Fernando Luengo

Objective: To evaluate the efficacy of mesenchymal stromal cells' (MSC) secretome delivered as conditioned media (CM) as an adjunct to a xenograft (XG) and collagen membrane (MEM) for guided bone regeneration (GBR) in chronic non‐contained mandibular defects in minipigs. Methods: Chronic bilateral mandibular defects were surgically created in seven minipigs. In a split‐mouth design, defects were treated with either CM‐functionalized (test) or native XG + MEM (control) and evaluated after 4 and 12 weeks. New bone formation was assessed using in vivo computed tomography (CT) and ex vivo micro‐CT, histology and immunohistochemistry (IHC). Quantitative CT, micro‐CT and histomorphometric data were statistically analysed. Results: No significant differences in new bone formation were observed between the test and control group at either timepoint. These findings could be partly explained by a high intrinsic healing capacity and continual growth of the animals. Minimal residual XG material was detected in both groups at 4 and 12 weeks. When present, these remnants were associated with multinucleated Cathepsin K‐positive cells (IHC) with no observable differences between the groups. Conclusion: The adjunctive use of MSC secretome in combination with XG and MEM did not improve GBR outcomes in chronic non‐contained mandibular defects in the present minipig model. The suitability of this animal model for experimental GBR may be questionable.

ObjectivesThe aim of the present study was to evaluate the efficacy of a supportive peri-implant care (SPIC) protocol after surgical therapy of peri-implantitis, combining ultrasonic mechanical debridement and glycine powder air polishing. Materials and MethodsThirty subjects diagnosed with peri-implantitis and treated by means of access flap were randomized 6 months later into two different SPIC groups: the test group combined a piezoelectric ultrasonic instrumentation with a specific implant PEEK tip and glycine powder air polishing, while control group received the same ultrasonic instrumentation together with a rubber cup and a polishing paste. Patients were followed for 12 months, with intermediate SPIC visits every 3 months. Clinical, radiological, microbiological and biochemical outcome variables were registered and calculated. ResultsAfter 12 months of SPIC, probing depths (PD) showed a mean reduction of 0.33 +/- 0.11 mm, with significant differences (p < .001) between the test (-0.84 +/- 0.43 mm) and the control group (+0.18 +/- 0.73 mm). Healthy peri-implant tissues defined by PD <5 mm, absence of BoP (or in only one site around the implant), and no additional bone loss (<0.5 mm), were observed at the final visit in 83% of the implants (87% in the test group and 80% in the control group, p = .255). No adverse events were reported by the subjects participating in the study. ConclusionsThe SPIC protocol including mechanical ultrasonic debridement and glycine powder air-polishing demonstrated significantly better efficacy in terms of PD reductions. A strict SPIC protocol can maintain for 1 year, or even improve, the results obtained after surgical treatment of peri-implantitis.

Objectives: This in vitro investigation was aimed to evaluate the cleaning ability of four mechanical devices designed for decontaminating implant surfaces.Material and methods: Ninety‐six implants were coated with permanent ink and inserted into 3D‐printed resin blocks simulating three different intraosseous defect configurations (types Ib, Ic, and Ie). The four tested mechanical decontamination devices (air‐polishing with glycine powder, rotating titanium brush, polyetheretherketone [PEEK]‐coated ultrasonic tip, and stainless steel ultrasonic tip) were randomly applied onto the 5 mm exposed implant surface. Standardized photographs were taken from a frontal perspective and with a 30° angle coronally and apically to the implant axis. The area with remnant ink on the implant surface was calculated.Results: Although none of the groups achieved complete ink removal, air‐polishing with glycine and titanium brushes demonstrated a higher cleaning ability when compared with ultrasonic devices either with standard or PEEK tips for all three defect configurations. For the three tested models, the best cleaning ability in all groups was shown on implant surfaces without facing an intraosseous wall. Titanium brush was the most effective when the intraosseous walls existed. Cleaning effectiveness diminished in the threads located in the apical third, especially when using air‐polishing and ultrasonic devices.Conclusions: Titanium brushes and air‐polishing devices were more effective in removing artificial biofilm using this in vitro model, although their effectiveness was influenced by the presence of the intrabony component.

Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.