PR256 Periodontal Reflective

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PR256 Clinical Periodontics I

Periodontal Reflective Portfolio

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Student Name: Pauline Tran Student ID: 328

Topic Area: Evidence Based Dentistry Entry Date:
5/13/19

Description (what happened? What is being reflected upon?)

This quarter, I worked with a patient who presented with peri-implantitis around an implant that

was placed one year ago. The clinical exam revealed inflamed gingiva surrounding the implant, bleeding

upon probing, and heavy plaque buildup. My patient asked about how he could prevent the condition

from worsening to which I reinforced the need for good home care and returning regularly for his

cleanings. He expressed that access was an issue for him when it came to brushing his back teeth. With

this problem in mind, I wanted to explore the option of using a localized sustained release product as an

adjunct to treating his peri-implantitis. Since the inflammation and plaque accumulation was primarily

localized to this one implant, I thought it would be optimal to target this one area with a sustained release

product rather than opting for systemic antibiotics or host modulation therapy. I will be researching

minocycline microspheres (Arestin) and its efficacy as an adjunct treatment for peri-implantitis.
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Assessment (how can it be explained? What are the considerations? What

is the evidence?)

The use of localized sustained release products can be combined with mechanical therapy

to improve attachment levels, probing depths, and gingival bleeding. They contain antibiotics that

are effective against eliminating periodontal pathogens and can be applied directly to the site

affected. The benefit of these products is that it provides a long duration of controlled drug

release and is rapidly absorbed by the patient. I chose to research minocycline microspheres

(Arestin) specifically for its therapeutic effects on patients with peri-implantitis. In a randomized

controlled clinical trial by Cha et al., the clinical, microbial, and radiographic effects of minocycline

as an adjunct to surgical treatment of peri-implantitis were evaluated. The control group was

treated with open-flap debridement and a placebo ointment while the test group was treated

with both open-flap debridement and minocycline ointment. The surgical debridement involved

raising full-thickness mucoperiosteal flaps to clean the implant surfaces and to remove all

inflammatory tissue. The baseline plaque index, probing depth, bleeding on probing was

measured at baseline and all participants returned for 1, 3, and 6 month re-evaluations following

treatment. The results showed a significant decrease in probing depth for both groups with the

test group participants experiencing a greater reduction. Bleeding on probing was reduced by 50%

after 1 month in both groups and was further reduced in the test group as time progressed. A

microbial analysis also revealed a reduction in red complex bacteria like P. gingivalis and T.

forsythia after surgical treatment combined with minocycline. Another parameter this study

measured was the amount of vertical bone gain. The control group experienced a mean of 0.31

mm vertical bone gain whereas the test group had a mean of 0.72 mm. 1 This study was helpful in

that it performed a radiographic analysis before and after treatment to determine whether

minocycline had an additional effect on vertical bone gain, a sign of reosseointegration of the

exposed implant surface to newly formed bone. One down side to this study is that it was only

1
Cha, J. K., Lee, J. S., & Kim, C. S. (2019). Surgical Therapy of Peri-Implantitis with Local Minocycline: A 6-
Month Randomized Controlled Clinical Trial. Journal of Dental Research, 98(3), 288–295. 
 PR256 Periodontal Reflective
conducted up to 6 months, so our understanding of the benefits ofPortfolio
minocycline is limited to short-

term use.

In another randomized controlled clinical trial by Bassetti et al., the effects of non-surgical

treatment of peri-implantitis with minocycline microspheres versus photodynamic therapy was

studied. Photodynamic therapy has been used via laser as an adjunct to scaling and root planning

in the treatment of chronic periodontitis. It uses an appropriate light wavelength to stimulate

photosensitizers to produce an antibacterial effect and promote wound healing. 2 The two

experimental groups in Bassetti’s study were both mechanically debrided with titanium curettes

prior to treatment with either minocycline or photodynamic therapy. Bleeding on probing, pocket

depths, and bacterial counts were all measured before and after. Sites with residual bleeding

were retreated after 3, 6, 9, and 12 months. After 12 months, both groups exhibited a great

decrease in number of bleeding sites. A significant decrease in probing depth was observed in the

photodynamic therapy group up to 9 months and up to 12 months for the minocycline group. P.

gingivalis and T. forsythia counts were reduced from baseline to 6 months in the photodynamic

therapy group and to 12 months in the minocycline group. 3 One problem with this study is that it

did not have a proper control. There should have been a group that was only mechanically

debrided as the control; the results of this group could have been compared against the results

from the other two test groups to determine the efficacy of these adjunctive therapies. One idea

to be taken away from this study, however, is that photodynamic therapy may also be a good

option for an adjunct to treat peri-implantitis patients; its scope is not only limited to treating

cancer and chronic periodontitis.

A study by Heo et al. investigated the outcomes of treating peri-implantitis patients with

intrasulcular delivery of chlorhexidine and minocycline hydrochloride. The parameters measured

include: probing depth, bleeding on probing, clinical attachment level, and changes in osseous

2
Meimandi, M., Talebi Ardakani, M. R., Esmaeil Nejad, A., Yousefnejad, P., Saebi, K., & Tayeed, M. H.
(2017). The Effect of Photodynamic Therapy in the Treatment of Chronic Periodontitis: A Review of
Literature. Journal of lasers in medical sciences, 8(Suppl 1), S7–S11. doi:10.15171/jlms.2017.s2
3
Bassetti, M, Schär, D, Wicki, B, Eick, S, Ramseier, CA, Arweiler, NB, Sculean, A, Salvi, GE. Anti‐infective
therapy of peri‐implantitis with adjunctive local drug delivery or photodynamic therapy: 12‐month outcomes of
a randomized controlled clinical trial. Clin. Oral Impl. Res. 00, 2013; 1– 9.
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Portfolio decrease in PD, CAL,
morphology of intrabony defects. They found that there was a considerable

and BOP after treatment and that bone levels increased in all intrabony defects noted. 4 While

promising, these results may not be the most reliable due to the small sample size of 20 patients.

Outcome (What did the event mean for me? What have I learned? What
are the future implications?)

The research I have done has shown that minocycline has proven to be overall successful

as an adjunct in treating peri-implantitis for its ability to eliminate periodontal pathogens and

decrease bleeding on probing and probing depths. I can now comfortably offer and explain this

option to my patients who present with peri-implantitis. This can be particularly beneficial for

patients who cannot reliably clean their teeth at home due to poor access or dexterity. Applying

localized sustained release products like the minocycline requires little effort on the patient’s part

once it is placed because it will continue to slowly release the drug on its own and is

bioabsorbable. Prior to my research, I was unaware of the effects minocycline could have on

promoting bone growth, but it shows promising results from the studies I have looked at. Moving

forward, I can present this as a great non-invasive treatment option that can accompany

traditional debridement procedures to help bring my patients back to periodontal health.

4
Heo S, Kim HJ, Joo JY, Lee J, Kim SJ, Choi J. Simplified nonsurgical treatment of peri-implantitis using
chlorhexidine and minocycline hydrochloride.J Periodontal Implant Sci. 2018 Oct;48(5):326-333. 
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References

1. Cha, J. K., Lee, J. S., & Kim, C. S. (2019). Surgical Therapy of Peri-Implantitis with
Local Minocycline: A 6-Month Randomized Controlled Clinical Trial. Journal of Dental
Research, 98(3), 288–295. 

2. Meimandi, M., Talebi Ardakani, M. R., Esmaeil Nejad, A., Yousefnejad, P., Saebi, K., &
Tayeed, M. H. (2017). The Effect of Photodynamic Therapy in the Treatment of
Chronic Periodontitis: A Review of Literature. Journal of lasers in medical
sciences, 8(Suppl 1), S7–S11. doi:10.15171/jlms.2017.s2

3. Bassetti, M, Schär, D, Wicki, B, Eick, S, Ramseier, CA, Arweiler,

NB, Sculean, A, Salvi, GE. Anti‐infective therapy of peri‐implantitis
with adjunctive local drug delivery or photodynamic therapy: 12‐
month outcomes of a randomized controlled clinical trial. Clin. Oral
Impl. Res. 00, 2013; 1– 9.

4. Heo S, Kim HJ, Joo JY, Lee J, Kim SJ, Choi J. Simplified nonsurgical treatment of peri-
implantitis using chlorhexidine and minocycline hydrochloride.J Periodontal Implant
Sci. 2018 Oct;48(5):326-333. 
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Feedback Form – For Faculty Mentor to Complete

Description Comments
Experience well described
Experience was not well described

Final sentence not appropriate for reflection

assignment

Final sentence does not specifically state what you

are reflecting upon

Topic too broad – please focus more

Assessment Comments
Thorough assessment of the topic
Assessment does not go very deep for this topic
Good use of the literature for support
Look for stronger evidence to support your
statements
Look for systematic reviews with meta-analysis
when available
Consider the reputation of the journals you cite

Use PubMed for literature search

Good analysis of the strengths and weaknesses

of available literature
Discuss strengths and weaknesses of studies
cited
Thoughts are poorly organized

Assessment is not well focused

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Outcome Comments
Nice reflection forward and back; you learned
from this experience

You did not discuss how your reflection will

affect your future behavior

You did not discuss how your reflection affected

your opinion of how you managed your past
experience

You did not learn what you should have from

this experience.

Guidelines Comments
Guidelines followed and submitted on time

Well written

Guidelines not followed

Grammar, spelling and/or punctuation need

improvement.

Late submission.