20. Topical Antimicrobial-Containing Biomaterials for Peri-Implant Infections in the Oral Cavity

Implant mucositis and peri-implantitis have an infectious etiology. If left untreated the inflammatory responses and the infection will result in loss of alveolar bone around dental implants. Clinically, this is combined with edema and redness of the soft tissues surrounding the implant. The ultimate consequences of implant mucositis and peri-implantitis may be loss of the implant.

Dental implant manufacturers have focused on implant design, ease of placement, esthetics, and new prosthetic components. Enhancement of osseo-integration has been attempted by changing titanium surface structures, titanium purity, and various coatings.

The biofilm structures at titanium dental implants comprise of bacteria that co-aggregate with each other and are difficult to eliminate mainly due to the rough threaded surfaces of oral implants making them difficult to debride. The microbiota initiates a host inflammatory response that in many aspects are similar to what can be seen in periodontitis. The prevalence of peri-implantitis ranges between 15 and 25%. Patients who have lost teeth due to periodontitis may be more prone to peri-implantitis. The susceptibility may be directly associated with a genetically complex predisposing risk.

Recent data suggest that professional mechanical debridement of pockets around implants and the patients’ own ability to keep implants free from bacteria is unpredictable. Professional debridement may be efficacious over shorter time periods and would most likely require intensive supportive therapy. In the event of limited response to nonsurgical mechanical supportive therapy, the adjunct use of local application of a slow-release antimicrobial agent could be considered. Surgical treatment to eliminate soft tissue pocket and attempts to establish hygienic conditions may not be acceptable to the patient in the esthetic areas. In these situations regenerative therapy may be considered.

Antibiotics are commonly used in medicine to treat infections. Restrictive use of antibiotics is a necessity to prevent the occurrence of wide-spread antibiotic resistance. Peri-implantitis is a local infection confined to the area around the affected implant. Therefore, local administration of an antibiotic drug in a high concentration is logical. Several local antibiotic products have been developed and studied extensively. Such local antibiotic drugs have been on the market for some years but due to a variety of factors some of these local antibiotics have been withdrawn from the market or may only be available in some countries. There is a need to develop new methods allowing effective delivery of local antibacterial and anti-inflammatory agents for the treatment of implant infections.