Rotating titanium made brushes for efficient open flap debridement in peri-implantitis therapy

Background & Aim: Due to the continuously increasing number of implants placed in everyday clinical practice, it is reasonable to anticipate an increasing prevalence of peri-implantitis, which underlines the necessity for a predictable therapy. Peri-implantitis-associated bone loss is characterized by a non-linear progression, with the rate of loss increasing over time. After bone loss the implant surface becomes exposed to microbial colonization in the form of microbial plaque biofilms. The anti-infective surgical treatment of peri-implantitis in cases with a considerable pocket formation larger than 5mm is based on the open flap debridement followed by implant surface decontamination. To achieve a sufficient implant debridement concrements and tissue remnants have to be removed. Well designed rotating brushes with stiff titanium made bristles allow an efficient debridement in a short time of treatment. Additional disinfection is necessary in order to avoid recontamination after mechanical cleaning. Previous in-vitro tests about the effects of titanium made debridement brushes compared to the treatment with curettes demonstrated an effective surface cleaning of the exposed implants with only minor impact on the implant structure. The aim of the study is to give treatment recommendations for the use of the rotating brush (Tigran™ PeriBrush™) regarding the load/force used in the mechanical debridement. Methods and material: The correct horizontal load/force for the rotating PeriBrush and therefore onto the surface of implants was measured using SEM images of the surface and the brush before and after treatment. A spring based construction (spring steel wire) with defined distances of impression under load was used. Patients with similar peri-implantitis (pocket depth higher than 6 mm) were treated by open flap debridement followed by implant surface decontamination. The mechanical debridement was performed with rotating titanium made brushes using a horizontal load/force of 20-30 g / 0.2-0.3N and additional rinsing with saline solution. The time used for the procedure was measured. Results: Rotating titanium debridement brushes allow a surface cleaning with only minor impact on different tested implant structures. The analyzed brush (Tigran™ PeriBrush™) is more effective compared to the vertical movements of curettes in the treatment of peri-implantitis and can shorten the treatment time. The optimal horizontal load/force onto the angle-piece for a sufficient debridement and minor effects on the implant surface and the bristles should be 20-30 g / 0.2-0.3 N for 60 sec. Keywords: peri-implantitis, open flap debridement, titanium brush, mechanical debridement