Effects of an amino acid buffered hypochlorite solution as an adjunctive to air-powder abrasion in open-flap surface decontamination of implants failed for peri-implantitis: an ex vivo randomized clinical trial

Abstract

Objectives: To evaluate ex vivo the efficacy of an amino acid buffered hypochlorite solution supplemented to surface debridement with air-powder abrasion in removing bacterial biofilm following open-flap decontamination of implants failed due to peri-implantitis.

Materials and methods: This study was an ex vivo, single-blind, randomized, intra-subject investigation. Study population consisted of 20 subjects with at least three implants failed for peri-implantitis (in function for > 12 months and progressive bone loss exceeding 50%) to be explanted. For each patient, implants were randomly assigned to surface decontamination with sodium bicarbonate air-powder abrasion (test-group 1) or sodium bicarbonate air-powder abrasion supplemented by amino acid buffered hypochlorite solution (test-group 2) or untreated control group. Following open-flap surgery, untreated implants (control group) were explanted. Afterwards, test implants were decontaminated according to allocation and explanted. Microbiological analysis was expressed in colony-forming units (CFU/ml).

Results: A statistically significant difference in the concentrations of CFU/ml was found between implants of test-group 1 (63,018.18 ± 228,599.36) (p = 0.007) and implants of test-group 2 (260.00 ± 375.80) (p < 0.001) compared to untreated implants (control group) (86,846.15 ± 266,689.44). The concentration of CFU/ml on implant surfaces was lower in test-group 2 than in test-group 1, with a statistically significant difference (p < 0.001).

Conclusion: The additional application of amino acid buffered hypochlorite solution seemed to improve the effectiveness of implant surface decontamination with air-powder abrasion following open-flap surgery.

Clinical relevance: Lacking evidence on the most effective method for biofilm removal from contaminated implant surfaces, the present experimental study provides further information for clinicians and researchers.

Keywords: Air-powder abrasion; Biofilms; Chemical decontamination; Dental implant; Microbiota; Peri-implantitis.

Fig. 1

Amino acid buffered hypochlorite solution applied on implant surface after air-powder debriding with sodium bicarbonate

Fig. 2

Simple bar chart based on the exponent (0.5) of mean CFU. The graph shows fewer CFU on implant surfaces of test-group 2 compared to those of test-group 1 or control group. The error bar represents the standard deviation of mean CFU/ml expressed using logarithmic notation

Fig. 3

Diagram of pairwise comparison of decontamination methods: the numbers reflect the average rank for each group, and orange lines reflect a statistically significant pairwise comparison. Pairwise comparisons are detailed in the table below the diagram: the first column indicates which comparison is made and in what direction; the test statistic column reports the difference between mean ranks of the two groups; the Std. error and Std. test statistic columns present the standard error and the standardized statistic test, respectively; the Sig. and the Adj. columns show the unadjusted and adjusted p value, respectively