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Table of Contents
PRACTITIONER SECTION
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 45-49

The effect of two regenerative surgical treatments for peri-implantitis defect using porous titanium granules alone and a combination of bovine bone mineral with collagen membrane: A systematic review


Department of Prosthodontics and Crown and Bridge, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission09-Sep-2019
Date of Acceptance11-Nov-2019
Date of Web Publication08-Jul-2020

Correspondence Address:
Dr. Nayana Shriram Anasane
Department of Prosthodontics and Crown and Bridge, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune - 411 018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_20_19

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   Abstract 

Implant success has broad definitions in clinical practice. Dental implant is becoming a common option for the replacement of lost teeth; there are various reasons for implant failure; one of them is peri-implantitis. This systematic review compares the two regenerative surgical treatment options for peri-implantitis. This systematic review was conducted to compare the effect of porous titanium granules and bovine bone mineral with the collagen membrane as a regenerative surgical treatment for peri-implantitis. A systematic search was performed in the PubMed database, Google Scholar, Institutional Library, and manual search of various journals. Cross-references were checked from relevant articles. Filters were put for the dates of publication from January 2000 to December 2016. Language restriction was put to English only. A total number of 367 articles were identified through the electronic search. Only six articles were included on the basis of inclusion and exclusion criteria. All the six articles were reviewed for the study characteristic. All the articles have shown good results when porous titanium granules and combination bovine bone mineral with collagen material was used to treat peri-implantitis. Porous titanium granules can be used as a regenerative surgical treatment for peri-implantitis; however, bovine bone mineral along with collagen membrane is a better regenerative treatment.

Keywords: Bone regeneration and bovine bone mineral, peri-implantitis, porous titanium granules


How to cite this article:
Qureshi MS, Anasane NS, Jagtap A. The effect of two regenerative surgical treatments for peri-implantitis defect using porous titanium granules alone and a combination of bovine bone mineral with collagen membrane: A systematic review. J Dent Implant 2020;10:45-9

How to cite this URL:
Qureshi MS, Anasane NS, Jagtap A. The effect of two regenerative surgical treatments for peri-implantitis defect using porous titanium granules alone and a combination of bovine bone mineral with collagen membrane: A systematic review. J Dent Implant [serial online] 2020 [cited 2020 Oct 22];10:45-9. Available from: https://www.jdionline.org/text.asp?2020/10/1/45/289234


   Introduction Top


Implants have become very common treatment options for edentulism. Along with the implants comes the failure which is also very common. There are various reasons for implant failure such as improper diagnosis and treatment planning, failure to achieve osseointegration, failure to achieve implant protective occlusion, parafunction, and poor oral hygiene resulting in severe inflammation.[1],[2] Peri-implantitis is defined as a severe inflammation associated with bleeding at the implant site.[3] Peri-implantitis is associated with the presence of a submarginal plaque which contains a large variety of bacteria.[3] In peri-implantitis along with bacterial colonization, significant bone loss is also seen.[4] Peri-implantitis can be associated with numerous factors such as systemic disease, smoking habit, or poor oral hygiene.[5] There are several treatment options available to treat peri-implantitis which includes laser, surgical, and antibiotic therapy. Surgical therapy includes the debridement of the infected site and placement of regenerative materials to regenerate the osseointegration. Porous titanium granules and deproteinized bone material collagen matrix are some regenerative materials which are used to treat peri-implantitis. Porous titanium granules were introduced in the treatment of sinus-lift surgeries[6] and in cases of severe resorption of bone, to give stability to the implant-supported denture.[7] Deproteinized bovine bone mineral also helps in the clot stabilization which makes it a bone substitute for treating peri-implantitis.[8] There is no comparison available between porous titanium granules and bovine bone material for regenerative surgical treatment for peri-implantitis. Hence, the purpose of this systematic review is to compare porous titanium granules and bovine bone material with a collagen matrix.


   Materials and Methods Top


Eligibility criteria

Inclusion and exclusion criteria were fixed, and the studies were screened based on the criteria mentioned below:

Inclusion criteria

  1. All the randomized control trials evaluating porous titanium granules and Bio-Oss Collagen Matrix
  2. All the case reports evaluating porous titanium granules
  3. All the case series evaluating the Bio-Oss collagen membrane
  4. All the studies comparing between porous titanium granules and Bio-Oss collagen membrane
  5. All the studies conducted from 2000 to 2016.


Exclusion criteria

  1. All the studies conducted in vitro
  2. All the narrative reviews
  3. All the letter to editor
  4. All the articles published in other languages.


Information sources

Literature search strategy was developed using keywords related to peri-implantitis, porous titanium granules, bovine bone mineral, and collagen membrane. Data were searched from PubMed and Google Scholar from January 1, 2000, to December 31, 2016. Cross-references were checked from relevant articles. Handsearching was done for the articles when the full text of the articles was not available through electronic databases.

Search strategy

The comprehensive data search was done on PubMed and Google Scholar. While carrying out the search, filters were put for the dates of publication from January 1, 2000, to December 31, 2016. Language restriction was put to English articles only. No filters for the full text and for the study design were kept. The keywords for the search were decided by the review of the literature. The search strategy used for searching articles in PubMed was porous titanium granules AND bovine bone mineral AND collagen membrane AND peri-implantitis [Table 1].
Table 1: Search strategy

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Data collection process

A standardized data extraction form was prepared in Microsoft Excel with the help of an expert. Initially, 3–4 entries were made in the Excel and it was reviewed by an expert. Any disagreement between the authors was resolved by discussion. The following criteria were predetermined for extracting the data:

  1. The major interest was to obtain the baseline and posttreatment values for different parameters of peri-implantitis
  2. Follow-up period from 6 months onward was considered.



   Results Top


Study selection

One review author (MSQ) independently screened the titles and abstracts obtained by search strategy and included them if they met the inclusion criteria. Later, full texts of all the included studies were obtained. After obtaining the full texts of the articles, they were screened by reading the whole article and then decided if they met the inclusion criteria. Whenever there was uncertainty regarding any study to be eligible for inclusion, the problem was resolved by discussing it with the second author (NA). Finally, the search yielded six studies to be included in the systematic review. All the excluded studies were recorded with reasons for exclusion for each study. None of the authors were blinded to the journal titles, study authors, or the institutions where the studies were conducted.

Prisma chart

It depicts the process of selecting the articles and excluding them at each step. Three hundred and fifty-seven records were identified through the data search using a search strategy in PubMed. Through Google scholar, ten articles were selected based on the titles. Total articles number arrived to be 367. The second step was screening through the titles, and after screening, 357 articles were excluded because they were not related to the objectives of the systematic review. Some articles mentioned the study done on animals, whereas, some mentioned materials other than porous titanium granules and bovine bone mineral. Ten articles remained were screened for duplicates manually. Of ten articles, four articles were found to be duplicates, and hence, the remaining six articles were screened through abstracts as a next step. Finally, six articles were screened for full text. At the end, six studies remained which underwent qualitative synthesis [Figure 1]. One hundred and thirty-three articles yielded ten estimates which were entered in the Excel sheet [Figure 2].
Figure 1: Prisma chart

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Figure 2: Excel sheet

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   Discussion Top


Peri-implantitis is a very common failure feature of an implant procedure. It can be accounted for different reasons from individual to individual. The present systematic review was commenced with the aim to find the different treatment procedures. This review consisted of six such articles which have treated the peri-implantitis patients with porous titanium granules and bovine bone mineral with a collagen membrane.

Summary of evidence

Mijiritsky et al.[9] conducted a study among 16 patients with 18 implant sites having peri-implantitis. The site of peri-implantitis was treated using porous titanium granules, using the bone loss (pretreatment) and bone filling (posttreatment) as parameters to assess the results. The mean bone lost prior to the treatment was 4.4 ± 2.1 which reduced to 2.3 ± 2.1 posttreatment. It suggests that the porous titanium granules alone can help in reducing the peri-implantitis.

Matarasso et al.[10] conducted a study in 11 patients having peri-implantitis, at least at 11 sites. They were treated using a bovine bone mineral with a resorbable collagen membrane. Probing depth and clinical attachment loss were calculated pre- and post-treatment. Posttreatment probing depth reduced from 8.1 ± 1.8 to 4.0 ± 1.3 after 12 months of treatment, while clinical attachment loss reduced from 9.7 ± 2.5 to 6.7 ± 2.5. It suggests that the bovine bone mineral and collagen membrane can be used together to reduce the signs of peri-implantitis.

Bassi et al.[11] observed a case of a 48-year-old patient who presented with signs of per-implantitis, probing depth of >10 mm, bleeding on probing, and bone defect. It was treated using deproteinized bovine bone mineral and resorbable membrane. After 6months, follow-up was done, which showed the reduction in the probing depth from >10 to 1 mm, without any bleeding and mobility. The patient was followed up every 6 months till 17 years, which showed probing depth of 1.5 mm without any signs of bleeding on probing and mobility.

Jepsen et al.[12] conducted a study among 63 participants with one peri-implantitis site. The participants received porous titanium granules along with open-flap debridement and were compared to only open-flap debridement group. Probing depth and bleeding on probing were assessed after 12 months of the treatment. Probing depth was reduced from 6.3 ± 1.3 to 3.5 ± 1.5 in porous titanium granules with open-flap debridement group, while in open-flap debridement group, it was reduced from 6.3 ± 1.6 to 3.5 ± 1.1, bleeding on probing was reduced from 89.4% to 33.3% in porous titanium granules group, and in open-flap debridement group, it reduced from 85.8% to 40.4%. This study does not show any significant difference among the two groups and suggests that porous titanium granules group was equally effective as only open-flap debridement treatment.

Arab et al.[13] conducted a study comparing porous titanium granules and bovine bone material with collagen membrane among 10 patients having 24 sites of peri-implantitis. The parameters calculated were probing depth, clinical attachment loss, and bone filling posttreatment (radiograph). Group 1 received porous titanium granules as the treatment, while the Group 2 received bovine bone material as the treatment for peri-implantitis. The probing depth was reduced from 4.1 ± 1.3 to 3 ± 1.4 in Group 1, while in Group 2, it reduced from 4.5 ± 1.2 to 2.1 ± 1. Clinical attachment loss was 4.5 ± 2.2 in Group 1 prior to the treatment, and clinical attachment regained posttreatment (3.4 ± 2.1), while in Group 2 clinical attachment gain was 2.6 ± 1.3 from 5 ± 1.4. The bone filling was seen 0.85 ± 1.06 in Group 1 and 1.4 ± 1.04 in Group 2. In this study, the results suggest that the bovine bone mineral with a resorbable collagen membrane is a better treatment option than the porous titanium granules.

Roccuzzo et al.[14] conducted a study among 76 participants who were having a crater-like lesion and probing depth of >6 mm with no implant mobility. All the participants received bovine bone mineral along with 10% collagen as the treatment. The probing depth was reduced from 7.7 ± 1.61 to 4.24 ± 1.36, while bleeding on probing was reduced to 71.5 ± 34.4–18.3 ± 28.6 after 1 year posttreatment. The results suggest that the bovine bone mineral is effective in treating peri-implantitis.

In all the six studies, a study conducted in 2012 used the porous titanium granules as the treatment option for the peri-implantitis. A similar study was conducted in 2015 which also used porous titanium granules as a treatment along with open-flap debridement. Both the studies have shown that the porous titanium granules are effective treatment options.

Three studies have taken bovine bone mineral as a treatment option along with collagen membrane. All the three studies have shown a reduction in the parameters of peri-implantitis. There is only one study that has compared the porous titanium granules and bovine bone mineral with collagen membrane, in which the results showed that both the treatments are effective in treating the peri-implantitis. However, bovine bone mineral and collagen membrane treatment was better in improving the signs of peri-implantitis as well in maintaining the implant at its site.

The number of the studies included in this systematic review is less, and of six studies, three have used bovine bone material as a treatment option and two studies have used porous titanium granules, while one study has compared the two materials as a treatment option. The comparative study of two materials yielded the results as a bovine bone mineral with a collagen membrane is a better regenerative material in treating peri-implantitis when compared with porous titanium granules.

Limitation

A total number of articles screened for full text are limited in number, i.e., only six articles are screened in this systematic review.


   Conclusion Top


There is still a lack of evidence about the better regenerative surgical treatment for peri-implantitis. However, the evidences which are available show that bovine bone mineral along with collagen membrane is a better regenerative surgical treatment option for peri-implantitis, but porous titanium granules can be used as a regenerative surgical treatment option for peri-implantitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: Their prevention, diagnosis and treatment. Clin Oral Implants Res 2000;11 Suppl 1:146-55.  Back to cited text no. 1
    
2.
Renvert S, Lessem J, Dahlén G, Renvert H, Lindahl C. Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis: A randomized clinical trial. J Periodontol 2008;79:836-44.  Back to cited text no. 2
    
3.
Mombelli A, van Oosten MA, Schurch E Jr., Land NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol 1987;2:145-51.  Back to cited text no. 3
    
4.
Tabanella G, Nowzari H, Slots J. Clinical and microbiological determinants of ailing dental implants. Clin Implant Dent Relat Res 2009;11:24-36.  Back to cited text no. 4
    
5.
Guobis Z, Pacauskiene I, Astramskaite I. General diseases influence on peri-implantitis development: A systematic review. J Oral Maxillofac Res 2016;7:e5.  Back to cited text no. 5
    
6.
Bystedt H, Rasmusson L. Porous titanium granules used as osteoconductive material for sinus floor augmentation: A clinical pilot study. Clin Implant Dent Relat Res 2009;11:101-5.  Back to cited text no. 6
    
7.
Holmberg L, Forsgren L, Kristerson L. Porous titanium granules for implant stability and bone regeneration – A case followed for 12 years. Ups J Med Sci 2008;113:217-20.  Back to cited text no. 7
    
8.
Postlethwaite AE, Seyer JM, Kang AH. Chemotactic attraction of human fibroblasts to type I, II, and III collagens and collagen-derived peptides. Proc Natl Acad Sci U S A 1978;75:871-5.  Back to cited text no. 8
    
9.
Mijiritsky E, Yatzkaier G, Mazor Z, Lorean A, Levin L. The use of porous titanium granules for treatment of peri-implantitis lesions: Preliminary clinical and radiographic results in humans. Br Dent J 2013;214:E13.  Back to cited text no. 9
    
10.
Matarasso S, Iorio Siciliano V, Aglietta M, Andreuccetti G, Salvi GE. Clinical and radiographic outcomes of a combined resective and regenerative approach in the treatment of peri-implantitis: A prospective case series. Clin Oral Implants Res 2014;25:761-7.  Back to cited text no. 10
    
11.
Bassi F, Poli PP, Rancitelli D, Signorino F, Maiorana C. Surgical treatment of peri-implantitis: A 17-year follow-up clinical case report. Case Rep Dent 2015;2015:574676.  Back to cited text no. 11
    
12.
Jepsen K, Jepsen S, Laine ML, Anssari Moin D, Pilloni A, Zeza B, et al. Reconstruction of peri-implant osseous defects: A multicenter randomized trial. J Dent Res 2016;95:58-66.  Back to cited text no. 12
    
13.
Arab H, Shiezadeh F, Moeintaghavi A, Anbiaei N, Mohamadi S. Comparison of two regenerative surgical treatments for peri-implantitis defect using natix alone or in combination with bio-Oss and Collagen Membrane. J Long Term Eff Med Implants 2016;26:199-204.  Back to cited text no. 13
    
14.
Roccuzzo M, Gaudioso L, Lungo M, Dalmasso P. Surgical therapy of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen. J Clin Periodontol 2016;43:311-8.  Back to cited text no. 14
    


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