Ohiienko S. A., Avetikov D. S., Pyuryk V. P., Ohiienko T. Yu., Pyuryk Ya. V.

IMPROVEMENT OF ALGORITHMS FOR THE PREVENTION AND TREATMENT OF MUCOSITIS AND PERIIMPLANTITIS AFTER THE SURGICAL STAGE OF DENTAL IMPLANTATION USING BIOSCOMPATIBLE ANTIBACTERIAL AGENTS

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About the author:

Ohiienko S. A., Avetikov D. S., Pyuryk V. P., Ohiienko T. Yu., Pyuryk Ya. V.

Heading:

DENTISTRY

Type of article:

Scientific article

Annotation:

Inflammatory complications following dental implantation (peri-implant mucositis up to 82.0%, periimplantitis up to 44.5%) remain a formidable clinical challenge, leading to the disintegration of dental implants in 9.8–11.2% of cases during the first year of functional loading. Traditional treatment protocols utilizing chemical antiseptics and antibiotics demonstrate limited efficacy against mature pathogenic biofilms and contribute to the global emergence of antimicrobial resistance. In this context, the application of polyvalent bacteriophages (specifically, the «Piophag» preparation) represents a promising vector in precision medicine, ensuring targeted eradication of pathogens without exerting cytotoxic effects on human cells. The aim of the study is to improve clinical algorithms for the prevention and treatment of peri-implantitis through the selective elimination of periodontopathogens using the polyvalent bacteriophage solution “Piophag”. A retrospective analysis of the medical records of 250 patients (685 implants) and a prospective clinical study involving 165 patients (305 dental implants) were conducted. In the prospective phase, patients were allocated into main (receiving “Piophag” application) and control (standard oral hygiene or decamethoxine solution) groups. Peri-implant tissue status was evaluated using periodontal indices. The subgingival microbiome was analyzed using polymerase chain reaction (PCR) and mass spectrometry. In vitro bactericidal activity and cytotoxicity were assessed via the MTT assay. The findings were evaluated against current clinical practice guidelines established by the European Federation of Periodontology (EFP) based on the GRADE system. The retrospective analysis confirmed a strong correlation between complication rates and risk factors compromising optimal osseointegration: a history of periodontitis triggered mucositis in 81.9% and periimplantitis in 23.7% of cases, while removable prostheses correlated with complications in 76.4% and 21.9% of cases, respectively. In vitro testing demonstrated the indisputable superiority of the biological approach: 82.1% of the microbial associations exhibited sensitivity to the bacteriophage preparation, compared to only 53.4% to decamethoxine and 62.3% to cephalosporins. The high efficacy of bacteriophages is attributed to the ability of their enzymes to degrade the exopolysaccharide matrix of biofilms. The MTT assay revealed critical cytotoxicity of the chemical antiseptic: following a 65-minute exposure to decamethoxine, eukaryotic cell viability plummeted to 7.9%, whereas “Piophag” maintained cell viability at 81.9%, which is fundamentally important for preserving the osteoblast and fibroblast pool. PCR diagnostics confirmed radical pathogen eradication in the main groups: during mucositis treatment, the detection rate of pathogens decreased by 57.9–81.3% (vs. 25.7–40.8% in the control group). In the surgical management of peri-implantitis, the detection of the highly aggressive P. gingivalis dropped by 94.7% following bacteriophage application, whereas decamethoxine showed no effect on this parameter. Clinically, it was proven that the preventive use of the preparation nearly eliminated the risk of peri-implantitis over a 3-year follow-up (0.7% vs. 23% in the control) and accelerated the resolution of acute inflammation to 3,1±0,4 days (14.9% faster than antiseptics). The risk of disease progression to peri-implantitis was reduced by 54.6%, and periodontal indices stabilized 14.5–32.7% more effectively. These outcomes are entirely consistent with the EFP doctrine, which strongly recommends against the use of systemic antibiotics and categorizes local antiseptics as agents with unproven efficacy. The incidence of inflammatory complications in dental implantology remains a critical issue, as conventional antibiotic and antiseptic therapies are largely incapable of significantly overcoming mature bacterial biofilms. Given the current international EFP guidelines advocating for the restriction of systemic antibiotic use, integrating biological agents into clinical protocols is becoming a mandatory element. Driven by osmotic lysis mechanisms, the polyvalent preparation “Piophag” facilitates the targeted eradication of highly aggressive periodontopathogens, exhibiting significantly higher efficacy than decamethoxine. The unprecedented biocompatibility of this preparation fosters optimal conditions for the regeneration of both soft and bone tissues. The preventive application of bacteriophages halves the risk of postoperative complications, and its combination with professional mechanical plaque removal constitutes a highly rational therapeutic algorithm that aligns with global standards for microbiome preservation.

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Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 2, 181, 289-295 pages, index UDC 616.314-089.843-002

DOI:

10.29254/2077-4214-2026-2-181-289-295