Impact of abrasive versus non‐abrasive cleaning on peri‐implantitis titanium release: A randomized clinical trial

Abstract Background Surface decontamination is integral to peri‐implantitis treatment. However, abrasive mechanical methods can cause implant surface degradation with possible adverse biological effects. No human studies have examined whether these treatments cause titanium release or impair regenerative outcomes. The primary objective was to compare abrasive mechanical (titanium scalers; Abr) versus non‐abrasive mechanical (rotary polymer microbrushes; NonAbr) surface treatments on titanium release to the peri‐implant microenvironment post‐debridement. Methods Adults with peri‐implantitis with intrabony defects had implants randomized to Abr or NonAbr and received non‐surgical and surgical treatment. Titanium release in peri‐implant plaque at 8 weeks and 12 months post‐treatment was assessed as the primary outcome. Clinical and radiographic changes following therapy, including peri‐implant probing depth, bleeding/suppuration on probing, marginal bone levels, and disease resolution, were assessed as secondary outcomes at baseline, 5 months, and 12 months. Results Eighteen participants were randomized to Abr and 16 to NonAbr ( N = 34). At 8 weeks, the primary outcome variable titanium concentration showed a trend ( p = 0.069) for higher levels in Abr than in NonAbr, with no significant difference observed at 12 months ( p > 0.05). Thirty‐one participants underwent surgery. The mean bone gain and probing depth reduction were 1.50 ± 0.49 mm (SE; p = 0.004) and 1.93 ± 0.70 mm ( p = 0.01) greater in NonAbr than Abr at 12 months, respectively. Total disease resolution was higher in NonAbr (62.5%) versus Abr (16.7%) ( p = 0.01) and was significantly associated with titanium levels and group ( p < 0.05). In NonAbr, 75% of early/moderate (9/12) and 25% of advanced (1/4) cases resolved ( p < 0.05), versus 21.4% (3/14) and 0% (0/4), respectively, in Abr ( p > 0.05). Conclusion Abrasive cleaning showed a transient increased trend in titanium concentration after non‐surgical therapy, returning to baseline at 1 year after flap surgery. Overall, abrasive treatment produced inferior clinical outcomes and progressive bone loss in several cases, suggesting that abrasive cleaning is an adverse factor for regenerative treatment. Non‐abrasive cleaning yielded significantly better regenerative results and is recommended for optimal peri‐implantitis regenerative outcomes. Trial Registration https://clinicaltrials.gov/ct2/show/NCT03384446