fibrin and Peri-Implantitis

The objective of this study is to evaluate micro and nano-hydroxyapatite (NHA) blended clot adhesion to citric acid-conditioned peri-implantitis-affected surfaces.. Forty hopeless implants with peri-implantitis designated for removal were included in this study. Implants were divided into eight groups of five each: group 1 (G1) test areas were coated with hydroxyapatite of a microparticle size (MHA); group 2 (G2) test areas were coated with NHA; group 3 (G3) implants were coated with MHA after surface conditioning using citric acid; group 4 (G4) samples were treated in the same manner as in G3 except for the use of NHA; group 5 (G5) samples were coated without surface treatment with MHA mixed with whole human blood; group 6 (G6) implant samples were treated in the same manner as in G5 except for the use of NHA; group 7 (G7) implant samples were treated in the same way as in G5 plus surface conditioning using citric acid; and group 8 (G8) samples were treated in the same manner as in G7 except for the use of NHA. All implants in all groups were agitated for 3 minutes in phosphate-buffered saline. All samples were prepared for scanning electron microscopy evaluation.. G1 and G2 non-etched implants coated with MHA or NHA sizes were devoid of any bone particle adhesion to the peri-implantitis-affected surfaces. Contrary to the lack of microparticle adhesion to the root surface that was seen in G3, G4 acid-treated and NHA-coated samples revealed nearly complete coverage of the peri-implantitis-affected parts by the graft material. G5 non-etched, clot-blended MHA showed some areas of clot-blended graft adhesion covering 6.7% of the examined surfaces. G6 non-etched, clot-blended NHA showed NHA retention within the fibrin strands in areas where the implant surface pores were exposed (24.3%). G7 acid-treated and clot-blended MHA-treated implant surfaces showed partial coverage of the implant surface with detached fibrin clot-blended graft material (31.4%). G8 acid-treated and NHA clot-blended graft-coated implants showed complete coverage of the implant surface by the clot-blended graft material (93.4%).. Peri-implantitis-affected surface conditioning with citric acid improves NHA-blended clot adhesion to titanium implant surfaces.

Topics: Acid Etching, Dental; Adhesiveness; Adult; Blood Coagulation; Bone Substitutes; Citric Acid; Dental Implants; Dental Materials; Durapatite; Fibrin; Humans; Image Processing, Computer-Assisted; Microscopy, Electron, Scanning; Middle Aged; Nanoparticles; Particle Size; Peri-Implantitis; Porosity; Prospective Studies; Single-Blind Method; Surface Properties; Titanium

The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri-implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)".. The protocol utilized entailed apical positioning and stabilization of peri-implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet-rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap.. A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri-implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5-5.2 mm) of peri-implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5-4.5 mm) at 3 years post-FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8-6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6-5.6 mm). The mean of maxilla was significantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri-implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri-implantitis patients were removed due to advanced peri-implantitis.. The present case series provides proof-of-principle data for efficacy of FIVE for peri-implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft.

Topics: Alveolar Ridge Augmentation; Dental Implants; Female; Fibrin; Humans; Male; Mandible; Peri-Implantitis