Peri-implantitis reconstructive treatment implementing a titanium brush: 5-year extension results from a randomized clinical trial.

Background: Peri-implantitis has become an important health issue in implant dentistry in the past years. Despite the magnitude of this problem and the potential grave consequences, the predictability and long-term stability of its treatment is still a matter of controversy. The aim of this study was to assess clinical and radiographic results 5 years after the peri-implantitis reconstructive treatment.

Methods: A 5-year follow-up observational study was carried out on patients who had been included in a previous randomized clinical study evaluating the effectiveness of a titanium brush in the peri-implantitis reconstructive treatment. The reconstruction was carried out by means of an alloplastic graft and a collagen membrane. The primary outcome was the reduction in probing pocket depth at the deepest site (PDd).

Results: A total of 17 patients were available for evaluation. An overall reduction of 2.86 mm (SD 2.27) and 4.10 mm (SD 1.79) in PDd was noted for control and test group, which means an increase of 0.14 mm (SD 1.07) and 1.30 mm (SD 1.77) from data reported at 12 months (p = 0.159), respectively. A lower bleeding index and daily use of interdental brushes were significantly associated with lower probing depth (PD) values. There was bone loss in both groups of less than 0.5 mm, and radiographic bone fill represented 32.77% (SD 48.18) and 54.91% (SD 51.49) of the initial defect in the control and test group.

Conclusions: Although with a slight progression, PD reduction can be maintained after the reconstructive treatment around dental implants 5 years after treatment. The trial was registered at ClinicalTrials.gov (NCT03512730).

Plain language summary: Treatment of peri-implantitis, specifically reconstructive surgical treatment has been widely investigated. Nevertheless, the paucity of long-term studies reporting on the adjunctive use of a titanium brush in the reconstructive treatment of peri-implantitis underscores the need for further research to validate its effectiveness and long-term benefits. To assess outcomes, stability, and real added benefit of this tool, long term results are of substantial value. Moreover, long-term studies assessing outcomes after reconstructive treatment in peri-implantitis lesions are specially needed taking into account their scarceness in the scientific literature. Five years post-treatment, peri-implantitis reconstructive therapy with a titanium brush showed significant PD reductions (2.86 mm in control, 4.10 mm in test group) and minor bone loss (< 0.5 mm); however, no significant differences were found between groups. Radiographic bone fill was 32.77% in the control group and 54.91% in the test group. Lower bleeding index and daily interdental brush use correlated with better outcomes, indicating sustained improvements. Based on the study's findings, incorporating a titanium brush in the reconstructive treatment of peri-implantitis could enhance long-term outcomes. Highlighting the significance of interdental brush daily use and maintaining a low bleeding index may further improve treatment success.