Systemic antibiotic therapy as an adjunct to non-surgical peri-implantitis treatment:A single-blind RCT

Aim The aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis. Material and methods Patients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T-0) to 3-month follow-up (T-3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis. Results 57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T-3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters. Conclusions Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase

Non-surgical peri-implantitis treatment using a pocket irrigator device; clinical, microbiological, radiographical and patient-centred outcomes-A pilot study

Aim: The aim of this prospective cohort study was to assess the effect of a pocket irrigator/evacuator device (IED) in the non-surgical treatment of peri-implantitis. Material and Methods: In total 24 patients having 38 implants diagnosed with peri-implantitis were included in this study. Peri-implant pockets were irrigated six times in three consecutive weeks. The primary outcome was bleeding on probing (BoP). Secondary outcome parameters included plaque index (Pl), suppuration on probing (SoP), probing pocket depth (PPD), marginal bone loss (MBL), presence and numbers of periodontal pathogens. Parameters were assessed at baseline and 3 months after the last treatment. Treatment pain perception was scored using the visual analog scale (VAS) after the first and last treatment. Results: At 3 months, IED treatment revealed significant reduction of peri-implant BoP (71% [±20] vs 57% [±28] [P =.014]) and peri-implant plaque scores (10 [±14] to 5 [±9] [P =.039] [T0 vs T3 respectively]). Significant reduction in mean peri-implant PPD from 4.92 mm (SD ± 1.28) to 4.66 mm (SD ± 1.35) (P =.041) was observed. In addition, a reduction in VAS pain score between the first and the last (6th) treatment was found (P =.039). No reduction in SoP (P =.088) was found. No changes in mean periodontal full mouth plaque, BOP, SOP and PPD levels, MBL and microbiological outcomes were found. Conclusion: Beneficial clinical effects in terms of BoP, PPD and PI were found at 3 months after IED treatment. However, the IED does not seem to effectively treat peri-implantitis in terms of disease resolution

Erythritol airpolishing in the non-surgical treatment of peri-implantitis:A randomized controlled trial

OBJECTIVES: To compare erythritol air-polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: Eighty patients (n=139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5mm, marginal bone loss (MBL) ≥2mm as compared to bone level at implant placement, bleeding and/or suppuration on probing (BoP/SoP)) were randomly allocated to air-polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9 and 12 months. Differences between both groups were analysed using multilevel statistics. RESULTS: Three months after therapy, no significant difference in mean BoP (%) between the air-polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = 0.380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%) and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score air-polishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = 0.222). All successfully treated patients at T3 (18.4%) were still considered successful at 12 months follow-up. CONCLUSIONS: Erythritol air-polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantits. Hence, the majority of patients required further surgical treatment

Erythritol air polishing in the surgical treatment of peri-implantitis:A randomized controlled trial

Objectives: To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis. Material and Methods: During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test. Results: No differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD0.5 mm) was achieved for a total of 18 implants (19.2%). Conclusions: Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success

The Peri-Implant Microbiome-A Possible Factor Determining the Success of Surgical Peri-Implantitis Treatment?

The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment has failed to solve peri-implantitis underwent resective surgical treatment. Their periimplant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12).The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and t-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients. Eubacterium was significantly lower on T12 compared to T0 for the peri-implantitis samples. Treponema and Eubacterium abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of Treponema and Eubacterium seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success

Implant decontamination with phosphoric acid during surgical peri-implantitis treatment:a RCT

BACKGROUND: Peri-implantitis is known as an infectious disease that affects the peri-implant soft and hard tissue. Today, scientific literature provides very little evidence for an effective intervention protocol for treatment of peri-implantitis. The aim of the present randomized controlled trial is to evaluate the microbiological and clinical effectiveness of phosphoric acid as a decontaminating agent of the implant surface during surgical peri-implantitis treatment. METHODS: Peri-implantitis lesions were treated with resective surgical treatment aimed at peri-implant granulation tissue removal, bone recontouring, and pocket elimination. Fifty-three implant surfaces in 28 patients were mechanically cleaned and treated with either 35% phosphoric etching gel (test group) or sterile saline (control group). Microbiological samples were obtained during surgery; clinical parameters were recorded at baseline and at 3 months after treatment. Data were analyzed using multi-variable linear regression analysis and multilevel statistics. RESULTS: Significant immediate reductions in total anaerobic bacterial counts on the implant surface were found in both groups. Immediate reduction was greater when phosphoric acid was used. The difference in log-transformed mean anaerobic counts between both procedures was not statistical significant (p = 0.108), but there were significantly less culture-positive implants after the decontamination procedure in the phosphoric acid group (p = 0.042). At 3 months post-surgery, 75% of the implants in the control group and 63.3% of the implants in the test group showed disease resolution. However, no significant differences in clinical and microbiological outcomes between both groups were found. CONCLUSIONS: The application of 35% phosphoric acid after mechanical debridement is superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant does not seem to enhance clinical outcomes on a 3-month follow-up. TRIAL REGISTRATION: Netherlands National Trial Register, NTR5185 (www.trialregister.nl)

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo