The Adjunctive Effect of a Titanium Brush in the Non-Surgical Treatment of Peri-Implantitis

Inclusion Criteria:

• Adult patients with ≥18 years of age.

• Ability to understand all the study procedures and to comply with them along theentire study period. Ability and willingness to give written informed consent.

• An adequate level of oral hygiene (plaque index ≤ 25%) (O'Leary et al., 1972).

• Treated periodontal disease.

• Presence of at least one titanium implant with peri-implantitis [i.e., presence ofbleeding and/or suppuration on gentle probing with probing depth of ≥6 mm, andprogressive bone loss. In the absence of initial radiographs, a bone level ≥2 mmapical to the most coronal part of the intrabony portion of the implant will be usedas threshold of disease (Romandini et al., 2021)].

• Horizontal and vertical peri-implant bone defects.

• Implant function time ≥ 1 year.

• Presence of ≥2mm of keratinized peri-implant mucosa.

• Screw-retained single and multiple restorations.

Exclusion Criteria:

• Untreated periodontitis.

• Smokers > 10 cigarettes per day.

• Local or systemic diseases that would interfere with routine periodontal therapy (i.e., uncontrolled diabetes mellitus, cancer, HIV, chronic high-dose steroidtherapy, metabolic bone disease, radiation, immunosuppressive disease, hepaticdysfunction, immunosuppressive disease, autoimmune disease).

• Pregnant or lactating women.

• Previous surgical and non-surgical treatment of affected implants at least 12 monthsprior to the beginning of the study.

• Radiographic peri-implant bone loss > two-thirds.

• Mobility of the implant.

• Known allergy or intolerance to macrolides.

• Use of systemic antibiotics during the last 3 months.

• Need of endocarditis prophylaxis.