Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial

Abstract

Objectives: To compare the efficacy of three mechanical procedures for surgically treating peri-implantitis. Materials and Methods: In a randomized, prospective, parallel-group study, 47 patients with peri-implantitis were treated with (a) plastic curettes (n = 15 patients, 25 implants), (b) an air-abrasive device (Perio-Flow®, n = 16 patients,22 implants), or (c) a titanium brush (Ti-Brush®, n = 16 patients, 23 implants). Patients were assessed for the following measures at three timepoints (baseline, and three and six months after surgery): plaque index, bleeding on probing, gingival index, probing pocket depth (PPD), relative attachment level, and bone loss. Treatment outcome was considered successful when the implant was still present with PPD ≤ 5 mm, no bleeding on probing, and no further mean bone loss ≥ 0.5 mm. Results: A greater reduction of gingival index and PPD was observed in the titanium brush group than in the other groups at six months (P < 0.001). Relative attachment level decreased from baseline in each group at three months but was more marked in the titanium brush group (P < 0.001). At six months, there was less bone loss in the titanium brush group than in the plastic curette group (P < 0.001; linear mixed model and Kruskal–Wallis). A successful outcome was observed in 22% of implants in the plastic curette group, 27% in the Perio-Flow® group, and 33% in the Ti-Brush® group. Conclusions: The titanium brush and glycine air-polishing device were more effective than the other methods, but treatment success remained low. Combining mechanical procedures with antimicrobials and/or antibiotics might be a more effective strategy and warrants careful investigation.

In vitro surgical and non-surgical air-polishing efficacy for implant surface decontamination in three different defect configurations

“…In general, various systematic reviews [9,11,21] as well as recent clinical studies [23,40] show advantageous results in the use of glycine-based air-polishing devices for the (non-)surgical treatment of peri-implantitis. However, their ability to restore the biocompatibility of the implant surface [41] and to maintain achieved results in the long term [42] are questioned.…”

“…Alternatives such as lasers and air-polishing systems partly offer beneficial results when used on complex implant surfaces [21,22]. However, this benefit seems to be limited depending on defect morphology and extension [9,20,23]. Using the laser, this limitation additionally seems to be due to its rigid tip, which impairs the application of the laser beam, and the consequently poorer accessibility [24].…”

Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment

“…5). 34 Piezoelectric scalers and hand instruments are also effective in reducing BOP score, plaque index, and PD. Ultrasonic scalers with metal tips and metal curettes can eliminate surface material down to 0.83 μm in size and efficiently remove bacteria.…”

“…Mechanical plaque removal methods can be combined with antibiotics or surgical methods for a better outcome. In a randomized trial, Toma et al 34 compared three mechanical treatments (air-abrasive device, titanium brush, and plastic curettes,) for peri-implantitis. They found that the air-polishing device and titanium brush were more efficient than the others; however, the success was low.…”

“…Reproduced from Ref. 34 under the Creative Commons Attribution License (CC BY 4.0) from Frontiers Media S.A.…”