Evaluation of the Adjunctive Use of Er: <scp>YAG</scp> Laser or Erythritol Air‐Polishing in the Non‐Surgical Treatment of Peri‐Implantitis: A Pilot <scp>RCT</scp>

AIM: Evaluate the efficacy of adjunctive mechanical/physical decontamination to non-surgical submarginal instrumentation in patients with peri-implantitis. MATERIAL AND METHODS: Patients with at least one implant diagnosed with peri-implantitis were included in this 6-month single-masked randomized clinical trial with three parallel groups: non-surgical submarginal instrumentation with titanium curettes (control); control plus erythritol air-polishing (test 1) and control plus Er:YAG laser (test 2). Clinical variables were collected at baseline, 1, 3 and 6 months. The primary outcome was probing pocket depth (PPD) reduction. Secondary outcomes included bleeding on probing (BoP) reduction and endpoint of therapy (implants with PPD ≤ 5 mm, BoP ≤ 1 site, no suppuration). A multilevel logistic model was computed to evaluate the predictive value of implant- and patient-level variables. RESULTS: Forty-seven patients (84 implants) were enrolled. PPD reductions were observed in all groups (mean: 1-1.4 mm at 1 month), remaining stable at 3 months, with slight relapse at 6 months. All treatments led to significant BoP reduction (24%-36%) at 1 month, with no further significant changes at later follow-ups and no intergroup differences. Therapeutic endpoint rates were 12%-18%. Multilevel analysis suggested an association between the presence of ≥ 2 mm vestibular keratinized mucosa and the use of Er:YAG with higher odds of achieving treatment success. Healing was uneventful in all groups, except for one case of surgical emphysema associated with erythritol air-polishing. CONCLUSION: Irrespective of the adjunctive treatment modality, achievement of peri-implantitis therapeutic endpoint was limited across groups. Possible associations with treatment outcomes were observed; these findings require confirmation in larger studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03451981.