Clinical Oral Investigations

, Volume 22, Issue 6, pp 2199–2207 | Cite as

Vancomycin and tobramycin impregnated mineralized allograft for the surgical regenerative treatment of peri-implantitis: a 1-year follow-up case series

  • José Nart
  • Beatriz de Tapia
  • Àngels Pujol
  • Andrés Pascual
  • Cristina VallesEmail author
Original Article



To assess the clinical and radiographic outcomes of the regenerative treatment of peri-implantitis using a vancomycin and tobramycin impregnated allograft (VTA) after a 12-month period.

Material and methods

Thirteen consecutive patients who required a regenerative treatment of peri-implantitis were recruited. For the 17 implant sites, a flap was raised, and after mechanical and chemical implant decontamination, a vancomycin and tobramycin impregnated allograft was placed in the defect and then covered with a collagen membrane. Soft tissues were sutured allowing a non-submerged healing. Clinical and radiographic variables were evaluated at baseline and at 12 months after treatment.


No signs of continuous bone loss were observed and no implant was lost, yielding a 100% survival rate. All patient’s clinical examination at 12 months revealed peri-implant health showing absence of suppuration and a statistically significant reduction in terms of bleeding on probing scores (70.6%, P = 0.001). Initial probing pocket depth (7.88 ± 1.22 mm) was significantly reduced at 12 months healing, a mean reduction of 4.23 ± 1.47 mm (P = 0.001) was achieved. The mean radiological infrabony defect at baseline reached 4.33 ± 1.62 mm, and was significantly reduced up to 0.56 ± 0.88 mm, which represents an 86.99 ± 18.2% bone fill from the original infrabony defect.


Within the limits of the study, the application of VTA with a collagen membrane yielded positive outcomes in terms of radiographic bone fill, pocket depth reduction, and attachment gain after a 12-month period. Thus, VTA plus a collagen membrane seem to be suitable for the regenerative treatment of peri-implantitis.

Clinical relevance

The use of locally delivered antibiotic together with the bone graft may reduce the undesirable effects related to the systemic administration and the risk of resistances. In the light of the results obtained, these grafting materials might offer new treatment strategies in the surgical regenerative treatment of peri-implantitis.


Peri-implantitis Surgical treatment Regeneration Allograft Local antibiotic Antibiotic 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants, were in accordance with ethical standards of the institutional research committee and with the principles stated in the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Lindhe J, Meyle J and Group DoEWoP (2008) Peri-implant diseases: consensus report of the sixth European workshop on periodontology. J Clin Periodontol 35(8 Suppl):282–285. Google Scholar
  2. 2.
    Serino G, Turri A, Lang NP (2013) Probing at implants with peri-implantitis and its relation to clinical peri-implant bone loss. Clin Oral Implants Res 24(1):91–95. PubMedCrossRefGoogle Scholar
  3. 3.
    Derks J, Tomasi C (2015) Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 42 Suppl 16:S158–S171. PubMedCrossRefGoogle Scholar
  4. 4.
    Marotti J, Tortamano P, Cai S, Ribeiro MS, Franco JE, de Campos TT (2013) Decontamination of dental implant surfaces by means of photodynamic therapy. Lasers Med Sci 28(1):303–309. PubMedCrossRefGoogle Scholar
  5. 5.
    Heitz-Mayfield LJ, Salvi GE, Mombelli A, Faddy M, Lang NP, Implant Complication Research G (2012) Anti-infective surgical therapy of peri-implantitis. A 12-month prospective clinical study. Clin Oral Implants Res 23(2):205–210. PubMedCrossRefGoogle Scholar
  6. 6.
    Alhag M, Renvert S, Polyzois I, Claffey N (2008) Re-osseointegration on rough implant surfaces previously coated with bacterial biofilm: an experimental study in the dog. Clin Oral Implants Res 19(2):182–187. PubMedCrossRefGoogle Scholar
  7. 7.
    Schou S, Holmstrup P, Jorgensen T, Stoltze K, Hjorting-Hansen E, Wenzel A (2003) Autogenous bone graft and ePTFE membrane in the treatment of peri-implantitis. I. Clinical and radiographic observations in cynomolgus monkeys. Clin Oral Implants Res 14(4):391–403. PubMedCrossRefGoogle Scholar
  8. 8.
    Machado MA, Stefani CM, Sallum EA, Sallum AW, Tramontina VA, Nogueira-Filho GR, Nociti Junior FH (2000) Treatment of ligature-induced peri-implantitis defects by regenerative procedures. Part II: a histometric study in dogs. J Oral Sci 42(3):163–168. PubMedCrossRefGoogle Scholar
  9. 9.
    Albouy JP, Abrahamsson I, Persson LG, Berglundh T (2011) Implant surface characteristics influence the outcome of treatment of peri-implantitis: an experimental study in dogs. J Clin Periodontol 38(1):58–64. PubMedCrossRefGoogle Scholar
  10. 10.
    Buchter A, Meyer U, Kruse-Losler B, Joos U, Kleinheinz J (2004) Sustained release of doxycycline for the treatment of peri-implantitis: randomised controlled trial. Br J Oral Maxillofac Surg 42(5):439–444. PubMedCrossRefGoogle Scholar
  11. 11.
    Rams TE, Degener JE, van Winkelhoff AJ (2014) Antibiotic resistance in human peri-implantitis microbiota. Clin Oral Implants Res 25(1):82–90. PubMedCrossRefGoogle Scholar
  12. 12.
    Mombelli A, Decaillet F (2011) The characteristics of biofilms in peri-implant disease. J Clin Periodontol 38(Suppl 11):203–213. PubMedCrossRefGoogle Scholar
  13. 13.
    Fraimow HS (2009) Systemic antimicrobial therapy in osteomyelitis. Semin Plast Surg 23(02):90–99. PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Campoccia D, Montanaro L, Speziale P, Arciola CR (2010) Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use. Biomaterials 31(25):6363–6377. PubMedCrossRefGoogle Scholar
  15. 15.
    Buttaro MA, Gimenez MI, Greco G, Barcan L, Piccaluga F (2005) High active local levels of vancomycin without nephrotoxicity released from impacted bone allografts in 20 revision hip arthroplasties. Acta Orthop 76(3):336–340PubMedGoogle Scholar
  16. 16.
    Winkler H, Stoiber A, Kaudela K, Winter F, Menschik F (2008) One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics. J Bone Joint Surg Br 90(12):1580–1584. PubMedCrossRefGoogle Scholar
  17. 17.
    Appelbaum PC (2007) Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 30(5):398–408. PubMedCrossRefGoogle Scholar
  18. 18.
    Whelton A (1984) The aminoglycosides. Clin Orthop Relat Res:66–74Google Scholar
  19. 19.
    Winkler H, Janata O, Berger C, Wein W, Georgopoulos A (2000) In vitro release of vancomycin and tobramycin from impregnated human and bovine bone grafts. J Antimicrob Chemother 46(3):423–428. PubMedCrossRefGoogle Scholar
  20. 20.
    Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4(1):1–6. PubMedCrossRefGoogle Scholar
  21. 21.
    Ramel CF, Lussi A, Ozcan M, Jung RE, Hammerle CH, Thoma DS (2016) Surface roughness of dental implants and treatment time using six different implantoplasty procedures. Clin Oral Implants Res 27(7):776–781. PubMedCrossRefGoogle Scholar
  22. 22.
    O’Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43(1):38. PubMedCrossRefGoogle Scholar
  23. 23.
    Serino G, Turri A, Lang NP (2015) Maintenance therapy in patients following the surgical treatment of peri-implantitis: a 5-year follow-up study. Clin Oral Implants Res 26(8):950–956. PubMedCrossRefGoogle Scholar
  24. 24.
    Renvert S, Polyzois I, Claffey N (2012) Surgical therapy for the control of peri-implantitis. Clin Oral Implants Res 23 Suppl 6:84–94. PubMedCrossRefGoogle Scholar
  25. 25.
    Charalampakis G, Rabe P, Leonhardt A, Dahlen G (2011) A follow-up study of peri-implantitis cases after treatment. J Clin Periodontol 38(9):864–871. PubMedCrossRefGoogle Scholar
  26. 26.
    Khoshkam V, Chan HL, Lin GH, MacEachern MP, Monje A, Suarez F, Giannobile WV, Wang HL (2013) Reconstructive procedures for treating peri-implantitis: a systematic review. J Dent Res 92(12_suppl):131S–138S. PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Carcuac O, Derks J, Charalampakis G, Abrahamsson I, Wennstrom J, Berglundh T (2016) Adjunctive systemic and local antimicrobial therapy in the surgical treatment of peri-implantitis: a randomized controlled clinical trial. J Dent Res 95(1):50–57. PubMedCrossRefGoogle Scholar
  28. 28.
    Jepsen K, Jepsen S, Laine ML, Anssari Moin D, Pilloni A, Zeza B, Sanz M, Ortiz-Vigon A, Roos-Jansaker AM, Renvert S (2016) Reconstruction of peri-implant osseous defects: a multicenter randomized trial. J Dent Res 95(1):58–66. PubMedCrossRefGoogle Scholar
  29. 29.
    Roos-Jansaker AM (2007) Long time follow up of implant therapy and treatment of peri-implantitis. Swed Dent J Suppl:7–66Google Scholar
  30. 30.
    Roccuzzo M, Bonino F, Bonino L, Dalmasso P (2011) Surgical therapy of peri-implantitis lesions by means of a bovine-derived xenograft: comparative results of a prospective study on two different implant surfaces. J Clin Periodontol 38(8):738–745. PubMedCrossRefGoogle Scholar
  31. 31.
    Sahrmann P, Attin T, Schmidlin PR (2011) Regenerative treatment of peri-implantitis using bone substitutes and membrane: a systematic review. Clin Implant Dent Relat Res 13(1):46–57. PubMedCrossRefGoogle Scholar
  32. 32.
    Chan HL, Lin GH, Suarez F, MacEachern M, Wang HL (2014) Surgical management of peri-implantitis: a systematic review and meta-analysis of treatment outcomes. J Periodontol 85(8):1027–1041. PubMedCrossRefGoogle Scholar
  33. 33.
    Matarasso S, Iorio Siciliano V, Aglietta M, Andreuccetti G, Salvi GE (2014) Clinical and radiographic outcomes of a combined resective and regenerative approach in the treatment of peri-implantitis: a prospective case series. Clin Oral Implants Res 25(7):761–767. PubMedCrossRefGoogle Scholar
  34. 34.
    Heitz-Mayfield LJ and Mombelli A (2014) The therapy of peri-implantitis: a systematic review. Int J Oral Maxillofac Implants 29 Suppl:325–45. doi:
  35. 35.
    Etter TH, Hakanson I, Lang NP, Trejo PM, Caffesse RG (2002) Healing after standardized clinical probing of the perlimplant soft tissue seal: a histomorphometric study in dogs. Clin Oral Implants Res 13(6):571–580. PubMedCrossRefGoogle Scholar
  36. 36.
    Claffey N, Clarke E, Polyzois I, Renvert S (2008) Surgical treatment of peri-implantitis. J Clin Periodontol 35(8 Suppl):316–332. PubMedCrossRefGoogle Scholar
  37. 37.
    Mombelli A, Feloutzis A, Bragger U, Lang NP (2001) Treatment of peri-implantitis by local delivery of tetracycline. Clinical, microbiological and radiological results. Clin Oral Implants Res 12(4):287–294. PubMedCrossRefGoogle Scholar
  38. 38.
    Renvert S, Lessem J, Lindahl C, Svensson M (2004) Treatment of incipient peri-implant infections using topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement. J Int Acad Periodontol 6(4 Suppl):154–159PubMedGoogle Scholar
  39. 39.
    Renvert S, Lessem J, Dahlen G, Lindahl C, Svensson M (2006) Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections: a randomized clinical trial. J Clin Periodontol 33(5):362–369. PubMedCrossRefGoogle Scholar
  40. 40.
    Schar D, Ramseier CA, Eick S, Arweiler NB, Sculean A, Salvi GE (2013) Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: six-month outcomes of a prospective randomized clinical trial. Clin Oral Implants Res 24(1):104–110. PubMedCrossRefGoogle Scholar
  41. 41.
    Renvert S, Lessem J, Dahlen G, Renvert H, Lindahl C (2008) Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis: a randomized clinical trial. J Periodontol 79(5):836–844. PubMedCrossRefGoogle Scholar
  42. 42.
    Bassetti M, Schar D, Wicki B, Eick S, Ramseier CA, Arweiler NB, Sculean A, Salvi GE (2014) Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial. Clin Oral Implants Res 25(3):279–287. PubMedCrossRefGoogle Scholar
  43. 43.
    Renvert S, Polyzois I, Maguire R (2009) Re-osseointegration on previously contaminated surfaces: a systematic review. Clin Oral Implants Res 20(Suppl 4):216–227. PubMedCrossRefGoogle Scholar
  44. 44.
    Bert F, Leflon-Guibout V, Le Grand J, Bourdon N, Nicolas-Chanoine MH (2009) Emergence of vancomycin-dependent enterococci following glycopeptide therapy: case report and review. Pathol Biol (Paris) 57(1):56–60. CrossRefGoogle Scholar
  45. 45.
    Edin ML, Miclau T, Lester GE, Lindsey RW, Dahners LE (1996) Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop Relat Res:245–251Google Scholar
  46. 46.
    van Winkelhoff AJ, Herrera D, Oteo A, Sanz M (2005) Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and Spain. J Clin Periodontol 32(8):893–898. PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • José Nart
    • 1
  • Beatriz de Tapia
    • 1
  • Àngels Pujol
    • 1
  • Andrés Pascual
    • 1
  • Cristina Valles
    • 1
    Email author
  1. 1.Deparment of Periodontology, School of DentistryUniversitat Internacional de CatalunyaBarcelonaSpain

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