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Exploring The Complexities of Ultrasonic Cavitation And Peri-Implantitis

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As dental professionals, it’s crucial to keep an ear to the ground for innovations in your field. In doing so, you’ll keep providing your patients optimal care for decades to come. 

 

No more is this above notion reflected than with learning about the usage of ultrasonic cavitation to help treat peri-implantitis. 

 

Peri-implantitis occurs when the peri-implant soft tissues are inflamed. The inflammation is connected to the supporting bone loss after osseointegration is established. It’s one of the most significant issues arising from dental implant surgery

 

Treatments for this condition have been the subject of many spirited arguments and scholarly papers

 

At the centre of the issue is implant-surface decontamination. 

 

Many protocols have been presented, primarily using power-driven tools, antimicrobial agents, air abrasives, and manual or laser instruments. Yet, there isn’t a decontamination method officially deemed superior. 

 

However, a decontamination method that’s gaining steam is ultrasonic cavitation, entailing vapour phase bubble formation inside a liquid due to rapid, localized pressure changes. This new, exciting approach has succeeded in microscopically ridding a substrate of biofilms, causing no underlying surface damage. 

 

We’ll explore this topic further below.

 

Decontamination as a Concept

 

The micro and nano topography of dental implants can change, which seems to increase contact between the bone and its implant. 

 

At the same time, implant threads can catalyze initial biofilm formation on rough surfaces when exposed to the oral cavity.  

 

There are some obstacles to contend with here. 

 

Namely, decontamination approaches to this point (e.g., manual/laser instruments, power-driven tools, antimicrobial agents) are limited in their success. Implants, even after treatment, still have contaminated areas. This could adversely impact proliferation and adhesion. 

 

Micro-roughened surfaces can also be damaged by some of the methods mentioned above. So, there’s been plenty of research into biofilm disruption and developing a novel, more successful approach. 

 

A protocol with more updated studies revolves around cavitation implementation in the cooling water surrounding the ultrasonic scaler tips. This approach allows for contact-free execution. 

 

The exposed region of the implant is surrounded by conveyed cooling liquid and is made sure to cavitate. From there, every surface crevice (e.g., macroscopic/microscopic irregularities) and the screw space connection are reachable. 

 

Ultrasonic cavitation makes a complete biofilm disruption possible without implant surface modifications, separating it from other decontamination methods.

 

Why Is Completing Decontaminations So Essential?

 

The chances of getting a new osseointegration process with previously infected implants are minimal when surrounding incompletely detoxified, polished, or physiochemically altered surfaces. 

 

Alternatively, this process is more useful when surrounding a correctly decontaminated, micro-roughened surface. 

 

Comprehensive, predictable decontamination is a 100% necessity to successfully execute the new osseointegration process with a treated implant. Since there are no measurable titanium surface changes and no layer of organic smear, the environment for osteoblast-like proliferation and adhesion is ideal. 

 

Therefore, the potential for new osseointegration is high.

 

How To Perform Decontaminations

 

You’ll need to create a confined space surrounding the exposed region of an implant.

 

Here, the cooling-liquid pools together, changing at decreased flow rates. 

The ultrasonic scaler operates in the air throughout clinical use. Cooling water flows near the tip. 

 

It’s crucial to fully immerse the ultrasonic tip in a water flow since it’s difficult to establish successful cavitation within the water mist. 

 

Here are some other tidbits you’ll need to know when performing decontaminations:

  • The device is comprised of two parts: 
    - An ultrasonic tip (which must connect to a piezoelectric handpiece). It will come with three micro holes, promoting cooling water circulation. ​
    - A cavitation chamber made of silicone. This is medical grade and designed to pool cooling water–it will fit any crestal bone shape. 
  • Assembly requires that you insert the cavitation chamber onto the ultrasonic tip. 
  • Place the cavitation chamber near the exposed implant region when prosthetic parts are removed. Then, activate the piezoelectric device to establish a secluded space for the cooling liquid to cavitate but not disperse. 
  • The medical-grade silicone comprising the cavitation chamber ensures the cooling liquid concentrates locally, surrounding the implant’s exposed portion. This makes complete decontamination possible in microgrooves, implant threads, and other spaces typically not accessible to Gracey’s curettes, power-driven brushes, etc. 
  • A complete biofilm disruption should occur in about 3 minutes. Take a quick break every minute, so the cooling liquid doesn’t overheat.

Clinical Case Study

 

One clinical case study, featured by DentalTown, involved a 55-year-old patient thought to have peri-implantitis in their implant on #11. Examinations through probing and X-rays confirmed this diagnosis, meaning there was likely a large bone defect affecting the buccal side. 

 

After intensive ultrasonic cavitations treatments, these were the results: 

  • The mBl, mPll, and PD values were lower than their baseline values. 
  • HBT was much higher at re-entry surgery compared to where treatments began. 
  • VBD was substantially lower at re-entry surgery than at the beginning.

In easier-to-understand terms, the treated implant was viewed as healthy after one year.

 

Once you garner a more expert understanding of ultrasonic cavitations to treat peri-implantitis, you’ll have another valuable tool in your toolkit to improve patient outcomes.

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