Surgical Protocol for Peri-implantitis Treatment-2

NCT ID: NCT03977285

Last Updated: 2020-11-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-02

Study Completion Date

2021-12-31

Brief Summary

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Peri-implant diseases are common post-restorative complications in implant rehabilitations and they occur with an incidence of 12-43%.

Based on the available data in literature, the surgical therapy for peri-implantitis is effective in disease resolution. Surgical access to peri-implant lesions facilitates the removal of all granulation tissue from the defect area as well as debridement and decontamination of the exposed implant surface defect area.

Different techniques have been used for implant surface decontamination during peri-implant surgery, including mechanical, chemical and laser treatments.

Detailed Description

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Peri-implantitis are defined as inflammatory diseases caused by bacterial biofilm around implant surface characterized by bleeding on probing, probing depth and eventually bone loss; if not successfully treated they may lead to implant loss. Based on the available parameters that have been reported in literature non surgical therapy doesn't seem to be effective on peri-implantitis. Therefore it is recommended to consider advanced therapies such as surgical interventions when non surgical peri-implant therapy fails to achieve significant improvements in clinical parameters.

Numerous approaches have been used for implant surface decontamination during per-implant surgery, including mechanical, chemical and laser treatments.

Conventional mechanical means don't seem to be effective on peri-implant diseases. In addition, the rough implant surface is a retentive factor for bacterial colonization and therefore makes implant surface difficult to debride.

A treatment protocol that may offer an advantage over traditional mechanical treatment includes the use of laser therapy and air-powder devices. Data have shown that treatments with Er.Yag laser have a bactericidal effect and are safe and effective on implant surfaces. Slightly better clinical results in terms of debridement, probing depth, bleeding on probing and clinical attachment level have been reported by Er:Yag laser treatment compared with traditional non surgical mechanical debridement with titanium curettes and pellet with saline in the surgical treatment of peri-implantitis.

The air abrasive method for debridement has also been used on implant surfaces demonstrating no relevant adverse effect. Until now, powders based on sodium bicarbonate and glycine have been used with pressured air/water. Nowadays a less abrasive method involves the use of erythritol powder.

The aim of the present randomized controlled clinical trial is to assess the efficacy in improving clinical parameters of two further methods of implant decontamination (er:Yag laser or air-abrasive device) after chemical treatment and chemical cleaning during surgical treatment of peri-implantitis in addition to chlorhexidine in vertical defects with keratinised tissue around implant surfaces. Furthermore the bone defect will be filled with bio-material.

Conditions

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Peri-Implantitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Chlorhexidine

Access flap will be raised to gain access to the implant surface. Inflammatory tissue, excess cement or plaque deposits will be removed using titanium curettes and the implant surface will be cleaned by copious irrigation with sterile saline and surgical gauze soaked in Chlorhexidine.

Group Type SHAM_COMPARATOR

chlorhexidine

Intervention Type PROCEDURE

Inflammatory tissue, excess cement or plaque deposits will be removed using titanium curettes and the implant surface will be cleaned by copious irrigation with sterile saline and surgical gauze soaked in chlorhexidine.

Er:YAG laser

Er: Yag laser treatment will be provided on the implant surface.

Group Type EXPERIMENTAL

chlorhexidine

Intervention Type PROCEDURE

Inflammatory tissue, excess cement or plaque deposits will be removed using titanium curettes and the implant surface will be cleaned by copious irrigation with sterile saline and surgical gauze soaked in chlorhexidine.

Air Powder

An Air-Powder treatment will be provided on the implant surface

Group Type ACTIVE_COMPARATOR

chlorhexidine

Intervention Type PROCEDURE

Inflammatory tissue, excess cement or plaque deposits will be removed using titanium curettes and the implant surface will be cleaned by copious irrigation with sterile saline and surgical gauze soaked in chlorhexidine.

Interventions

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chlorhexidine

Inflammatory tissue, excess cement or plaque deposits will be removed using titanium curettes and the implant surface will be cleaned by copious irrigation with sterile saline and surgical gauze soaked in chlorhexidine.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* presence of at least one screw-type titanium implant exhibiting bleeding and/or suppuration on probing combined with:

1. PPD ≥ 5 mm and bone loss ≥ 2 mm (compared to crestal bone levels at the time of placement of the reconstruction)
2. PPD ≥6 and bone loss ≥3 (not compared to crestal bone levels at the time of placement of the reconstruction)
* single tooth and bridgework restorations without overhangs
* no evidence of occlusal overload (i.e. occlusal contacts revealed appropriate adjustment),
* treated chronic periodontitis and proper periodontal maintenance care FMPS \< 20%
* non-smoker or light smoking status in smokers (\<10 cigarettes per day) implant function time ≥ 1 year.

Exclusion Criteria

* Patients with uncontrolled diabetes
* patients with osteoporosis or under bisphosphonate medication, pregnant or lactating women
* patients with a history of radiotherapy to the head and neck region
* hollow implants
* implant mobility
* implants at which no position could be identified where proper probing measurements could be performed;
* previous surgical treatment of the peri-implantitis lesions
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Università Vita-Salute San Raffaele

OTHER

Sponsor Role lead

Responsible Party

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Marco Clementini

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Massimo De Sanctis

Role: STUDY_CHAIR

Università Vita-Salute San Raffaele

Locations

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Università Vita-Salute San Raffaele

Milan, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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marco clementini

Role: CONTACT

0226432806

Facility Contacts

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Marco Clementini

Role: primary

0226432806

Other Identifiers

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peri-implant surgical-2

Identifier Type: -

Identifier Source: org_study_id