Dataset Information

Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial.

ABSTRACT:

Introduction

Implant-supported prostheses are often successfully used in edentulous patients. However, the incidences of peri-implant mucositis and peri-implantitis increase over time. The accumulation of pathogenic bacteria adjacent to prostheses can induce peri-implant disease. Plaque removal is recommended to prevent and manage peri-implant diseases. The purpose of this study is to compare the plaque removal efficacy of ultrasonic debridement with/without erythritol air-polishing powder around implants and bridges in patients with full-arch fixed implant-supported prostheses as well as the effects of these two methods on the rates of peri-implant mucositis and peri-implantitis, and the submucosal microbiota composition over 5 years in patients undergoing supportive periodontal therapy.

Methods and analysis

We plan to enrol 10 edentulous (maxilla and/or mandible) patients seeking full-arch fixed implant-supported prostheses. The study will use a split-mouth model in which contralateral quadrants are randomly assigned to two groups. Group 1: one contralateral quadrant of full-arch fixed implant-supported prostheses will undergo ultrasonic debridement combined with erythritol air-polishing powder. Group 2: a separate contralateral quadrant of full-arch fixed implant-supported prostheses will undergo ultrasonic debridement. The 5-year trial will involve a total of 10 re-examinations per participant. The mucosal conditions around the implants will be recorded at 6-month intervals after restoration. Peri-implant submucosal plaque will be collected at each re-examination, and the bacterial flora will be analysed by 16s ribosomal RNA gene sequencing. X-ray examinations will be conducted at 12-month intervals to evaluate the marginal bone level around implants.

Ethics and dissemination

This prospective single-centre, randomised controlled trial (PKUSSIRB-202054045) has been approved by the Ethics Committee of Stomatology School and Hospital of Peking University. Data will be registered with the International Clinical Trials Registry Platform. Additionally, we will disseminate the results via publication in scientific journals.

Trial registration number

ChiCTR-2000032431.

SUBMITTER: Yang J

PROVIDER: S-EPMC8655551 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial.

Yang Jingwen J Jia Pingyi P Yue Zhaoguo Z Liu Jianzhang J Liu Zhongning Z Tang Lin L Liu Qi Q Hou Jianxia J

BMJ open 20211207 12

<h4>Introduction</h4>Implant-supported prostheses are often successfully used in edentulous patients. However, the incidences of peri-implant mucositis and peri-implantitis increase over time. The accumulation of pathogenic bacteria adjacent to prostheses can induce peri-implant disease. Plaque removal is recommended to prevent and manage peri-implant diseases. The purpose of this study is to compare the plaque removal efficacy of ultrasonic debridement with/without erythritol air-polishing powd ...[more]

PMID: 34876432

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Project description:BackgroundDue to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.MethodsTwenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA-DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).ResultsA significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).ConclusionsThe 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.Trial registrationThe clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Project description:BackgroundSupportive periodontal therapy (SPT) is the key for a stable periodontal health following active treatment. Likewise, implant maintenance is crucial following implant placement. This systematic review aimed to assess clinical outcomes, patients' perception, and cost-effectiveness of repeated periodontal therapy with air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments (conventional interventions) in SPT and implant maintenance.MethodsElectronic search for randomised controlled clinical trials with minimum 6 months follow-up for SPT and implant maintenance programme was conducted for data published from 01 January 2000 to 30 April 2020 using multiple databases and hand searching. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (RoB 2).ResultsA total of 823 articles were screened. 4 SPT and 2 implant maintenance studies were eligible for inclusion. For SPT, repeated APDs interventions revealed no statistically significant difference when compared to the conventional interventions (weighted mean difference [WMD] 0.11 mm, p = 0.08). Likewise, no statistical difference was noted in terms of percentage of bleeding on probing (BOP) and clinical attachment level (CAL) gain. APDs were associated with lower pain score (based on Visual Analogue Scale) and higher patient acceptance in SPT studies. For implant maintenance, APDs resulted in reduction in PPD and percentage of BOP. However, CAL gain was comparable between the two groups. In terms of patient reported outcomes, no implant maintenance studies recorded any forms of patient reported outcomes. In addition, no studies reported on economic evaluation of APDs in both SPT and implant maintenance.ConclusionWithin the limitations of this systematic review and meta-analysis, repeated subgingival debridement using APDs in SPT resulted in similar clinical outcomes but better patients' comfort when compared to the conventional interventions. For implant maintenance, there is limited evidence to show that repeated application of APDs leads to improved clinical outcomes when compared to conventional treatments.

Project description:BackgroundA variety of interventions have been explored in the non-surgical management of peri-implantitis. In spite of extensive testing of various study protocols, effective treatments largely remain unavailable. The objective of the present 12-month single-centre, examiner-masked, randomized controlled clinical trial was to explore whether a low-abrasive erythritol air-polishing system produces added clinical benefit when used adjunctive to conventional non-surgical management of peri-implantitis and to record any associated patient-centered outcomes.MethodsForty-three patients with mild to severe peri-implantitis including at least one implant either received ultrasonic/curette subgingival instrumentation and erythritol air-polishing (test) or ultrasonic/curette instrumentation only (control) at baseline and at 3, 6, 9, and 12 months. Probing depth (PD), bleeding on probing (BoP), dental plaque, suppuration (SUP), crestal bone level (CBL), and peri-implant crevicular fluid (PCF) were recorded at baseline, 6 and 12 months. Visual Analogue Scale (VAS) scores were collected immediately following subgingival interventions at all time-points.ResultsA reduction in PD was observed from baseline to 6 months for the test (p = 0.006) and control (p < 0.001) and from baseline to 12 months for the control (p < 0.001). No intergroup differences were observed for primary outcome variables PD or CBL over time (p > 0.05). At 6 months, a intergroup difference in PCF was observed in favor of the test (p = 0.042). Moreover, a reduction in SUP from baseline to 6 and 12 months was observed in the test (p = 0.019). Overall, patients in the control group experienced less pain/discomfort compared with the test (p < 0.05), females reporting more pain/discomfort than males (p = 0.005).ConclusionsThis study confirms that conventional non-surgical management of peri-implantitis produces limited clinical improvement. It is shown that an erythritol air-polishing system may not produce added clinical benefits when used adjunctive to conventional non-surgical management. In other words, neither approach effectively resolved peri-implantitis. Moreover, the erythritol air-polishing system produced added pain/discomfort particularly in female patients.Trial registrationThe clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04152668 (05/11/2019).

Project description:This ex vivo study aimed to investigate surface roughness and substance loss after treatment with different professional cleaning methods and to determine whether subsequent polishing with a rubber cup and polishing paste is necessary. Samples (flat and natural surfaces) of human enamel and dentin were prepared (baseline) and treated with either a curette, air-polishing with erythritol, a rubber cup and polishing paste, or a combination thereof (treatment). Subsequently, all samples were immersed in an ultrasonic bath (ultrasonic) to remove residues from the treatment procedures. The surface roughness values sRa and sRz as well as tissue loss were measured profilometrically. Linear regression models were used to compare group differences (roughness and loss) considering the corresponding baseline value. The significance level was set at p<0.05. sRa increased significantly after treatment with curettes or air-polishing with erythritol in both enamel (p<0.001) and dentin (p<0.001) of flat samples. The same effect was observed for sRz in dentin (p<0.001) but not for enamel compared to negative control. Polishing with a rubber cup and paste alone had no significant effect on roughness values. When combined with other treatments, the effect of curette or air-polishing with erythritol dominated the effect. In enamel, none of the tested methods led to measurable tissue loss. In dentin, air-polishing with erythritol caused ≤50% tissue loss compared to the curette. Conclusively, for enamel, treatment effects on roughness were measurable but of limited clinical relevance. For dentin, air-polishing resulted in a smaller but insignificant roughness increase and less tissue loss compared to the curette. Polishing with a rubber cup and paste did not affect surface roughness. Regarding the clinical application, the use of air-polishing seems to be a less invasive procedure than using a curette; polishing with rubber cup and paste offers no advantage in terms of reducing roughness as a final procedure.

Dataset Information

Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial.

Introduction

Methods and analysis

Ethics and dissemination

Trial registration number

Publications

Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial.

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