Mechanical modification of the implant surface as an adjunctive measure during surgical treatment of peri-implantitis

Background. Peri-implantitis has been defined as a biofilm-associated pathological condition, occurring in tissues around dental implants, and characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Numerous surgical approaches, including access flap surgery, and resective or augmentative techniques, have been proposed previously in order to treat peri-implantitis. The mechanical modification of the implant surface has been proposed as an adjunctive measure during surgical treatment of peri-implantitis. Implantoplasty is a procedure based on the mechanical removal of implant threads to create a smooth surface that is less predisposed to plaque accumulation and reinfection. Objective of the study. This study aims to evaluate the clinical efficacy of mechanical modification of the implant surface as an adjuvant measure during resective surgical treatment of peri-implantitis. Material and Methods: Peri-implantitis was defined as radiographic bone loss ≥ 3 mm and/or probing depths ≥ 6 mm, followed by profuse bleeding. 12 patients with peri-implantitis were included in the study. The control group (CG, n=6) received resective surgical treatment with implantoplasty, while the test group (TG, n=6) received the same treatment using rotating titanium brushes for decontamination. Tungsten carbide instruments were used for implantoplasty on titanium during the surgical treatment of peri-implantitis. Mechanical debridement of implant surfaces was preceded by the application of antibacterial and chemical agents, such as 0,05 % chlorhexidine gluconate and 3% hydrogen peroxide The following outcome variables were assessed: peri-implant probing depth (PiPD), modified bleeding on probing (mBoP), modified plaque index (mPI), suppuration (SUP) and recession (REC). Results. All subjects had previously received submarginal instrumentation. At the 3-month follow-up, both groups showed clinical improvements. The reduction in clinical index, mBoP were quite similar between the study and control groups (p > 0.05). However, the GC group demonstrated a statistically significant greater reduction of the indices mPI and PiPD (p < 0.05). There was no statistically significant difference in suppuration index between the two groups (p > 0.05). The sites treated with implantoplasty revealed significantly more soft-tissue recession (CG: 1.9±0.4 mm; TG: 1.1±0.35 mm; p < 0.05) and consequently marked exposure of the implant surface. C onclusions. Patients from the control group showed better results on mPI and PiPD indices. Both methods resulted in stable conditions, with high improvement in clinical indices. Implantoplasty is more suitable for lateral areas. Implant surface polishing is indicated at implant sites where no bone regeneration is expected.