Aim
To answer the following PICOS question: In adult patients with peri‐implantitis, what is the efficacy of sub‐marginal instrumentation combined with chemical surface decontamination in comparison ...with sub‐marginal instrumentation with or without placebo, in terms of changes in probing depth (PD) and/or bleeding on probing, as reported in prospective randomized controlled trials, non‐randomized controlled trials, or prospective cohort studies, with a minimum of 6‐month “follow‐up”.
Materials and Methods
A systematic literature search was performed in PubMed, Web of Science, Embase, Scopus, Ovid Medline, and The Cochrane Library of the Cochrane Collaboration (CENTRAL) for articles published until March 2022. Data addressing the primary and secondary outcomes were extracted.
Results
The search gave 2033 results of which 3 fulfilled the inclusion criteria. Two studies investigated the use of anti‐microbial photodynamic therapy as adjunct to sub‐marginal instrumentation and the third study assessed the adjunctive use of a desiccant material. A meta‐analysis was not deemed meaningful because of the large heterogeneity among the studies. All three studies showed favourable results in terms of PD reduction for chemical surface decontamination over control approaches, but were inconsistent or showed no differences for the other outcome variables.
Conclusions
Adjunctive chemical approaches for implant surface decontamination may offer an advantage over sub‐marginal instrumentation alone, in terms of improved PD.
Aim
To compare biomarker levels in peri‐implant crevicular fluid (PICF) of healthy implants with levels in PICF of implants with peri‐implantitis (before and after non‐surgical treatment).
Materials ...and methods
Samples were taken from 20 healthy implants (n = 17 patients) and from 20 implants with peri‐implantitis (n = 19 patients) before and 3 months after non‐surgical treatment using the Airflow Master Piezon® (EMS). A Luminex™ assay was used to evaluate pro‐inflammatory and anti‐inflammatory cytokines IL‐1β, TNF‐α, IL‐6 and G‐CSF, collagen degradation enzyme MMP‐8, chemokines MCP‐1 & MIP‐1α/CCL3, bone markers OPG and sRANKL and interferon‐γ. Clinical and radiographical characteristics were assessed. A Mann–Whitney U and Wilcoxon signed‐rank test analysed between‐ and within‐group differences.
Results
IL‐1β and MMP‐8 levels were found significantly elevated in implants with peri‐implantitis (p = .007; p = <.001, respectively). No difference in levels of TNF‐α, IL‐6, MCP‐1 and MIP‐1α/CCL3, OPG and G‐CSF between healthy and diseased implants was found. Levels of sRANKL and INF‐γ were under the level of detection. None of the biomarker levels improved after non‐surgical therapy, and levels of IL‐1β and MMP‐8 remained high.
Conclusion
Implants diagnosed with peri‐implantitis have higher levels of IL‐1β and MMP‐8 in PICF compared to healthy implants. Non‐surgical therapy did not influence the inflammatory immune response.
Aim
The objective of this randomized, double‐blind, placebo‐controlled trial was to study the effect of implant surface decontamination with chlorhexidine (CHX)/cetylpyridinium chloride (CPC) on ...microbiological and clinical parameters.
Material & Methods
Thirty patients (79 implants) with peri‐implantitis were treated with resective surgical treatment consisting of apically re‐positioned flap, bone re‐contouring and surface debridement and decontamination. Patients were randomly allocated to decontamination with 0.12% CHX + 0.05% CPC (test‐group) or a placebo‐solution (without CHX/CPC, placebo‐group). Microbiological parameters were recorded during surgery; clinical and radiographical parameters were recorded before (pre‐) treatment (baseline), and at 3, 6 and 12 months after treatment.
Results
Nine implants in two patients in the placebo‐group were lost due to severe persisting peri‐implantitis. Both decontamination procedures resulted in significant reductions of bacterial load on the implant surface, but the test‐group showed a significantly greater reduction than the placebo‐group (log 4.21 ± 1.89 versus log 2.77 ± 2.12, p = 0.006). Multilevel analysis showed no differences between both groups in the effect of the intervention on bleeding, suppuration, probing pocket depth and radiographical bone loss over time.
Conclusion
Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri‐implantitis leads to a greater immediate suppression of anaerobic bacteria on the implant surface than a placebo‐solution, but does not lead to superior clinical results. The long‐term microbiological effect remains unknown.
Objectives
Objective of this study was to identify prognostic indicators for the outcome of resective peri‐implantitis treatment, by an analysis of the pooled data of two previously conducted ...randomized controlled trials.
Material and methods
Data of 74 patients with peri‐implantitis (187 implants) who had received resective surgical treatment were available. Primary outcome variable was failure of peri‐implantitis treatment after 12 months. Multilevel univariable and multiple logistic regression analyses were performed to evaluate the effect of various potentially prognostic indicators on the primary outcome.
Results
Peri‐implantitis treatment was unsuccessful in 106 implants (57%) and 48 patients (67%) after 12 months. In the multiple regression analysis, the variables “order of inclusion” (P = 0.016) and mean bone loss at baseline (P = 0.030) were significant prognostic indicators for treatment failure. To eliminate the effect of “order of inclusion,” post hoc analyses were carried out in a subgroup of patients. The univariable post hoc analysis showed a significant association for smoking (P = 0.015), maximum pocket depth at baseline (P = 0.073), mean bone loss at baseline (P = 0.003), and presence of plaque (P = 0.100). In the multiple regression post hoc analysis, only the variables smoking (P = 0.044) and mean bone loss (P = 0.043) remained statistically significant.
Conclusions
The outcome of surgical peri‐implantitis treatment is influenced by the experience of the surgical team with the surgical procedure. The observed learning effect has consequences for clinical practice and for conducting and interpreting clinical trials on peri‐implantitis treatment. Other prognostic indicators are amount of peri‐implant bone loss at baseline and smoking, and to a lesser extent, probing pocket depth at baseline and presence of plaque during follow‐up. Early diagnosis of peri‐implantitis and control of behavioral factors are crucial in achieving peri‐implantitis treatment success.
Aim
The aim of this single‐blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non‐surgical treatment of ...peri‐implantitis.
Material and methods
Patients (N = 62) with peri‐implantitis were randomly assigned to receive full‐mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T0) to 3‐month follow‐up (T3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis.
Results
57 patients with 122 implants completed 3‐month follow‐up. Both groups showed major clinical improvements at T3 in both peri‐implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters.
Conclusions
Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non‐surgical peri‐implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full‐mouth non‐surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri‐implantitis treatment phase.
Functional recovery of patients after a total knee arthroplasty (TKA) usually is measured with questionnaires. However, these self-report measures assess the patient's perspective on his or her ...ability to perform a task. Performance-based tests are needed to assess the patient's actual ability to perform a task.
The main purpose of this study was to quantify improvement in performance of the sit-to-stand movement of patients with a TKA.
In this prospective study of 16 patients with end-stage knee osteoarthritis followed by a TKA, the maximal knee angular extension velocity and amount of unloading (shifting weight) of the affected leg during the sit-to-stand movement and the visual analog scale score for pain were assessed preoperatively and 6 months and 1 year postoperatively. These data were compared with data for a control group of individuals who were healthy (n=27).
Before surgery, the participants in the TKA group unloaded their affected leg, but within 6 months after implantation, the affected leg was almost fully loaded again and comparable to the loading symmetry ratio of the control group. Furthermore, knee extension velocity also had increased, but remained lower than that of the control group. The changes in knee extension velocity took place during the first 6 months, after which a plateau was visible. Limitations A potential limitation of the study design was that the patients were not perfectly matched with the control subjects.
Implantation of a total knee prosthesis partly improved performance of the sit-to-stand movement. Participants in the TKA group could fully load their operated leg, but they could not generate enough knee angular velocity during rising compared with the control group.
Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ...ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients.
Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006-2013) and a temporal validation cohort (n = 73, 2014-2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48 h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC).
The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 6.9-20.8 vs 6.1 4.6-10.4 p = 0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9-18.2) and one-year-mortality (OR 3.9, 95% CI 1.5-10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8-10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71-0.89, p < 0.01). Temporal validation resulted in an AUC of 0.74 (95% CI 0.61-0.87, p < 0.01).
In the era of the new generation of cfLVADs, vasoplegia remains a prevalent (33%) and critical condition with worse short-term outcomes and survival. We identified previous cardiothoracic surgery, preoperative treatment with dopamine, preoperative bilirubin levels and preoperative creatinine clearance as independent predictors.
Objectives
To compare erythritol air polishing with piezoelectric ultrasonic scaling in the non‐surgical treatment of peri‐implantitis.
Material and methods
Eighty patients (n = 139 implants) with ...peri‐implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics.
Results
Three months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis β (95% CI) −0.037 (−0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12‐month follow‐up.
Conclusions
Erythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non‐surgical treatment of peri‐implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri‐implantitis. Hence, the majority of patients required further surgical treatment.
The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment ...has failed to solve peri-implantitis underwent resective surgical treatment. Their peri-implant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12). The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and
-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients.
was significantly lower on T12 compared to T0 for the peri-implantitis samples.
and
abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of
and
seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success.
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