Subgingival pocket irrigation treatment of peri-implantitis+ clinical and microbiological outcomes

Background

The most effective approach to treat peri-implantitis remains to be found. Recently, a new pocket irrigator evacuator device, The Fluxion®, based on an alternated interplay between vacuum and fluid (water), has been introduced. A periodontal study showed decreased probing pocket depths and reduced bleeding on probing. Moreover patients reported less pain after treatment compared to conventional treatment. Whether the pocket irrigator can be used for treatment of peri-implantitis seems unknown.

Aim/Hypothesis

The aim of the present prospective cohort study was to assess the clinical and microbiological effects and patient-reported pain in the non-surgical treatment of peri-implantitis using The Fluxion® pocket irrigator.

Material and Methods

In total 24 adult patients with 42 implants diagnosed with moderate to severe peri-implantitis (bone loss ≥ 2 mm in combination with bleeding and or suppuration on probing) were included in this prospective cohort study. Peri-implant pockets were irrigated twice a week during a period of three weeks consecutively (6 times in total). Two trained oral hygienists treated all infected implants. Patients received extensive oral hygiene instructions prior to submucosal irrigation and reinforcement took place every appointment. Clinical outcomes (probing pocket depth, bleeding on probing (%), suppuration score (%), plaque score (%)) and microbiological testing were assessed at baseline and at 3 months (T3) after the first treatment. Patient pain perception related to the treatment method was evaluated using a Visual Analog Scale (VAS) after the first and last (6th) treatment.

Results

A significant reduction in bleeding on probing (73% ± 20% (T0) to 58% ± 28% (T3), P = 0.048, Wilcoxon signed rank test) and peri-implant plaque score (12% ± 15% (T0) to 5% ± 9% (T3), P = 0.027) was found. No significant differences were found for mean PPD (5.00 mm ± 1.47 mm (T0) to 4.69 mm ± 1.54 mm (T3), P = 0.127) and suppuration on probing (30% ± 25% (T0) to 17% ± 22% (T3), P = 0.056). A significant reduction in VAS-pain score (scale 0-10) between the first treatment (0.41 ± 0.91) and the last (6th) treatment (0.05 ± 0.21) was found (P = 0.039). No significant change in microbiological outcomes were found between baseline and 3 months after treatment.

Conclusion and Clinical Implications

Results of this prospective cohort study indicate that, although beneficial effects were found in terms of reduced bleeding on probing (%) and reduced plaque score (%) at 3 months after treatment, pocket irrigator The Fluxion® does not seem to effectively treat moderate to severe peri-implantitis in terms of disease resolution. The effect of the pocket irrigator for treatment of incipient peri-implantitis lesions, peri-implant mucositis or in supportive peri-implant therapy remains unknown.