Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-implantitis

Objectives: Mechanical decontamination of the implant surface through surgical approach is recommended to control peri-implantitis. A lot of different interventions or combination have been already proposed nevertheless the most effective treatment is still uncertain. This prospective randomized controlled study aimed to compare three mechanical procedures: plastic curette, glycine air-polishing (Perio-Flow®) and titanium brush (Ti-Brush®) without antimicrobials in the surgical treatment of peri-implantitis.
Methods: 70 implants from 42 patients with peri-implantitis were treated surgically using either 1) plastic curette (control group, n=13) or 2) glycine air-polishing device (Perio-flow®, n=14) or 3) a titanium brush (Ti-Brush®, n=15). Clinical and radiological parameters: Plaque Index (PlI), Gingival Index (GI), Probing Pocket Depth (PPD), Relative Attachment Level (RAL) and Bone Level (BL) were assessed at baseline (T0), 3 (M3) and 6 months (M6). Success treatment outcome was defined as implant survival with PPD ≤ 5mm, absence of bleeding and no additional bone loss.
Results: PlI scores remained low in all groups during the entire study period. All groups presented a similar decrease of gingival inflammation, without difference of GI from one another group at M3 and M6. A PPD reduction value was observed in each group at M3, with a more pronounced reduction in the titanium brush group at 6 months (p< 0.05). RAL values were decreased in each group at M3, but was more marked in the titanium brush group (p< 0.05). At M6, bone loss appeared lower in titanium brush than plastic curette group (p<0.05). At M6, treatment success achieved 8% of the implants in the plastic curette group, 12% in the glycine air-polishing group and 14% in the titanium brush group (repeated measures ANOVA).
Conclusions: The results obtained so far indicated the higher efficiency of the titanium brush and glycine air-polishing device as compared with plastic curette. However, treatment success score remained low. Adjunction of antimicrobials an/or antibiotics has to be evaluated in a new randomized controlled trial.