Titanium curettes

Peri-apical radiographs were obtained using the parallel technique, and the peri-implant bone levels were evaluated. Patients received a full mouth examination one week after supragingival scaling. Periodontal parameters, including pocket probing depth (PPD), bleeding index (BI) (Mazza et al., 1981 (link)), and plaque index (PLI) (Silness and Loe, 1964 (link)), were recorded at all six sites (mesio-buccal, mid-buccal, disto-buccal, mesio-lingual, mid-lingual, and disto-lingual) for each tooth. All clinical examinations were performed by the same clinician, and the treatment procedure was performed by another clinician.
Before treatment, oral hygiene instructions were provided to improve the plaque control. Under appropriate anesthesia, debridement with titanium curettes (Hu-Friedy, Chicago, IL, USA) and irrigation with 0.12% chlorhexidine were performed for the diseased peri-implant sites. For periodontitis sites, scaling and root planing using an ultrasonic device and a metal curette (Gracey curette, Hu-Friedy, Chicago, IL, USA) were performed before peri-implant mechanical debridement. A re-examination was performed eight weeks after the treatment.

The surgical peri-implantitis treatment was performed using local anaesthetics. After performing an incision ≥1 mm apical of the mucosal margin, in order to better facilitate the removal of the inflamed soft tissue collar and create pocket reduction, a full-thickness flap was raised buccally and lingually, and the implant surface was exposed. Granulation tissue was removed using titanium curettes (Hu Friedy^®, Chicago, IL, USA). Calculus, if present, was carefully removed with a scaler tip. The implant surface was cleaned using an air-polishing device with erythritol-based powder and hand instruments combined with gauzes soaked in saline solution until the implant surface was deemed to be clean by the surgeon. After repositioning the mucosal flap with single interrupted sutures, the patient was given postoperative instructions. Patients were instructed to use an antiseptic mouthwash (0.2% chlorhexidine, Orasol^®, ICM Pharma Pte. Ltd., Singapore) for 2 weeks after surgery, two times daily. Two weeks after surgery, the sutures were removed, and further oral hygiene instructions were given (twice daily use of an electric toothbrush and use of interdental brushes). The patients were recalled 3, 6, 9, and 12 months after the treatment for a re-examination and peri-implant maintenance therapy.