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Journal of Oral Science & Rehabilitation No. 4, 2016

Journal of Oral Science & Rehabilitation 56 Volume 2 | Issue 4/2016 S u r g i c a l t r e a t m e n t o f p e r i i m p l a n t i t i s with a thin layer of PLGA, enhancing the materi- al handling and forming a stable scaffold for re- generation within the defect site. This in situ hardening PLGA-coated biomaterial has been proven to provide excellent soft-tissue healing aftersocketgraftingandequivalentperformance interms ofnewboneformation has beenfound,12 comparable to the results reported for other bovine and synthetic biomaterials.13 The aim of the present preliminary prospective study was to test the outcome of a surgical approach to treating periimplant circumferential and semi- circumferential defects using only a self- stabilizing graft material. Materials and methods In January 2013, at the Department of Oral Sur- gery, University of Valencia, Valencia, Spain, a preliminaryprospectiveclinicaltrialwasdesigned to test the efficacy of a self-stabilizing graft ma- terial in the treatment of bony defects resulting fromperiimplantitis.Onlythosepatientswhohad received implant therapy at the Department of Stomatologyinthepast,hadagood-qualityperi- apical baseline radiograph obtained after pros- theticrehabilitation,attendedcontrolvisits,were olderthan18years,andpresentedwithacircum- ferentialorsemicircumferentialperiimplantbony defect were included in the study.6 Exclusion criteriawere relevant medicalconditions (Amer- ican SocietyofAnesthesiologists PhysicalStatus Class III orIV), > 10 cigarettes/dayorpipe orcigar smokers, plaque index and bleeding on probing scores>25%,pregnantorlactatingpatients,and patients with a history of bisphosphonate ther- apy (Fig. 1). The patients were informed about the study and the intervention and asked to sign an infor- med consent document in order to be involved. The investigation was conducted according to the principles embodied in the Declaration of Helsinki of 1975, as revised in 2013. All of the proceduresandmaterialsinthepresentprospec- tive study were approved by the local ethics committee of the University of Valencia (H1447757419931). P r e o p e r a t i v e p h a s e Factors possibly influencing the periimplant pa- thology were evaluated and problems solved before the surgical phase. This included occlusal adjustment, modification or change of poorly designed prostheses, and periodontaltreatment when necessary. Two weeks priorto the surgical therapy, all of the patients received professional prophylaxis (total oral district disinfection) and 0.12% chlorhexidine digluconate (rinsing b.i.d.; GUM Paroex 0.12%, Sunstar Suisse) was pre- scribed.Antibiotictreatmentconsistingofamox- icillin 850 mg and clavulanate 125 mg every 8 h was administered to all of the patients, starting two days before the surgical treatment and ending one week after the intervention. S u r g i c a l p h a s e The surgical intervention was performed under localanesthesiawith4%articaineand1:100,000 epinephrine (Laboratorios Inibsa, Barcelona, Spain). The prosthesis was removed and a full-thickness flap was elevated to allow access to the periimplant defect and the exposed im- plant surface. Once the granulation tissue had been remo- ved, the implant surface was mechanically de- brided using PTFE curettes and further cleaned with a cotton pellet soaked in 0.2% chlorhexidi- nedigluconate.Theinsideoftheimplantconnec- tionwascleanedusing0.2%chlorhexidine(GUM Paroex 0.2%, SunstarSuisse). Perforationswere performed to increase blood supply to the re- maining bone and the periimplant bone defects were filled using a double-layer graft:17 autolo- gous bone onthe implant surface (collectedfrom a neighboring area using scrapers) and an allo- plastic, resorbable bone graft substitute consis- ting of 100% beta-tricalcium phosphate (GUI- DOR easy-graft CLASSIC) to fill the remaining gap and act as a stabilizing shell, that is, a tent- like structure. After defect filling, cover screws were inserted. Tensionless soft-tissue closure of theflapwasperformedwitha5-0suture(Fig.2). Sutures were removed two weeks after the in- tervention. Abutments and prostheses were cleaned according to Canullo et al. using ultra- sound and an extraoral argon plasma device (Plasma R, Diener Electronic, Jettingen, Germa- ny).14 One to two months thereafter, the cleaned prosthetic components were reinserted after microsurgical reopening. F o l l o w - u p a n d m a i n t e n a n c e Beforesutureremoval,thepatientswereadvised todiscontinuetoothbrushingandtoavoidtrauma atthe site ofsurgery.Afterthe healing phase,the patients were placed on an individually tailored

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