Clinical trials on therapies for peri-implant infections

Peri-implant infections are pathological conditions which are normally localized in the soft tissues surrounding an oral implant. They may range from a rather localized mucositis lesion reflecting the host response to a bacterial challenge to a more advanced lesion "termed peri-implantitis" when previously osseointegrated oral implants have been partially disintegrated; i.e. have lost alveolar bone around the implant. Usually these lesions start as a result of plaque accumulation and show similar progression as observed around teeth. Muscositis seems to be a prerequisite for the following peri-implantitis. However, the factors involving the transition to a more advanced lesion are still not known. Logically, the therapy for peri-implant infection has to be related to antibacterial treatment prior to the attempt to surgically regenerate peri-implant alveolar bone lost as a result of the infection. In order to diagnose these lesions at an early stage frequent assessments of clinical parameters are needed during maintenance therapy. The anti-infective treatment may intercept the development of the lesion. Following mechanical debridement of plaque deposits the application of efficacious antiseptics (chlorhexidine) is a necessity. Following this, antibiotics may cumulatively be applied to control the infection. Only a few longitudinal studies have documented the efficacy of such treatment regimens, and controls have generally not been available for ethical reasons. In regenerating the lost jaw bone only case reports are available today. Controlled animal studies will have to be performed to document the possibility of re-osseointegration and the factors influencing predictability.