Preventive Strategies

Since one of the marked differences between peri-implantitis and periodontitis is the more rapid progression of peri-implantitis and the severity of associated tissue destruction, treatment success (outcome, prognosis) relies heavily on prevention, and early diagnosis and treatment.

Toothbrushes

In general, electro-mechanical toothbrushes have been shown to be more effective in plaque removal than manual toothbrushes, especially in mandibular lingual areas.40,41 While well controlled prospective studies that demonstrate the superiority of powered brushes specifically around dental implants have not been done, it is intuitive that maintaining good plaque control around dental implants is beneficial.

Dentifrices

There are no controlled, prospective studies comparing the efficacy of various toothpaste formulations around dental implants. However, there is robust evidence that, dentifrices with stannous fluoride and those containing triclosan with a copolymer have statistically significant antiplaque and antigingivitis activity.42

More recently, in controlled 6-month clinical trials, a stannous fluoride-sodium hexametaphosphate containing dentifrice has been shown to have superior antiplaque and antigingivitis efficacy.43,44 In addition, the stannous fluoride-sodium hexametaphosphate formulation has been shown to have antigingivitis activity in subjects previously found to be non-responsive to a triclosan-copolymer containing dentifrice.45

Mouthwashes

There are no controlled, prospective studies comparing the efficacy of various mouthwash formulations around dental implants. However, there is robust evidence that mouthwash formulations containing chlorhexidine and essential oils have statistically significant antiplaque and antigingivitis activity.42 The same meta-analysis also concluded that the anti-plaque and anti-gingivitis effects of cetylpyridinium chloride (CPC) mouthwashes are formulation-dependent.

In a 6-month placebo controlled clinical trial, a 0.07% cetylpyridinium chloride mouthrinse was found to be statistically superior to placebo in reducing plaque and gingivitis.46 Another 6-month study showed no statistically significant difference in the antiplaque and antigingivitis effects of a 0.07% cetylpyridinium chloride mouthrinse when compared to an essential oil-containing mouthrinse.47

A recent study evaluated the performance of four commercially available CPC-containing mouthrinses versus a negative control (CTR) using the Disk Retention Assay (DRA) and the Plaque Glycolysis and Regrowth Method (PGRM).48 The DRA assessed the percentage of CPC adsorption onto anionic cellulose discs and provided a measure of the substantivity and bioavailability of CPC mouthrinses. The PGRM test examined the effects of CPC on the metabolism and growth properties of sampled in vivo plaque following treatment.

Products tested were Crest Pro Health (CPH700 ppm); Colgate Total US (CT750 ppm); Scope Mouthwash (SCP450 ppm); and Colgate Total Puerto Rico (CT450). Comparison of DRA to PGRM showed a linear relation between CPC bioavailability and its clinical antimicrobial performance with rank ordered efficacy, i.e., CPH700>CT750>SCP450>CT450>CTR. The study concluded that the antiplaque and antigingivitis activity of CPC-containing mouthrinses is predicated on optimal CPC substantivity and bioavailability.