Peri-İmplantitis Tedavisinde İmplant Yüzeyi Dekontaminasyonu ve Elektrolitik Yaklaşım

Ece Açıkgöz Alparslan

doi:10.37609/akya.4124

Yazarlar

Ece Açıkgöz Alparslan

https://orcid.org/0000-0003-4560-6156

DOI: https://doi.org/10.37609/akya.4124.c6518

Özet

Peri-implantitis, biyofilmle ilişkili inflamasyon ve ilerleyici kemik kaybı ile karakterize olan ve implant başarısını tehdit eden önemli bir klinik tablodur. Tedavide temel hedef, biyofilm kaynaklı inflamatuvar yükün azaltılması ve hastalığın ilerlemesinin durdurulmasıdır. Ancak implant yüzeyinin makro ve mikro-topografisi, pürüzlülüğü, yüzey serbest enerjisi ve erişimi kısıtlayan defekt morfolojileri, etkili dekontaminasyonu güçleştirmektedir. Güncel klinik uygulamalarda mekanik/fiziksel yöntemler, hava-toz abraziv sistemler, kimyasal ajanlar ve enerji temelli teknikler farklı kombinasyonlarla kullanılıyor olmasına rağmen biyofilmi tamamen elimine eden ve yüzey bütünlüğünü güvenle koruyan üstün bir yöntem henüz tanımlanamamıştır. Son yıllarda elektrolitik/elektrokimyasal dekontaminasyon, implant yüzeyinde elektrokimyasal süreçler aracılığıyla biyofilm yükünü azaltmayı amaçlayan yenilikçi bir yaklaşım olarak öne çıkmıştır. İn vitro çalışmalar, bu yöntemin bakteri yükünü azaltabildiğini ve bazı koşullarda hücresel uyumluluk açısından avantaj sağlayabildiğini göstermektedir. Klinik çalışmalar ise elektrolitik yaklaşımın rekonstrüktif tedavi protokollerine entegre edilebildiğini ve klinik/radyografik iyileşmeye katkı sunabileceğini bildirmektedir. Bununla birlikte mevcut kanıtlar, yöntemin klinik üstünlüğünü kesin olarak ortaya koymak için yeterli değildir. Elektrolitik yaklaşım, güncel veriler ışığında, özellikle erişimi güç implant yüzeylerinde tamamlayıcı bir dekontaminasyon stratejisi olarak değerlendirilmektedir.

Peri-implantitis is a biofilm-associated pathological condition characterized by inflammation of the peri-implant mucosa and progressive bone loss, posing a major threat to implant survival. The primary treatment goal is to reduce the biofilm-related inflammatory burden and prevent further disease progression. However, effective decontamination remains challenging because of implant macro- and micro-topography, surface roughness, surface free energy, and defect morphologies that limit access to contaminated areas. Current treatment strategies include mechanical/physical methods, air-powder abrasive systems, chemical agents, and energy-based techniques, often applied in combination. Nevertheless, no single method has yet been shown to eliminate biofilm while preserving implant surface integrity and biocompatibility. In recent years, electrolytic/electrochemical decontamination has emerged as an innovative approach aimed at reducing biofilm burden through electrochemical processes on the implant surface. In vitro studies suggest that this approach can reduce bacterial load and may offer favorable cellular compatibility under certain conditions. Clinical studies also indicate that electrolytic decontamination can be integrated into reconstructive peri-implantitis treatment protocols and may contribute to clinical and radiographic improvement. However, current evidence is still insufficient to establish clinical superiority. Based on available data, the electrolytic approach should be considered a complementary decontamination strategy, particularly for implant micro-topographies that are difficult to access.

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