Peri-implantitis non-surgical treatment associated with antimicrobial photodynamic therapy. Case report

Abstract

Peri-implantitis is considered a risk factor for failure in implant rehabilitation. It is characterized by peri-implant tissue inflammation and bone resorption involving implant threads. Its etiopathogenesis resembles periodontitis due to the presence of a specific dysbiotic bacterial biofilm related to the individual's inflammatory and immunological response. Treatment can involve non-surgical procedures such as mechanical debridement to disrupt the bacterial biofilm, with or without the use of systemic antibiotics or local antimicrobial agents. Antimicrobial photodynamic therapy (aPDT) acts as an adjunct after mechanical debridement, helping to reduce microbial contamination and promoting tissue healing through photobiomodulation. This paper reports a clinical case demonstrating the non-surgical treatment of peri-implantitis with mechanical debridement, systemic antibiotic therapy, and local aPDT. The patient complained of pain on the vestibular surface of tooth 46, which had been rehabilitated with a single implant-supported prosthesis. There was swelling, suppuration, a probing depth of 10 mm on this surface, and radiographically, bone resorption involving the implant threads was observed. Systemic antibiotic therapy was indicated because the patient presented with lymphadenopathy. Periodontal debridement with an ultrasonic device was performed, followed by peri-implant pocket area irrigation with 0,12% chlorhexidine digluconate, and application of PDT using a combination of 0,01% methylene blue, previously, and application of red laser with 9 J energy. Analgesics were prescribed, and bacterial biofilm chemical control was performed. After 4 months, a reduction in depth to 2 mm was observed, associated with the occurrence of peri-implant mucosal recession. Therefore, TFDa, associated with the non-surgical therapy procedures performed in this clinical case, presents itself as a possible treatment for peri-implantitis, enabling the elimination of inflammatory characteristics and the restoration of the health of peri-implant tissues.