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Journal of Oral Science & Rehabilitation No. 4, 2016

Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 59 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 Table 1 Table 1 Clinical parameters (mean ± standard deviation) at baseline and at six months and 12 months (13 implants). es over time, the paired t-test was used. The ʸ error was set at 0.05. Results Ten patients were included in the study. A total of 13 implants were treated. During the entire observation period of 12 months, two patients failedtoattendthescheduledrecallsessionsand, therefore, were excluded from the study. No pa- tient reported any sign of swelling or pain two weeks after the surgery. The clinical and radio- graphic data are summarized in Table 1. Essen- tially, mean probing depth values were signifi- cantly reduced by 4.1 mm and 3.9 mm at six and 12 months, respectively. The surgical procedure was associated with a pronounced increase in mucosal recession and clinical attachment level; however, stable periimplant conditions at six and 12 months were reported. Mean bleeding on probing values were significantly reduced at six and 12 months. Before treatment, pus was pres- ent around four implants. At the end of the ob- servation period, the tissue around the implants was in a healthy condition. All of the patients presented with low plaque index values throughout the entire observation period. Radiographic analysis demonstrated a complete or semicomplete filling of the defect in all of the cases, with a significant bone gain at six and12months(Fig.4).Microbiologicalanalysis,in termsoftotalbacterialcountandsinglepathogens, demonstrated a significant decrease of microbio- logical contamination in all of the test sites be- tween baseline and the 12 months follow-up: at the sulcus,the neighboringteeth andthe connec- tion. The data are summarized in Table 2. Discussion The data reported in the present study showed a good short-term resolution of periimplantitis defects using the proposed surgical approach and concomitant dentalhygienictreatment.The graft material proposed is self-stabilizing in the defect, which might suggest that the use of a membrane with the bone graft substitute can be omitted. This feature helped to stabilize the bone graft substitute in situ in a tentlike struc- ture overthe autologous bone in a double-layer graft technique, thereby providing and protect- ing space for bone regeneration around the dental implant.Application of autogenous bone to the implant surface below the biomaterial might increase the osteopromotive capabilityof the technique as reported before.17 In the present study, no barrier membrane was used in addition to the bone graft substi- tute. This was due to the previously mentioned qualities of the tested graft material. The pre- sence of a collagen membrane might additio- nally prevent the invasion of connective tissue into the grafted site, but it does not provide any additional stabilization of the bone graft sub- stitute. It must be noted, however, that the co- veragewiththe intact periosteum might protect the graft material, allowing bone promotive cell diffusion into the grafted site.18 For this reason, in this preliminary study, preoperative marginal soft-tissue healing through professional oral hygiene (scaling) was achieved, applied by den- tal hygienists to resolve periimplant mucositis before treatment. Additionally, accurate soft-tissue management during the surgical phase was provided to minimize periosteum deficiencies. Baseline 6-month follow-up 12-month follow-up P-value† Plaque index 0.36 ± 0.61 0.06 ± 0.02 0.00 ± 0.00 0.003 Bleeding on probing (%) 81.10 ± 12.40 21.09 ± 19.20 20.20 ± 16.80 0.000 Probing depth (mm) 7.2 ± 1.8 3.1 ± 1.2 3.3 ± 1.1 0.000 Mucosal recession (mm) 0.65 ± 0.51 -0.40 ± 0.20 -0.30 ± 0.20 0.002 Clinical attachment level (mm) 7.8 ± 1.8 3.5 ± 1.4 3.6 ± 1.7 0.003 Radiographic bone loss (mm) 4.2 ± 0.9 1.8 ± 0.6 1.7 ± 0.7 0.040 † Comparison within group (paired t-test) Volume 2 | Issue 4/201659 Plaque index 0.36 ± 0.610.06 ± 0.020.00 ± 0.000.003 Bleeding on probing (%) 81.10 ± 12.4021.09 ± 19.2020.20 ± 16.800.000 Probing depth (mm) 7.2 ± 1.83.1 ± 1.23.3 ± 1.10.000 Mucosal recession (mm) 0.65 ± 0.51 -0.40 ± 0.20 -0.30 ± 0.200.002 Clinical attachment level (mm) 7.8 ± 1.83.5 ± 1.43.6 ± 1.70.003 Radiographic bone loss (mm) 4.2 ± 0.91.8 ± 0.61.7 ± 0.70.040

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