Tetracycline solution for Ailing Implant?

Make a slurry yourself Open a few capsules and mix with saline

You have described two different paradigms here; decontamination vs debridement. Chemotherapeutic agents (chlorhexidine gluconate, tetracycline hydrochloride, citric acid) are good at decontamination. However, they are inadequate with regard to debridement as they do not remove the bioburden from the implant surface. Only mechanical removal (rubber coated piezo tips, prophy jet, or abalative lasers) can accomplish complete debridement to leave the implant surface surgically clean. If, however,you use an erbium based laser, you can decontaminate AND debride the implant surface with a single instrument (no antibiotic needed). Once the implant surface is clean, you must graft the area to cover the implant body and then protect the graft both from microtrauma and salivary contamination. If you are using a modality from back in the 1980's (tetracycline alone), expect a poor surgical result. RJM

Pl show the X-ray / Ct scan/ camera picture .....may be i can suggest my way of treating the problem. Sam Jain, DMD Center For Implant Dentistry

Totally agree , Robert that has been our protocol for many years. Debridement is the key with a prophy jet and hand instruments then just graft with a synthetic graft and no Anti-biotics which may pollute the re-cleaned surface . In the mouth there are bacteria aplenty and use of a bacterio-static graft material is helpful and let the body do the rest. Be careful in aesthetic zone and things may take time to perfect but we have seen some interesting results . Peter

Robert Miller could you please point me in the direction to understand the effects of the erbium laser on the implant surface. I've never quite understood the relationship between the laser and the metal surface. (always think of a disco ball effect in my OR for some reason). Thanks

What implant surface are you trying to modify? machined, TPS, SLA,.. ?

Peter, could you please elaborate on which synthetic graft material(s) that you use. Thank you. DrT

There have been several papers published in the past few years describing the use of ablative lasers for the treatment of peri-implantitis. One of the earlier ones is our paper in the ICOI journal "Treatment of the Contaminated Implant Surface Using the Er,Cr:YSGG Laser", IMPLANT DENTISTRY / VOLUME 13, NUMBER 2 2004. It compares debridement using citric acid to an ablative erbium based laser. Clearly, using an SEM study, laser debridement was profoundly better and did not damage the implant surface when used within appropriate parameters. Subsequent studies of explanted failed implants debrided with ablative lasers demonstrated that we can surgically clean these implants to the point that they are indistinguishable from their sterile counterparts. While we cannot make a claim to sterilize these implants because of FDA regulations, I believe that the SEM photos speak for themselves. Our post-op healing of peri-implantitis treatment and bone grafting, and our survival tables, clearly demonstrate that laser debridement is the new standard for treatment of ailing implants, regardless of the type of surface. RJM

Dr T I have been using VItal for 9 years and Easygraft for 4 years in these situations . My oldest case is over 8 years in this area and all is well having restored the bone loss . We have been making Implants since 1985 and feel the best way to clean is merely blasting with a prophy jet and careful currettage . Citric acid may be used as well but as with the blasting be careful and try to protect the adjacent tissues . We have seen some very good results but it can be unpredictable ( about 80 % success ) so be wary about aesthetic zone cases . We feel that the ability of the graft materials to "set" is of great benefit here as is their "bacterio-static " nature . Regards Peter

Peter: Is the chemical nature of the Easygraft the same as the beta-TCP of Gem 21S? DrT

No , as there is a Poly-lactide coat which bonds the particles of BTcP together thus setting the material and stabalizing it . But in US Gem21S with a membrane would be good. BTcpcan be varied in so many ways from particle size and shape to porosity etc and thus the materials characteristics vary . The main thing is to get used to working with what you use. Peter

does anyone tried to do an implantoplasty? With rough surface implant its mainly impossible to remove all the bacteria and debris around the implants even with laser and CHX or prophyjet or acid citric. What i do is i remove the roughness of the implant in order to make it smooth or turned, and i then i clean it with CHX and whatever u like. I dont know if anyone of you have an experience with this.

The decision tree for peri-implant debridement and grafting versus implantoloplasty is determined by the horizontal level of adjacent bone or tissue level. Exposed threads in the intraoral environment cannot be covered. Implant threads that are above the horizontal component of adjacent bone cannot be grafted. An infrabony defect is ideal for repair and is the only indication for this modality. The others should be treated by implantoloplasty, but ONLY if there is pathology present. RJM

Hi ther bro, hmmmm i sugest that you Just replace or redo your implant with a new one, chlorhexidine, hinders osteoblastic function, citric acid and tetracycline are technique sensitive procedures,