Erythritol air-polishing in the non-surgical treatment of peri-implantitis; a randomized controlled trial.

Objectives To compare erythritol air-polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis. Material and methods Eighty patients (n=139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5mm, marginal bone loss (MBL) ≥2mm as compared to bone level at implant placement, bleeding and/or suppuration on probing (BoP/SoP)) were randomly allocated to air-polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9 and 12 months. Differences between both groups were analysed using multilevel statistics. Results Three months after therapy, no significant difference in mean BoP (%) between the air-polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = 0.380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%) and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score air-polishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = 0.222). All successfully treated patients at T3 (18.4%) were still considered successful at 12 months follow-up. Conclusions Erythritol air-polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantits. Hence, the majority of patients required further surgical treatment.