Combination of ultrasonic decontamination, soft tissue curettage, and submucosal air polishing with povidone-iodine application for non-surgical therapy of peri-implantitis: 12-month clinical outcomes

BackgroundThe aim of this study is to evaluate clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant povidone-iodine application with and without systemic antibiotics. MethodsForty-five patients with chronic periodontitis and a total of 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of>2mm, probing depth (PD)5mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone-iodine. Teeth with PD>4mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n=24), amoxicillin and metronidazole (AM) were prescribed for 7 days. ResultsAfter 12 months, implants treated without AM showed significant reductions (P<0.05) of mean PD (1.4 0.7mm), clinical attachment level (CAL) (1.3 +/- 0.8mm), and BOP (33.4% +/- 17.2%). In deep pockets (PD>6mm) changes of mean PD (2.3 +/- 1.3mm), CAL (2.0 +/- 1.6mm), and BOP (44.0% +/- 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD>4mm and BOP was significantly higher in patients with AM than in those without AM (31.8% +/- 12.6% versus 20.8% +/- 14.7%; P<0.05). ConclusionsThe combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.