Treatment of periimplantitis: Electro-chemical cleaning of the implant

Treatment of periimplantitis: Is there finally light at the end of the tunnel? The aim of this lecture is to provide an overview about efficacy of current treatment options of periimplantitis and to present a new electro-chemical approach.

All implant and abutment surface topographies are susceptible to pathogen adherence and biofilm formation. This can trigger an inflammatory response in the mucosa (perimucositis) or in the surrounding bone (periimplantitis). Periimplant pathology turns out to be a frequent problem nowadays. Incidence increases due to the raising number of installed implants and the cumulated time of their incorporation. In epidemiological studies, it has been estimated that the prevalence of perimucositis ranges from 19 to 65% while that of periimplantitis ranges from 1 to 47% (Derks 2015). Implant surface decontamination without altering the implant surface is an essential step in the treatment of periimplant disease. Reviews on effectiveness and efficacy of treatment as well as dental community’s clinical experience demonstrate that no treatment modality achieves a reasonable long-term result. Inadequate surface decontamination compromised by bony defect anatomy, macro- and micro-design of the implant and supra structure may be main reasons. Neither complete removal of the biofilm nor acceptable amount of re-osseointegration are described in the literature.

A new method of surface cleaning using an electro-chemical method will be introduced. Several in vitro and in vivo studies (animal and human) prove the complete removal of biofilm and high incidence of complete re-osseointegration. Hydrocarbons will be removed resulting in a super-hydrophilic surface. After this optimal cleaning, re-osseointegration is primarily limited by anatomical issues like defect morphology and skills of the surgeon. The method works in different grades of titanium, alloys, surfaces, implant brands and macro designs of surfaces and removes biofilm completely. Once pathogens are removed from the implant surface, the inflammation is treated, but long-term success not guaranteed. Bacterial recolonization might occur anytime, especially if rough implant surfaces and macro modifications thereof, designed to be osseointegrated and covered by bone, are exposed to the oral cavity. Therefore, additional goals of peri-implantitis therapy are to regenerate hard and soft tissues including re-osseointegration of the formerly biofilm exposed implant surface to the indicated level of origin.

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