New Technological and Clinical Advances for Controlling Peri-Implantitis

Background/Objectives: Peri-implant diseases, including mucositis and peri-implantitis, pose significant clinical challenges due to their inflammatory nature and potential for progressive bone loss. These conditions, primarily driven by bacterial biofilm accumulation, require effective management to prevent further tissue destruction and maintain implant longevity. This systematic review aimed to determine whether the use of chitosan or titanium brushes in the surgical or non-surgical treatment of peri-implant mucositis or peri-implantitis provides clinical advantages—particularly reductions in probing pocket depth (PPD) and bleeding indices—compared to conventional decontamination protocols. Methods: The review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024489556). A comprehensive electronic search was conducted in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials in December 2024 and updated on 9 November 2025, using predefined Boolean equations. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool. Results: The initial and updated searches identified a total of 7470 records, of which nine studies met the inclusion criteria—seven randomized controlled trials and two prospective case series. Among them, five investigated chitosan brushes and three examined titanium brushes. Chitosan brushes showed significant intra-group improvements in PPD and bleeding indices, and titanium brushes demonstrated favorable results in surgical protocols, particularly when combined with regenerative therapies. However, inter-group comparisons revealed no statistically significant superiority of either device over conventional methods. Conclusions: Chitosan and titanium brushes are safe and effective tools for implant surface decontamination in peri-implant disease management but do not exhibit clear clinical superiority. The current evidence supports their use as adjunctive devices within standardized treatment protocols. Further large-scale randomized controlled trials with extended follow-up are warranted to strengthen the evidence base and define their clinical role. Full article

Implant placement requires a digital workflow and the use of surgical guides. However, there is divergence in the angulation length of influence and precision. Therefore, a 3D assessment is also required. This insertion study aims to evaluate the accuracy in vitro by utilizing guided templates, deviation analysis, depth, and orientation over different lengths and angles. Methods and Materials: This study comprises a total of 180 implants placed in 90 resin-printed mandibular models, divided into nine groups (a 3 × 3 factorial design, n = 20/group). A reference model was created using Real GUIDE software (version 5.3), integrating a CBCT scanner (Carestream CS 9600, Medit Corp., Seoul, Republic of Korea) and an intraoral scanner (Medit i900) (Medit Corp., Seoul, Republic of Korea). Implant planning and surgical guide design were digitally executed and printed with Mazic resin (Vericom Co., Ltd., Chuncheon, Republic of Korea). Implants were placed using Oxy Implant PSK Line (Oxy Implant, Brescia, Italy) fixtures in mannequins. Postoperative CBCT scans were used to measure deviations in angular, vertical, and lateral dimensions using CS Imaging (v8.0.22) (Carestream Dental LLC, Atlanta, GA, USA). Statistical analysis was run by using SPSS v26. Results: The results demonstrated that implant angulation significantly impacted the precision of placement. Angulating escalation leads to intensive deviations, which are linear and angular calculations. On the one hand, the most significant deviations were observed at a 25° angulation, particularly in the buccal and lingual apex regions. On the other hand, 0° exhibited minimal deviations. Longer implants showed reduced angular deviations, whereas shorter implants (8.5 mm) exhibited higher vertical deviations, particularly at 0° of angulation. Moderate angulation (15°) with 11.5 mm implants provided the highest precision, while 0° angulation with 15 mm implants consistently exhibited the least deviation. These findings pinpoint the fundamental importance of angulation and implant length for exceptional placement accuracy. Conclusions: This study demonstrates the influence of placement accuracy with static guides on implant angulation and length. Moderate angulation, which is (15°), enhances accuracy, particularly within 11.5 mm implants. On the other hand, steeper angles (25°) and longer implants (15 mm) result in elevated deviations. Guidance formation and operator experience are also vital. Full article

Peri-implantitis is marked by ongoing bone loss and soft tissue inflammation surrounding dental implants. Due to its ability to intensify tissue healing and its compatibility with the body, hyaluronic acid (HA) has appeared as a viable biomaterial for managing this oral condition. The goal of this scoping review is to examine current trends and future directions for refining HA-based interventions as an adjuvant peri-implant therapy over the past decade. Using the PRISMA-ScR guidelines, a review of the literature for the past 10 years was conducted. Articles related to HA’s anti-inflammatory, antimicrobial, regenerative mechanisms were taken into consideration to underline both achievements and research related to peri-implantitis treatment management. A total of 105 articles were found, and finally, five clinical studies were included. Despite encouraging results that showed good efficacy of HA use as an adjuvant and/or preventive therapeutic agent for peri-implantitis treatment, a larger number of randomized controlled trials and standardized protocols are needed to confirm HA’s therapeutic efficacy and establish its place in routine clinical practice. Full article

Implantoplasty is widely used to treat peri-implantitis by removing biofilms from Ti6Al4V dental implants using rotating drills. This study examined the effects of diamond and tungsten carbide drills, and rotation direction (clockwise/counterclockwise), on surface modification, corrosion behavior, and cytotoxicity. Machining was performed for one minute under a controlled load. Surface roughness, nanohardness, compressive residual stress, and wettability were evaluated, along with SEM and EDX microanalyses of the residues. Corrosion behavior was evaluated using potentiostatic and potentiodynamic tests in Hank’s solution. Ion release was monitored over time, and fibroblast viability was tested using extracts at various dilutions. The higher abrasiveness of diamond drills leads to increases roughness from 0.22 mm (control) to 0.73 and 0.59 for diamond and tungsten carbide drills, respectively; in hardness from 2.2 GPa for the control to 4.8 and 3.9 GPa; and in residual compressive stress from −26 to −125 and −111 MPa, with diamond drills inducing more significant changes and producing more hydrophilic surfaces with contact angles around 54° in relation to 80° and 62° for the control and tungsten carbide, respectively. Tungsten carbide drills caused lower corrosion rates (0.0323 mm/year) than diamond drills (0.052 mm/year). In addition, we observed the presence of tungsten ion release. Cytotoxic effects on human fibroblasts were observed with both bur types, and were more pronounced with tungsten carbide, especially at lower dilutions. Only 1:10 dilutions maintained consistent cytocompatibility. The rotation direction showed no significant impact. These findings emphasize the critical influence of bur selection in implantoplasty on the biological response of surrounding tissues. Full article