Peri-implantitis
Conditions
Keywords
Reconstructive therapy, peri-implantitis, Bone defect, barrier membrane
Brief summary
The aim of this randomized clinical study is to assess the additional clinical benefit of incorporating a resorbable collagen membrane (CM) alongside a xenogeneic bone graft-specifically, deproteinized bovine bone mineral with 10% collagen (DBBM-C)-in the reconstructive surgical treatment of peri-implantitis involving combined (i.e., contained and non-contained) defect configurations. Accordingly, the study addresses the following research questions: * Does the adjunctive use of a CM in combination with DBBM-C improve treatment success compared to DBBM-C alone in the management of combined peri-implantitis-related defects? * Does the combined use of a CM and DBBM-C lead to superior patient-reported outcomes (PROs) compared to the use of DBBM-C alone in the reconstructive treatment of such defects? A total of 60 patients who have been referred to the Gazi University Department of Periodontology will be randomly assigned to receive test (DBMM-C +CM) or control group (DBMM-C) treatments. Clinical parameters will be assessed at baseline (i.e., prior to surgery), and at the 6-, and 12-month post-operatively. Radiographic examinations will be carried out at baseline and 12 months post-operatively. Patient oral health related to the treatment procedures will be evaluated using a written questionnaire \[Oral Health Impact Profile (OHIP-14)\] prior to treatment and after 2 weeks, 1, and 12 months following surgical therapy. Regarding post-treatment pain and overall patient satisfaction with treatment modalities, responses will be scored on a visual analog scale (VAS, 100 mm).
Detailed description
Reconstructive surgical therapy for peri-implantitis has shown improved clinical and radiographic outcomes, with favorable postoperative mucosal margin levels and superior radiographic bone fill compared to other treatment modalities. However, no specific biomaterial or application technique has yet been identified as clearly superior. In particular, the potential added value of combining a barrier membrane with a bone substitute, as opposed to using bone substitute alone, remains a subject of ongoing debate. Recent studies have suggested that the adjunctive use of a barrier membrane does not necessarily enhance clinical or radiographic outcomes in peri-implantitis-associated intrabony defects. However, these studies often included heterogeneous defect morphologies, which may influence the regenerative potential and confound treatment outcomes. Indeed, contained and non-contained defects may behave differently due to biological factors such as space maintenance, clot stability, and wound protection. his highlights the need to tailor biomaterial selection to the specific defect configuration. While current evidence suggests that barrier membranes may not provide additional benefit in fully contained defects, there is a lack of data regarding their effectiveness in combined defects that include both supracrestal and intrabony components, particularly those with partially contained 2- or 3-wall morphologies. Therefore, the primary aim of this randomized clinical study is to evaluate the additional clinical benefit of incorporating a resorbable CM with DBMM-C in the reconstructive surgical treatment of peri-implantitis with combined defect morphology. The secondary objective is to assess patient-reported outcomes (PROs) in both treatment groups.
Interventions
DEVICEDBMM-C plus Resorbable collagen membrane
A trapezoidal flap design will be employed, including a sulcular incision and vertical releasing incisions extending approximately 2-3 mm beyond the mucogingival junction. Flap advancement will be facilitated through a periosteal-releasing incision at the flap base. Granulation tissue will be removed using a titanium curette, and implant surface decontamination will be performed with a titanium brush. The graft material will be placed in both supra- and intrabony defect components, followed by coverage with a resorbable collagen membrane. The flaps will then be coronally advanced and stabilized over the biomaterials.
DEVICEDBMM-C
A trapezoidal flap design will be employed, including a sulcular incision and vertical releasing incisions extending approximately 2-3 mm beyond the mucogingival junction. Flap advancement will be facilitated through a periosteal-releasing incision at the flap base. Granulation tissue will be removed using a titanium curette, and implant surface decontamination will be performed with a titanium brush. The graft material will be placed in both supra- and intrabony defect components, and then the flaps will be coronally advanced and stabilized over the graft material.
Sponsors
Gazi University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Peri-implantitis defined as the presence of a peri-implant probing pocket depth (PPD) ≥6 mm with bleeding and/or suppuration on probing (BoP/SoP) and radiographic marginal bone loss (MBL) ≥3 mm. * Presence of combined defect configuration Class \[Ib, Ic, Ie with horizontal components (i.e. Class II) (Schwarz et al., 2010)\] with an intrabony compartment of ≥3 mm. * Presence of a minimum width of 2 mm of keratinized peri-implant mucosa on the buccal aspect of the implant. * Implants placed in proper position (inside the bony housing) * Having an implant-supported prosthesis that allows for adequate oral hygiene procedures and peri-implant probing.
Exclusion criteria
* Full-mouth plaque score (FMPS) \< 25% * Full-mouth bleeding score (FMBS) \< 25% * Cigarette smoking \< 10 cig./day, * Diagnosed with active periodontal disease, * Having acute or chronic medical conditions or undergoing medications, such as intravenous amino-bisphosphonates, immunosuppressive drugs, and chemotherapy, that could interfere with the treatment outcome, * Receiving antibiotic treatment in the previous 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of treatment success (%) | 12 months after the surgical treatment | The absence of bleeding on probing (BOP) at more than one site, no suppuration, deepest PPD ≤5mm, and no further radiographic bone loss. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of bleeding on probing (BOP) (%) | 12 months after the surgical treatment | The percentage of BOP around six sites of the implant |
| Probing pocket depth (PPD) | 12 months after the surgical treatment | The distance between the bottom of the pocket and the mucosal margin around the implant |
| Change in radiographic vertical defect depth | 12 months after the surgical treatment | Marginal bone levels (MBL) will be assessed the distance between this line and the first bone-to-implant contact (BIC). The mesial and distal measurements will be averaged for further calculations. The radiographic vertical defect depth changes over time will be evaluated the difference between MBL at baseline and 12 months following the therapy. |
| Patient morbidity - Postoperative pain | At baseline and after 2 weeks and 1 and 12 months following surgical treatment | Postoperative pain will be assessed using a visual analogue score |
| Patient-reported satisfaction with the overall treatment | At baseline and after 2 weeks and 1 and 12 months following surgical treatment | Patient-reported satisfaction will be assessed using a visual analogue score |
Countries
Turkey (Türkiye)
Contacts
Primary ContactSila Cagri Isler, PhD
Outcome results
None listed