| Background:Peri-implantitis,as a common biological complication after implant repair,is a destructive lesion which is caused by plaque and could lead to soft tissue inflammation and supporting bone resorption other than physiologic bone remodeling.According to etiology related treatment concept,removing plaque is the key to control the progression of the disease.Currently,mechanical debridement(MD)combined with topical or syetemic application of antibiotics is commonly used in clinical treatment.However,the complex surface characteristics of implants and bone defect morphology tend to impair the effectiveness of MD.In the meanwhile,repeated application of antibiotics might increase the risk of bacterial resistance.Therefore,it is necessary to find a new way to remedy the deficiency of the previous traditional methods.Photodynamic therapy(PDT)is a light-induced chemical method with the ability to inactivate pathological cell,tissue and pathogenic microorganism.PDT,in the presence of oxygen,can combine photosensitizers with light irradiation to generate reactive oxygen clusters(ROS),which can oxidatively damage the cytoplasmic membrane or DNA of microbial cell,leading to its death.The in vitro and animal studies have shown that PDT can effectively kill periodontal pathogens with no damage on the implant surface characteristics and biocompatibility.However,there are few clinical studies with controversial conclusions on the treatment of peri-implantitis with PDT.Moreover,the efficacy discrepancy of PDT in comparison with topical application of antibiotics,as a commom adjuvant method,is insufficiently elucidated by the available evidences.Objective:The purpose of the present trail was to study the adjuvant effect of topical application of minocycline hydrochloride ointment(MHO)and PDT in non-surgical treatment for peri-implantitis,evaluate the therapeutic effect of by observing and comparing the changes of modified plaque index(mPLI),modified bleeding index(mSBI),peri-implant pocket probing depth(PD)and the level of inflammatory cytokine in peri-implantal crevicular fluid(PICF)before and after treatment,then tried to provide some theoretical basis for the clinical application of PDT.Methods:Forty patients with a total of 42 dental implants,characterized by peri-implantitis,were included in this study.The 42 implants were randomly divided into three groups: MD(Group A),MD + PDT(Group B),MD + MHO(Group C).mPLI,mSBI,PD and the level of interleukin1?(IL-1?)and tumor necrosis factor ?(TNF-?)in PICF were detected at baseline(T0),6 weeks(T1)and 12 weeks(T2)after treatment.The intra-group and inter-group comparisons of each index were performed by analysis of variance for repeated measures.Results:A total of 37 patients with 39 implants completed the trail and none of the patients developed symptoms of allergy,pain and mucosal staining.There was no statistical difference in age(P = 0.772)and sex distribution(P = 0.919)among the three groups.At T0,there was no statistical difference in all indexs between the three groups.At T1 and T2,all clinical indexs as well as the level of inflammatory cytokine in PICF decreased statistically significantly from T0 in the three groups(P < 0.05).And there was no statistically significant change in mPL at each time point after treatment between the three groups(P > 0.05).The mSBI and PD,together with the level of IL-1? and TNF-? in PICF at implants in Group B were statistically significantly lower than Group A at T1 and T2(P < 0.05),as is in Group C.But no statistically significant differences were observed between Group B and C with respect to all indexs(P > 0.05).Conclusions:An adjunctive use of PDT following non-surgical mechanical debridement MD could lead to further clinical improvement of peri-implantitis and reduce the level of inflammatory cytokine in PICF,resulting in equal effect as with topical application of MHO.PDT can be used as a safe and effective antibacterial method to replace the local application of MHO in the adjuvant treatment of peri-implantitis. |
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