Pulsed electromagnetic field therapy on nonsurgical treatment of peri-implantitis: 12-26 months follow-up.

BACKGROUND

Pulsed electromagnetic field (PEMF) therapy, renowned for its immunomodulatory effects and established efficacy in orthopedics, shows promise for managing peri-implantitis by reducing soft tissue inflammation and marginal bone loss. This study aimed to compare the long-term clinical and radiographic outcomes of nonsurgical peri-implantitis treatment with and without PEMF therapy. This multicenter retrospective-prospective analysis combined data from two centers.

METHODS

Thirty-three patients, with a total of 47 implants displaying peri-implantitis diagnosed with pocket probing depths (PD) of 6-8 mm with bleeding on probing (BoP) and crestal bone loss ranging from 3-5 mm, completed this study. Nonsurgical mechanical debridement was conducted, and a novel healing abutment integrating active (25 test) or inactive (22 control) PEMF was installed. The abutments with PEMF provided an exposure ratio of 1/500-1/5000, an intensity of 0.05-0.5 mT, and a frequency of 10-50 kHz for 30 days. Patients were evaluated at baseline (T0), 3 months (T1), and 20 months (T2), assessing plaque index (PI), BoP, PD, recession depth (REC), suppuration (SUP), and radiographically measured vertical bone loss (VBL).

RESULTS

Follow-up assessments revealed a significantly lower mean of PD at the deepest site and BoP in the test group after a mean time of 20 months compared to the control (p < 0.001). Furthermore, within the test group, PD at the deepest site and mean PD decreased significantly between T0 and T2 (7.1 ± 1.5 mm to 4.6 ± 0.73 mm, 5.3 ± 1.3 mm to 3.7 ± 1.2 mm, respectively; p < 0.05). A decrease in mean PD was also observed in the control group for the latter (6.8 ± 1.1 mm to 5.4 ± 1.4 mm; p < 0.05). Although not significant, a positive trend was observed for VBL after 1 year in the test group compared to the control (0.2 ± 0.4 mm vs. -0.3 ± 0.11 mm). The clinical end point (PD < 5 mm, absence of BoP and/or SUP, and no bone loss) was 54.54% and 68% for the control and test group, respectively.

CONCLUSIONS

These findings suggest that focused PEMF therapy could offer a nonsurgical solution for peri-implantitis that can achieve the clinical goals. Nevertheless, larger samples and longer follow-ups are needed to understand its long-term benefits and limitations.

PLAIN LANGUAGE SUMMARY

The nonsurgical treatments of dental implant infections often result in a limited impact of the inflammation, reducing the bleeding on the gums around the implants. To overcome this limitation during treatment, this study evaluated the pulsed electromagnetic field (PEMF) employed in several medical fields, such orthopedics, for its immunomodulatory and bone-healing properties. A small device was coupled with the dental implant to release the pulse. The PEMF associated with nonsurgical debridement in the gums around diseased implants demonstrated that PEMF therapy improved the healthy status of these implants 12-26 months after treatment. The findings suggest potential clinical benefits of noninvasive PEMF in treating diseased implants.