRID2015-474839.009"></graphic></fig><fig id="fig10" orientation="portrait" position="float"><label>Figure 10</label><caption><p>The mucoperiosteal flap was repositioned to ensure transmucosal healing and proper wound closure.</p></caption><graphic xlink:href="CRID2015-474839.010"></graphic></fig><fig id="fig11" orientation="portrait" position="float"><label>Figure 11</label><caption><p>Postoperative radiograph indicating complete filling of the peri-implant defect.</p></caption><graphic xlink:href="CRID2015-474839.011"></graphic></fig><fig id="fig12" orientation="portrait" position="float"><label>Figure 12</label><caption><p>One-year after procedure, an absence of bleeding and reduced probing depth was observed.</p></caption><graphic xlink:href="CRID2015-474839.012"></graphic></fig><fig id="fig13" orientation="portrait" position="float"><label>Figure 13</label><caption><p>One-year postoperative radiographs depicting radiopacity at the location of the defect.</p></caption><graphic xlink:href="CRID2015-474839.013"></graphic></fig><fig id="fig14" orientation="portrait" position="float"><label>Figure 14</label><caption><p>Two-year postoperative clinical examination revealed health hard and soft tissues with no bleeding and reduced probing depth (buccal and lingual/palatal probing shown).</p></caption><graphic xlink:href="CRID2015-474839.014"></graphic></fig><fig id="fig15" orientation="portrait" position="float"><label>Figure 15</label><caption><p>Two-year postoperative clinical examination revealed health hard and soft tissues with no bleeding and reduced probing depth (buccal and lingual/palatal probing shown).</p></caption><graphic xlink:href="CRID2015-474839.015"></graphic></fig><fig id="fig16" orientation="portrait" position="float"><label>Figure 16</label><caption><p>Two-year postoperative radiographs depicting radiopacity at the location of the defect, showing a near complete regeneration of the missing bone.</p></caption><graphic xlink:href="CRID2015-474839.016"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Postsurgical clinical observations taken at baseline and 2 years. Baseline values were obtained immediately before surgery. Results are expressed as Mean ± SD and are the average values of the four areas investigated. BOP = bleeding on probing, PD = probing depth, MR = mucosal recession, CAL = clinical attachment level, and KM = keratinized mucosa width.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Implant site (tooth number)</th><th align="center" colspan="2" rowspan="1">PPD (mm)</th><th align="center" colspan="2" rowspan="1">BOP (%)</th><th align="center" colspan="2" rowspan="1">MR</th><th align="center" colspan="2" rowspan="1">KM</th><th align="center" colspan="2" rowspan="1">CAL</th></tr><tr><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1"> 2 years</th><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">7.0 ± 1.8</td><td align="center" rowspan="1" colspan="1">2.7 ± 0.5</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1.2 ± 0.7</td><td align="center" rowspan="1" colspan="1">1.0 ± 0.9</td><td align="center" rowspan="1" colspan="1">2.3 ± 0.6</td><td align="center" rowspan="1" colspan="1">2.4 ± 0.6</td><td align="center" rowspan="1" colspan="1">8.2 ± 2.3</td><td align="center" rowspan="1" colspan="1">3.7 ± 0.8</td></tr><tr><td align="left" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">8.3 ± 1.0</td><td align="center" rowspan="1" colspan="1">2.8 ± 0.4</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0.8 ± 0.7</td><td align="center" rowspan="1" colspan="1">1.4 ± 0.5</td><td align="center" rowspan="1" colspan="1">1.0 ± 1.0</td><td align="center" rowspan="1" colspan="1">1.0 ± 1.0</td><td align="center" rowspan="1" colspan="1">9.2 ± 1.2</td><td align="center" rowspan="1" colspan="1">4.1 ± 0.8</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Radiographic observations observed at baseline after 2 years and expressed as variations after 2 years. Baseline values were obtained immediately before surgery. Δ = changes of values compared with baseline after 2-year follow-up period. r-BF = the percentage of radiographic bone fill of the defect at 2 years. </p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="3" colspan="1">Implant site (tooth number)</th><th align="center" colspan="7" rowspan="1"> First bone-to-implant contact (FBIC)</th></tr><tr><th align="center" colspan="3" rowspan="1">Mesial (mm)</th><th align="center" colspan="3" rowspan="1">Distal (mm)</th><th align="center" rowspan="2" colspan="1">r-BF (%)</th></tr><tr><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th><th align="center" rowspan="1" colspan="1">Δ</th><th align="center" rowspan="1" colspan="1">Baseline</th><th align="center" rowspan="1" colspan="1">2 years</th><th align="center" rowspan="1" colspan="1">Δ</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">−3.0 mm</td><td align="center" rowspan="1" colspan="1">−0.1 mm</td><td align="center" rowspan="1" colspan="1">+2.9 mm</td><td align="center" rowspan="1" colspan="1">−8.1 mm</td><td align="center" rowspan="1" colspan="1">−0.1 mm</td><td align="center" rowspan="1" colspan="1">+8.0 mm</td><td align="center" rowspan="1" colspan="1">93.0%</td></tr><tr><td align="left" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">−6.9 mm</td><td align="center" rowspan="1" colspan="1">−0.2 mm</td><td align="center" rowspan="1" colspan="1">+6.7 mm</td><td align="center" rowspan="1" colspan="1">−5.8 mm</td><td align="center" rowspan="1" colspan="1">−0.2 mm</td><td align="center" rowspan="1" colspan="1">+5.6 mm</td><td align="center" rowspan="1" colspan="1">91.6%</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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