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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 3-5

Efficacy of antibacterial sealant to prevent microlekage at the implant superstructure interface – An in vivo study


1 Associate Professor, Department of Prosthodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
2 Professor, Department of Prosthodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
3 Professor and Head, Department of Microbiology, Maratha Mandals NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
4 Sr. Lecturer, Department of Microbiology, Maratha Mandals NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
5 Professor and Head, Department of Microbiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India

Date of Submission31-Dec-2020
Date of Acceptance25-Jan-2021
Date of Web Publication30-Apr-2021

Correspondence Address:
Dr. Aishwarya Nayak
Associate Professor, Department of Prosthodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_18_20

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  Abstract 


Objective: The aim of this study is to evaluate the efficacy of antibacterial sealants to prevent microleakage at the implant superstructure interface. Materials and Methods: Around twenty patients were selected after a thorough investigation with lower missing teeth (1st and 2nd premolars 1st and 2nd molars) by inclusion criteria. The patients were divided into two groups Group A (10 patients)– Control group and Group B (10 patients)-test group. The implants were placed with proper surgical protocol in all the patients except that in the test group antibacterial sealant was used before putting the coverscrew. The implants were allowed to osseointegrate for 3 months after which swabs were collected from the interior of the implant once the cover screw was removed. The swabs collected from all the patients were immediately transported to the microbiology laboratory by placing in 1 ml of phosphate buffered saline. The swabs were inoculated on brain heart infusion and McKonkeys medium and processed for routine culture and sensitivity. The identification of the isolates was done by standard microbiological methods. The data thus obtained were subjected to statistical analysis using t-tests for equality. Results: Microbial growth was found in both the groups, but lesser variation in colony-forming units was observed in the test group where antibacterial sealant was used. Conclusions: It was concluded that in spite of using antibacterial sealants; some amount of microleakage was still observed.

Keywords: Antibacterials, gapseal, Implant superstructure interface, microlekage, peri-implantitis


How to cite this article:
Nayak A, Nadiger R, Bhat K, Ingalgi P, Kulkarni R. Efficacy of antibacterial sealant to prevent microlekage at the implant superstructure interface – An in vivo study. Int J Med Oral Res 2021;6:3-5

How to cite this URL:
Nayak A, Nadiger R, Bhat K, Ingalgi P, Kulkarni R. Efficacy of antibacterial sealant to prevent microlekage at the implant superstructure interface – An in vivo study. Int J Med Oral Res [serial online] 2021 [cited 2021 Oct 20];6:3-5. Available from: http://www.ijmorweb.com/text.asp?2021/6/1/3/319417




  Introduction Top


Dental implantology is the fastest developing technology in the practice of dentistry today which provides a natural-looking appearance and has opened the door to the 21st century in dentistry. They represent a reliable treatment option in oral rehabilitation of partially or fully edentulous patients to secure various kinds of prostheses. Implant superstructures are the superior part of a fixed or a removable prosthesis that includes the replacement teeth and associated gingival/alveolar structures (GPT8). In this case, the superstructures are namely the cover screw (healing screw) and the gingival former or the gum former (superstructure that helps in the shaping of gums while they heal.) It has been postulated that a potential microscopic gap of 55–104 μ exists at the implant-abutment interface or the implant superstructure interface. Oral micro-organisms have a diameter of <10 microns and can easily pass through this microgap. This misfit may lead to microleakage of fluids and bacteria which may cause loss of marginal bone and may finally lead to periimplantitis.[1] Studies have been done where the implants have been subjected to rinsing with various antibacterial solutions, but these have just a short-term effect.[2] Therefore, this study is formulated to check how effective is the presealing done at the implant superstructure interface. The microleakage is then checked in the presence of these preventive sealers.


  Materials and Methods Top


A randomized controlled trial was conducted in the Department of Prosthodontics- SDM College of Dental Sciences and Hospital; Dharwad. The target population was patients undergoing implant fixation for missing teeth in the mandibular premolar and/or molar regions. Around 20 patients were selected after a thorough investigation with lower missing teeth (1st and 2nd premolars 1st and 2nd molars) by inclusion criteria. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each patient.

Inclusion criteria

  • Patients volunteering to participate in the study who have opted for implants as the choice of treatment
  • Missing mandibular premolars and molars
  • Healthy gingiva on the adjacent teeth
  • No bleeding on probing in the adjacent teeth
  • Healthy periodontium and surrounding tissue of the adjacent teeth
  • No pocket formation in the adjacent teeth
  • Adequate and healthy bone support.


Exclusion criteria

  • Patients not volunteering to participate in the study
  • Patients not willing for implant-supported prosthesis
  • Gingival inflammation is seen in adjacent teeth
  • Bleeding on probing
  • Periodontal pockets
  • Bone loss in the adjacent teeth and poor bone support.


The subjects were divided into two groups:

  • Group A (10)– Control group
  • Group B (10)– Test group


Part A

Two-stage implants were placed in both groups as per proper surgical protocol. In Group A; the implants were placed in the bone followed by fixing of the cover screw (superstructure). In Group B once the implants were placed in the bone a thymol-based antibacterial sealant GapSeal was injected in the internal part of the implant and cover screw was put. The flap was then closed to allow healing and osseointegration. A proper surgical protocol was followed in both the groups and intraoral periapical radiograph was taken to check osseointegration, once confirmed after 3 months; the flap was reopened in both groups and the cover screw was removed. Swabs were taken from the implant well using sterile endodontic paper points; sent for culture and healing abutments were screwed in the implants.

Part B

The swabs collected from all the patients were immediately transported to the microbiology laboratory by placing in 1 ml of reduced transport fluid (RTF) medium for further culture. The swabs were vortexed in the RTF medium and 100 μl of RTF was spread uniformly over brain heart infusion agar plate for routine culture and sensitivity. Identification of the isolates was done by standard microbiological methods and the colony-forming units were counted on a digital colony counter.

The data thus obtained were subjected to statistical analysis.


  Results Top


There was a variation in the number of colonies that were observed in the test and control groups. Group A had a range of colonies varying from 0 colonies to 800 colonies with a mean of 206.0 and a standard deviation of 324.05. In Group G, the number of colonies varied from 0 to 09 with a mean of 3.50 and a standard deviation of 3.47. A comparatively lesser variation in colony-forming units was observed in the Test Group where Gap Seal was used as a sealant. The basic data obtained in the A and B groups were subjected to statistical analysis using the test, a statistically significant value was seen where P value was 0.032 (P < 0.01; significant at 5% level significance). Further pairwise comparison was made using t-tests for equality; since both the groups did not have a normal distribution nonparametric test was used to compare the two groups. It was observed that the two groups did not differ significantly [Table 1], [Table 2], [Table 3].
Table 1: Number of colony forming units in Test and Control groups

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Table 2: Mean; Standard Deviation and Standard Error in Test and Control Groups

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Table 3: T Test for equality

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  Discussion Top


In implant rehabilitation, a microspace is created at the abutment-implant interface. Previous research has shown that the oral microbiome can proliferate in this microspace and affect peri-implant tissues, causing inflammation in peri-implant tissues.[3] Peri-implantitis is an irreversible inflammatory disease that is commonly caused by plaque and biofilm that accumulates on the exterior of a dental implant. It effects both the soft and hard tissues surrounding the implant, and without treatment, may result in excessive bone loss proximal to the implant and its eventual failure.[4]

The microorganisms that were said to colonize this gap were primarily anaerobic microbiota consisting of Gram-positive streptococci and Gram-negative anaerobic rods.[5] Peri-implant diseases affect a significant number of dental implants and patients and therefore, it is important to understand the difficulties in diagnosis of these diseases and risk factors which may be modified to reduce the potential for disease occurrence or progression.[6] Prosthetic connections with a better sealing capacity of the IAI have been investigated to eliminate bacterial leakage by using sealants like varnish containing 1% chlorhexidine, silicone sealant, and the silicone ring. It was verified that these materials were incapable of preventing bacterial leakage.[3] Preventing microbial leakages through the implant superstructure interface is an important goal in implantology.[7] However; microleakage in this study may be influenced by various factors like the amount of force or hand torque used in tightening of the superstructures; longevity of the antibacterial sealant tested for a short span of 3 months in a smaller number of subjects.


  Conclusion Top


Within the limitations of the study it can be concluded that

    Microbial growth is seen in both the test as well as control groups.
  1. Due to the antimicrobial sealant usage in the test group; the colony forming units are comparatively less as compared to the control group.


Acknowledgments

I would like to thank the BIOLINE Company Israel for providing me with the implants for the study and HagerwerKen Company Germany for providing me with the antibacterial sealants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fritzemeier CU. Periimplantitis Prophylaxis By Sealing Internal Implant Spaces with GapSeal; 2009. Available from: http://www.hagenA/erken.co. [Last accessed on 2020 Oct 15].  Back to cited text no. 1
    
2.
Buzello AM, Gerowitt HS, Nidermeier W. Antiseptic irrigations to reduce the bacterial growth at the implant abutment interface. Deutsch Z Zahnarztl Impl 2005;21:311-4.  Back to cited text no. 2
    
3.
Larrucea C, Conrado A, Olivares D, Padilla C, Barrera A, Lobos O. Bacterial microleakage at the abutment-implant interface, in vitro study. Clin Implant Dent Relat Res 2018;20:360-7.  Back to cited text no. 3
    
4.
An YZ, Lee JH, Heo YK, Lee JS, Jung UW, Choi SH. Surgical treatment of severe peri-implantitis using a round titanium brush for implant surface decontamination: A case report with clinical reentry. J Oral Implantol 2017;43:218-25.  Back to cited text no. 4
    
5.
Persson LG, Lekholm U, Leonhardt Å, Dahlen G, Lindhe J. Bacterial colonization on internal surfaces of Brånemark system® implant components. Clin Oral Implants Res 1996;7:90-5.  Back to cited text no. 5
    
6.
Lee CT, Huang YW, Zhu L, Weltman R. Prevalences of peri-implantitis and peri-implant mucositis: Systematic review and meta-analysis. J Dent 2017;62:1-2.  Back to cited text no. 6
    
7.
Mencio F, Papi P, Di Carlo S, Pompa G. Salivary bacterial leakage into implant-abutment connections: Preliminary results of an in vitro study. Eur Rev Med Pharmacol Sci 2016;20:2476-83.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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