Mechanical, chemical and laser treatments of the implant surface in the presence of marginal bone loss around implants

Purpose: The objective of this review was to summarise current evidence with regard to the decontamination of implant surfaces by mechanical, chemical and physical methods in the presence of marginal bone loss arising from peri-implant infections. Materials and methods: A PubMed search identified studies and publications dealing with 'periimplantitis', 'treatment', 'surface decontamination', 'laser application' 'air-abrasive treatment' and 'photodynamic therapy'. Only studies in international peer-reviewed journals were selected for further evaluation; case reports were not included. Results: Several therapeutic approaches were identified such as mechanical treatment, antiseptics and air-abrasive treatment, photodynamic treatment, and laser applications. Since treatment of infected surfaces with air-powder ± citric acid, gauze soaked with saline + citric acid or gauze soaked with chlorhexidine led to similar results in experimental studies, cotton pellets with saline may be adequate for cleaning micro-rough surfaces. Antimicrobial photodynamic therapy can effectively reduce the prevalence of pathogens on implant surfaces, but the clinical benefits remain unknown. The increase in temperature of the implant surface caused by the CO2 laser poses a risk. The Er:YAG laser is considered to possess the best properties for implant surface decontamination. In vivo, no single method of surface decontamination (chemical agents, air abrasives or lasers) was found to be superior. In several animal experiments, thorough cleaning of the infected implant surfaces and implantation of these previously infected devices into freshly prepared sites resulted in re-osseointegration, while currently there are no controlled clinical trials where re-osseointegration has been demonstrated in patients. Conclusions: For decontamination of the infected implant surfaces, rinsing with saline (or cleaning with cotton pellets soaked with sterile saline) and air-abrasive treatment seem to work. Laser decontamination of the surface does not improve healing results. Non-surgical therapy of implants with peri-implantitis does not lead to successful treatment outcomes. Keywords: air-abrasive treatment, antibiotics, antiseptics, decontamination, Er:YAG laser, implant surface, non-surgical periodontal therapy, osseointegration, peri-implantitis, periimplant mucositis, periodontal surgery, review, surface chemistry