Vancomycin and tobramycin impregnated mineralized allograft for the surgical regenerative treatment of peri-implantitis: a 1-year follow-up case series
- 251 Downloads
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.
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.
KeywordsPeri-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.
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 was obtained from all individual participants included in the study.
- 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. https://doi.org/10.1111/j.1600-0501.2011.02276.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1034/j.1600-0501.2003.120909.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.2334/josnusd.42.163 PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1016/j.biomaterials.2010.05.005 PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1302/0301-620X.90B12.20742 PubMedCrossRefGoogle Scholar
- 18.Whelton A (1984) The aminoglycosides. Clin Orthop Relat Res:66–74Google Scholar
- 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. https://doi.org/10.1177/0022034515601961 PubMedCrossRefGoogle Scholar
- 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.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. https://doi.org/10.1111/j.1600-051X.2011.01742.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1111/clr.12183 PubMedCrossRefGoogle Scholar
- 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: https://doi.org/10.11607/jomi.2014suppl.g5.3
- 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. https://doi.org/10.1034/j.1600-0501.2001.012004287.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1111/j.1600-051X.2006.00919.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1111/j.1600-0501.2012.02494.x PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1902/jop.2008.070347 PubMedCrossRefGoogle Scholar
- 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. https://doi.org/10.1111/clr.12155 PubMedCrossRefGoogle Scholar
- 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