title: Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial.
abstract: OBJECTIVE
  The objective of the study is to compare the clinical, microbiological and host-derived effects in the non-surgical treatment of initial peri-implantitis with either adjunctive local drug delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12 months.
  
  
  METHODS
  Forty subjects with initial peri-implantitis, that is, pocket probing depths (PPD) 4-6 mm with bleeding on probing (BoP) and radiographic bone loss ≤2 mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine-based powder airpolishing system. Implants in the test group (N = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (N = 20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12 months. The primary outcome variable was the change in the number of peri-implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host-derived biomarkers.
  
  
  RESULTS
  After 12 months, the number of BoP-positive sites decreased statistically significantly (P < 0.05) from baseline in both groups (PDT: 4.03 ± 1.66-1.74 ± 1.37, LDD: 4.41 ± 1.47-1.55 ± 1.26). A statistically significant (P < 0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD-treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P < 0.05) from baseline to 6 months in the PDT and to 12 months in the LDD group, respectively. CF levels of IL-1β decreased statistically significantly (P < 0.05) from baseline to 12 months in both groups. No statistically significant differences (P > 0.05) were observed between groups after 12 months with respect to clinical, microbiological and host-derived parameters.
  
  
  CONCLUSIONS
  Non-surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12 months. Adjunctive PDT may represent an alternative approach to LDD in the non-surgical treatment of initial peri-implantitis.
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Schär
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Wicki
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Eick
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Ramseier
authors.affiliation: Department of Periodontology, Philipps University, Marburg, Germany.
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Arweiler
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Anton
authors.initials: A
authors.lastname: Sculean
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Giovanni E
authors.initials: GE
authors.lastname: Salvi
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D057873:Peri-Implantitis / Q000188:drug therapy*; D010512:Periodontal Index; D010778:Photochemotherapy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline
keywords: clinical research; clinical trials; drug delivery; laser; microbiology; pharmacology; wound healing