title: Clinical outcome of a nonsurgical and surgical treatment protocol in different types of peri-implantitis: a case series.
abstract: OBJECTIVE
  The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed.
  
  
  METHODS
  During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline.
  
  
  RESULTS
  Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery.
  
  
  CONCLUSIONS
  The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery.
authors: Enter for Dental Specialities-Peridontology, German Armed Forces Hospital, Ulm. renethierbach@bundeswehr.org
authors: René
authors: R
authors: Thierbach
authors: Thomas
authors: T
authors: Eger
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001439:Bacteroides / Q000302:isolation & purification; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D002985:Clinical Protocols; D012534:Dental Scaling / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016967:Fusobacterium nucleatum / Q000302:isolation & purification; D005883:Gingival Crevicular Fluid / Q000201:enzymology; D005889:Gingival Recession / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods; D008297:Male; D020784:Matrix Metalloproteinase 8 / Q000032:analysis; D008875:Middle Aged; D057873:Peri-Implantitis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D017622:Periodontal Attachment Loss / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D010778:Photochemotherapy / Q000379:methods; D016966:Porphyromonas gingivalis / Q000302:isolation & purification; D011446:Prospective Studies; D016745:Root Planing / Q000379:methods; D013492:Suppuration; D013524:Surgical Flaps / Q000601:surgery; D016896:Treatment Outcome; D048373:Treponema denticola / Q000302:isolation & purification
chemical_list: D000891:Anti-Infective Agents, Local; C488762:MMP8 protein, human; D020784:Matrix Metalloproteinase 8; C010882:chlorhexidine gluconate; D002710:Chlorhexidine