Advertisement

Clinical Oral Investigations

, Volume 23, Issue 4, pp 1921–1930 | Cite as

Clinical evaluation of non-surgical cleaning modalities on titanium dental implants during maintenance care: a 1-year follow-up on prosthodontic superstructures

  • Kristina Emily Schmidt
  • Thorsten Mathias Auschill
  • Anton Sculean
  • Nicole Birgit ArweilerEmail author
Original Article

Abstract

Objectives

To investigate tissue health around implants with newly attached superstructures over 12 months of preventive maintenance appointments and instrumentation when necessary.

Material and methods

In a randomized, split-mouth study 32 implants (8 participants with 4 implants each) received followed-up care every 3 months after superstructure attachment. Implants and superstructures were randomly assigned to four treatment groups and treated if necessary: (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) rubber cup polishing (CON). Probing depths (PDs), bleeding on probing (BOP), modified gingival (mucosal) bleeding index (GBI) around implants, and full-mouth Plaque Control Record (PCR) were measured every 3 months. Clinical attachment levels (CALs) and height of keratinized mucosa (KM)/gingival margins (GMs) for implants/teeth and PD, BOP, and GBI for teeth were documented at baseline, 6 months, and 12 months. Matrix metalloproteinase 8 (MMP-8) and periopathogens were measured at baseline and 12 months.

Results

Participants exhibited minimal signs of periodontal inflammation with statistically significant PD improvement (3.0 ± 0.2 to 2.8 ± 0.3 mm; p = 0.022) and overall CAL (4.3 ± 0.8 to 4.0 ± 0.7 mm; p = 0.048) after 1 year. Implants showed no statistically significant differences (p > 0.05) between or within groups at baseline or 12 months for any parameter, except MMP-8 decreased significantly for PS (14.50 ± 17.58 to 4.63 ± 7.56 ng; p = 0.044), and after 12 months, PCR showed a significant difference between TC and PS (p = 0.018).

Conclusions

Treatment was necessary as inflammation was observed around newly placed superstructures within the first year of maintenance care. All tested treatment modalities yielded comparable clinical improvements.

Clinical relevance

Early assessment and diagnosis of mucositis and regular maintenance can promote long-lasting implant health.

Keywords

Titanium dental implants Maintenance Individualized care Oral hygiene Biocompatibility 

Notes

Funding source

This is a continuation of a study [18] that was financially supported by an unrestricted grant from the Oral Reconstruction Foundation (previously Camlog Foundation; Grant CF41203), Basel, Switzerland. The design, documentation, and analyses of this study were carried out independently. No financial conflict of interest exists between the authors and any previous funding received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Medical Ethics Committee, Philipps-University Marburg in Germany (no. 159/12) and conducted in accordance with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice guidelines as well as the Declaration of Helsinki.

Informed consent

All participants gave their informed consent prior to their inclusion in the study.

References

  1. 1.
    Pontoriero R, Tonelli MP, Carnevale G, Mombelli A, Nyman SR, Lang NP (1994) Experimentally induced peri-implant mucositis. A clinical study in humans. Clin Oral Implants Res 5:254–259CrossRefGoogle Scholar
  2. 2.
    Salvi GE, Aglietta M, Eick S, Sculean A, Lang NP (2012) Reversibility of experimental peri-implant mucositis compared with experimental gingivitis in humans. Clin Oral Implants Res 23:182–190CrossRefGoogle Scholar
  3. 3.
    Lindhe J, Meyle J, Group D of European Workshop on Periodontology (2008) Peri-implant diseases: consensus report of the sixth european workshop on periodontology. J Clin Periodontol 35(8 Suppl):282–285CrossRefGoogle Scholar
  4. 4.
    Mombelli A, Müller N, Cionca N (2012) The epidemiology of peri-implantitis. Clin Oral Implants Res 23(Suppl 6):67–76CrossRefGoogle Scholar
  5. 5.
    Renvert S, Polyzois I (2015) Clinical approaches to treat peri-implant mucositis and peri-implantitis. Periodontol 2000 68:369–404CrossRefGoogle Scholar
  6. 6.
    Figuero E, Graziani F, Sanz I, Herrera D, Sanz M (2014) Management of peri-implant mucositis and peri-implantitis. Periodontol 2000 66:255–273CrossRefGoogle Scholar
  7. 7.
    Armitage G, Xenoudi P (2016) Post-treatment supportive care for the natural dentition and dental implants. Periodontol 2000 71:164–184CrossRefGoogle Scholar
  8. 8.
    Renvert S, Roos-Jansåker A-M, Claffey N (2008) Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review. J Clin Periodontol 35:305–315CrossRefGoogle Scholar
  9. 9.
    Roccuzzo M, Bonino L, Dalmasso P, Aglietta M (2014) Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res 25:1105–1112CrossRefGoogle Scholar
  10. 10.
    Ramanauskaite A, Tervonen T (2016) The efficacy of supportive peri-implant therapies in preventing peri-implantitis and implant loss: a systematic review of the literature. J Oral Maxillofac Res 7:e12Google Scholar
  11. 11.
    Jepsen S, Berglundh T, Genco R, Aass A, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz-Vigon A, Polyzois I, Salvi GE, Schwarz F, Serino G, Tomasi C, Zitzmann NU (2015) Primary prevention of periimplantitis: managing peri-implant mucositis. J Clin Periodontol 42(Suppl 16):S152–S157CrossRefGoogle Scholar
  12. 12.
    Salvi GE, Ramseier CA (2015) Efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis. A systematic review. J Clin Periodontol 42(Suppl 16):S187–S201CrossRefGoogle Scholar
  13. 13.
    Arweiler NB, Auschill TM, Sculean A (2018) Patient self-care of periodontal pocket infections. Periodontol 2000 76:164–179CrossRefGoogle Scholar
  14. 14.
    Renvert S, Polyzois I (2015) Risk indicators for peri-implant mucositis: a systematic literature review. J Clin Periodontol 42(Suppl 16):S172–S186CrossRefGoogle Scholar
  15. 15.
    Monje A, Aranda L, Diaz KT, Alarcón MA, Bagramian RA, Wang HL, Catena A (2016) Impact of maintenance therapy for the prevention of peri-implant diseases: a systematic review and meta-analysis. J Dent Res 9:372–379CrossRefGoogle Scholar
  16. 16.
    Karoussis IK, Kotsovilis S, Fourmousis I (2007) A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clin Oral Implants Res 18:669–679CrossRefGoogle Scholar
  17. 17.
    Wennström JL, Ekestubbe A, Gröndahl K, Karlsson S, Lindhe J (2004) Oral rehabilitation with implant-supported fixed partial dentures in periodontitis-susceptible subjects. J Clin Periodontol 31:713–724CrossRefGoogle Scholar
  18. 18.
    Schmidt KE, Auschill TM, Heumann C, Frankenberger R, Eick S, Sculean A, Arweiler NB (2018) Clinical and laboratory evaluation of the effects of different treatment modalities on titanium healing caps: a randomized, controlled clinical trial. Clin Oral Investig 22:2149–2160CrossRefGoogle Scholar
  19. 19.
    Mombelli A, Lang NP (1994) Clinical parameters for the evaluation of dental implants. Periodontol 2000 4:81–86CrossRefGoogle Scholar
  20. 20.
    Heitz-Mayfield LJ (2008) Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol 35(8 Suppl):292–304CrossRefGoogle Scholar
  21. 21.
    O'Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38CrossRefGoogle Scholar
  22. 22.
    Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235Google Scholar
  23. 23.
    Mombelli A, Lang NP (1998) The diagnosis and treatment of peri-implantitis. Periodontol 2000 17:63–76CrossRefGoogle Scholar
  24. 24.
    Gupta S (2011) Intention-to-treat concept: a review. Perspect Clin Res 2:109–112CrossRefGoogle Scholar
  25. 25.
    Louropoulou A, Van der Weijden F (2014) Mechanical self-performed oral hygiene of implant supported restorations: a systematic review. J Evid Based Dent Pract 14(Suppl):60–69CrossRefGoogle Scholar
  26. 26.
    Máximo MB, de Mendonça AC, Renata Santos V, Figueiredo LC, Feres M, Duarte PM (2009) Short-term clinical and microbiological evaluations of peri-implant diseases before and after mechanical anti-infective therapies. Clin Oral Implants Res 20:99–108CrossRefGoogle Scholar
  27. 27.
    Louropoulou A, Slot DE, Van der Weijden FA (2012) Titanium surface alterations following the use of different mechanical instruments: a systematic review. Clin Oral Implants Res 23:643–658CrossRefGoogle Scholar
  28. 28.
    Louropoulou A, Slot DE, Van der Weijden FA (2015) Influence of mechanical instruments on the biocompatibility of titanium dental implants surfaces: a systematic review. Clin Oral Implants Res 26:841–850CrossRefGoogle Scholar
  29. 29.
    Porras R, Anderson GB, Caffesse R, Narendran S, Trejo PM (2002) Clinical response to 2 different therapeutic regimens to treat peri-implant mucositis. J Periodontol 73:1118–1125CrossRefGoogle Scholar
  30. 30.
    Trejo PM, Bonaventura G, Weng D, Caffesse RG, Bragger U, Lang NP (2006) Effect of mechanical and antiseptic therapy on peri-implant mucositis: an experimental study in monkeys. Clin Oral Implants Res 17:294–304CrossRefGoogle Scholar
  31. 31.
    Schmidt KE, Auschill TM, Heumann C, Frankenberger R, Eick S, Sculean A, Arweiler NB (2017) Influence of different instrumentation modalities on the surface characteristics and biofilm formation on dental implant neck, in vitro. Clin Oral Implants Res 28:483–490CrossRefGoogle Scholar
  32. 32.
    Louropoulou A, Slot DE, Van der Weijden F (2014) The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systematic review. Clin Oral Implants Res 25:1149–1160CrossRefGoogle Scholar
  33. 33.
    Schwarz F, Becker K, Sager M (2015) Efficacy of professionally administered plaque removal with or without adjunctive measures for the treatment of peri-implant mucositis. A systematic review and meta-analysis. J Clin Periodontol 42(Suppl. 16):S202–S213CrossRefGoogle Scholar
  34. 34.
    Heitz-Mayfield L, Salvi G, Botticelli D, Mombelli A, Faddy M, Lang N (2011) Implant complication research group. Anti-infective treatment of peri-implant mucositis: a randomised controlled clinical trial. Clin Oral Implants Res 22:237–241CrossRefGoogle Scholar
  35. 35.
    Leonhardt A, Gröndahl K, Bergström C, Lekholm U (2002) Long-term follow-up of osseointegrated titanium implants using clinical, radiographic and microbiological parameters. Clin Oral Implants Res 13:127–132CrossRefGoogle Scholar
  36. 36.
    Gupta N, Gupta ND, Gupta A, Khan S, Bansal N (2015) Role of salivary matrix metalloproteinase-8 (MMP-8) in chronic periodontitis diagnosis. Front Med 9:72–76CrossRefGoogle Scholar
  37. 37.
    Sorsa T, Gursoy UK, Nwhator S, Hernandez M, Tervahartiala T, Leppilahti J, Gursoy M, Könönen E, Emingil G, Pussinen PJ, Mäntylä P (2016) Analysis of matrix metalloproteinases, especially MMP-8, in gingival creviclular fluid, mouthrinse and saliva for monitoring periodontal diseases. Periodontol 2000 70:142–163CrossRefGoogle Scholar
  38. 38.
    Gonçalves PF, Huang H, McAninley S, Alfant B, Harrison P, Aukhil I, Walker C, Shaddox LM (2013) Periodontal treatment reduces matrix metalloproteinase levels in localized aggressive periodontitis. J Periodontol 84:1801–1808CrossRefGoogle Scholar
  39. 39.
    Papaioannou W, Quirynen M, Van Steenberghe D (1996) The influence of periodontitis on the subgingival flora around implants in partially edentulous patients. Clin Oral Implants Res 7:405–409CrossRefGoogle Scholar
  40. 40.
    Quirynen M, Vogels R, Peeters W, van Steenberghe D, Naert I, Haffajee A (2006) Dynamics of initial subgingival colonization of ‘pristine’ peri-implant pockets. Clin Oral Implants Res 17:25–37CrossRefGoogle Scholar
  41. 41.
    Axelsson P, Lindhe J (1981) The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol 8:281–294CrossRefGoogle Scholar
  42. 42.
    Pjetursson BE, Helbling C, Weber HP, Matuliene G, Salvi GE, Brägger U, Schmidlin K, Zwahlen M, Lang NP (2012) Peri-implantitis susceptibility as it relates to periodontal therapy and supportive care. Clin Oral Implants Res 23:888–894CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PeriodontologyPhilipps-University MarburgMarburgGermany
  2. 2.Department of PeriodontologyUniversity of BernBernSwitzerland

Personalised recommendations