Electrolytic cleaning of infected implant surface - a controlled clinical randomized trial

16182 ORAL COMMUNICATION CLINICAL INNOVATIONS

Background

Even though different treatment modalities have been described periimplantitis is difficult to treat. Clinical evidence of reosseointegration is lacking and even if success in treatment is defined by reduction of clinical signs of inflammation good long term results are not predictable to achieve. The bacterial biofilm is difficult to remove from micro- and macrotexture of an implant. No method is available to achieve an implant surface which re-integrates in the tissues.

Aim/Hypothesis

To prove the efficacy of an electrolytic approach to remove the biofilm compared to powder spray and to evaluate 6-month clinical results.

Material and Methods

24 healthy and periodontal stable patients with 37 implants diseased with periimplantitis were enrolled to the study. Only one implant per patient was randomized and used for statistical analyses. 12 patients were randomized to the test group (GalvoSurge, GS) and 12 to the control group (powder spray, AF). After flap elevation the granulation tissue was removed, a smear test for PCR testing (10 typical species, GS0, AF0) was taken, the implants were treated with the selected method and a sample for a further PCR test was done (GS1, AF1). The AF group ended here and was treated by GS followed by a third PCR test (AF2). PPD, bone loss (distance implant shoulder and bone, BL) was assessed on 6 points. After cleaning the bone defects were augmented. Exposures, infections and BL was assessed 6 months when second stage surgery took place.

Results

The difference between GS0 and AF0 was not significant pointing out homogenous groups. GS1 and GS2 were lower than AF0 proving a higher cleaning effectivity. 10 implants were covered by soft tissue 14 implants exposed (6 of them with a positive BoP, 1 with pus) after 6 months. BL in average at baseline was 6.97 mm and at 6 months 2.18 mm. In exposed sites, BL at 6 months was 3.53 mm and in non-exposed sites 1.03 mm. 1 implant hat to be removed after 6 months due to infection

Conclusion and clinical implications

Smear tests in GS1,GS2 and AF1 are difficult to interpret because any contact to the flap or fluids contaminates the paper-point. Furthermore undercuts of the treads cannot be reached. But the results prove the superiority of GS. The bone gain was highly significant after GS therapy and never achieved in literature before in this extend. Only one implant was infected after 6 months and had to be removed. Within the limits of this this study electrolytic cleaning seems to be a promising approach.