Academy of Modern Dentistry

in association with
Dr Sachdeva's Trident Dental Clinic


Cumulative Interceptive Supportive Therapy (CIST) protocol

Posted on 21 March, 2016 at 14:05

In part A of the CIST protocol, typically initiated whenplaque and BOP are present but PDs are 3 mm or less, patients are re-instructed in oral hygiene and motivated to initiate and continue maintenance; mechanical debridement is performed using nonmetallic curettes; and polishing takes place using a rubber cup andnonabrasive polishing paste.

Part B, when PDs of 4 to 5 mm are found, consists of antiseptic treatment. Here, chemical plaque control isperformed using chlorhexidine digluconate, typically as mouthrinses with 0.1% to 0.2% chlorhexidine for 30 seconds using approximately10 mL, application of local chlorhexidine gel (0.2%), and/or local irrigation with chlorhexidine (0.2%), 2 times a day for 3 to 4 weeks.

Protocol C, systemic or local antibiotic treatment, is initiated when PDs are greater than 5 mm. In addition, radiography should be used to supplementclinical findings. Typical systemic treatment is with ornidazole (1,000 mg 1) or metronidazole (250 mg 3) for 10 days, or acombination of amoxicillin (375 mg 3) and metronidazole (250 mg 3) for 10 days. Local treatment might include local application ofantibiotics using a controlled-release device for 10 days, eg, tetracycline fibers and minocycline microspheres.

Once treatment modalitiesA, B, and C have been completed, a surgical approach (D) may be considered. Surgical therapy for peri-implantitis should be performed in conjunction with systemic antibiotics and implant surface decontamination. If  regenerative treatment is chosen, a barrier membrane techniquealone or in combination with autogenous grafts and/or bone substitutes (deproteinized bovine bone mineral) may be considered.

Resective surgery may be considered when the peri-implant defect is not suitable for regenerative techniques.

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