Non-surgical treatment of peri-implantitis with submarginal erythritol air-polishing in severe periodontitis patients: a randomized controlled trial

TL;DR

This study compared two non-surgical treatments for peri-implantitis in patients with severe periodontitis and found both effective, with one showing better soft tissue results.

Contribution

Demonstrates the efficacy of erythritol air-polishing as a non-surgical treatment for peri-implantitis in severe periodontitis patients.

Findings

Both treatments reduced probing depth, but erythritol air-polishing showed greater improvement in soft tissue inflammation.

Keratinized mucosa width and adjacent teeth's probing depth reduction were favorable factors for treatment outcomes.

No significant difference in primary outcome (mean PPD) between the two groups at 3 months.

Abstract

To evaluate the clinical and radiographic outcomes of non-surgical treatment by either submarginal erythritol air-polishing or combined instrumentation for peri-implantitis in severe periodontitis patients.

This randomized clinical trial enrolled patients diagnosed with stage III/IV periodontitis and peri-implantitis affecting at least one dental implant. The test group received erythritol air-polishing while the control group received ultrasonic combined with manual instrumentation for peri-implant submarginal debridement. The primary outcome was the mean peri-implant probing depth (PPD) at 3 months. Clinical parameters were assessed at baseline (T0), T1 (6 weeks), and T2 (3 months); radiographic parameters were assessed at T0 and T2. Intergroup differences were analyzed using the Mann-Whitney U or t-test at each timepoint and verified by mixed-effects models. Factors potentially influencing PPD prognosis were assessed using Generalized Estimating Equations (GEE).

Initially, 40 patients (20 per group) with peri-implantitis were randomly assigned to the trial; 38 patients completed the study. At T2, mean PPD reduced from 6.0 ± 1.8 mm to 4.2 ± 1.6 mm (test group) and 4.7 ± 1.5 mm (control group) with no significant differences between groups. Mean modified sulcus bleeding index(mSBI) decreased in both groups, with a significantly greater reduction in the test group. The treatment efficacy of PPD can be influenced by keratinized mucosa width (KMW), PPD-T0, mSBI-T2, and probing depth reduction of adjacent teeth.

In patients with severe periodontitis, both non-surgical therapies were effective in improving clinical parameters of peri-implantitis. Erythritol air-polishing exhibited greater improvement in soft tissue inflammation. Adequate peri-implant keratinized mucosa and greater reduction in probing depth of adjacent teeth were identified as favorable prognostic factors for PPD.

This study had retrospectively registered at Chinese Clinical Trial Registry (ChiCTR2100048446) on July 7, 2021 (https://www.chictr.org.cn/showproj.html? proj=129220).

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