Eficácia antimicrobiana da aplicação local de minociclina na descontaminação de implantes afetados por peri-implantite: estudo piloto

Abstract

Introduction: Peri-implantitis is a complication of dental implant treatment, induced by microorganisms that lead to peri-implant bone loss. Debridement and implant surface decontamination with antibiotics has been suggested to be a crucial step in peri-implantitis resolution. However, there is no consensual protocol for decontamination. Purpose: The aim of this pilot study was to calculate the bacterial load present on implants affected by peri-implantitis after surface decontamination with a combined solution of chlorhexidine and minocycline. Materials and Methods: Five dental implants from three different subjects were selected for surface decontamination. A 100mg minocycline tablet was reduced to powder with the help of a condenser. 1ml of 0.2% chlorhexidine gel and 50mg of minocycline powder were weighed and mixed until a homogenous solution was reached. A sterile microbrush was used to collect a bacterial sample before the implant surface was covered with the prepared solution of chlorhexidine and minocycline for 1 minute. A second microbial sample was harvested from the implant surface. Both samples were tested for the presence of five periodontopathogens by Real-Time Polymerase Chain Reaction. DNA absolute quantification was done for total bacteria and for Streptococcus spp. A qualitative detection was made for Porphyromonas gingivalis, Prevotella intermedia, Aggregatibacter actinomycetemcomitans and Fusobacterium spp. Descriptive and analytical statistical methods were used for DNA absolute quantification results. Results: All five periodontopathogenic bacteria tested were detected in at least one implant sample. Streptococcus spp and Fusobacterium spp were found in all five implant samples. Analysis of the microbiological results demonstrated that a statistically significant decrease occurred in total bacteria (mean difference: 4.086 μg/ml; Z=-2.023; p=0.043) and Streptococcus spp (mean difference: 0.206 μg/ml; Z=-2.023; p=0.043) load. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans DNA exhibited a relative decrease in implants C1 and B1, respectively. Fusobacterium spp DNA was considered maintained in implants A1 and A3. Prevotella intermedia DNA was undetected in the second sample. Conclusions: Within the limitations of this pilot study, it is possible to say that implant surface decontamination with an association of chlorhexidine and minocycline resulted in periodontal pathogens reduction.