Cold atmospheric plasma for implant surface decontamination and osseointegration: a scoping review with implications for peri-implantitis management

BACKGROUND: Peri-implantitis is a biofilm-associated inflammatory condition leading to progressive bone loss around dental implants. Effective management requires both implant surface decontamination and re-establishment of osseointegration. Cold atmospheric plasma (CAP) has emerged as a promising approach due to its antimicrobial activity and its ability to modify implant surface properties. METHODS: This scoping review was conducted in accordance with the PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was performed to identify relevant studies. In vitro, ex vivo, and animal studies investigating the effects of CAP on implant surface decontamination and/or osseointegration were included. Given the limited availability of standardized peri-implantitis models, studies reflecting key biological components of the disease process were considered. RESULTS: A total of 77 studies were included. Among them, 31 focused on implant surface decontamination and 46 evaluated osseointegration-related outcomes. The included studies were highly heterogeneous in terms of plasma devices, gas composition, exposure parameters, implant materials, and biological models. Overall, CAP demonstrated consistent antibacterial effects and was associated with improved surface hydrophilicity, enhanced osteoblast response, and increased bone-to-implant contact in preclinical settings. CONCLUSIONS: CAP appears to possess a dual potential to support implant surface decontamination and osseointegration-related processes, targeting biological processes relevant to peri-implantitis. However, the evidence is largely preclinical and derived from heterogeneous models that do not uniformly reproduce the clinical condition of peri-implantitis. Therefore, current findings support the biological plausibility of CAP as an adjunctive strategy, while its clinical effectiveness and optimal application protocols remain to be established through well-designed in vivo studies and clinical trials.