Objectives: To evaluate the treatment of peri‐implant mucositis (PM) using a nonsurgical submarginal peri‐implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.Methods: Fifty‐six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6‐month follow‐up and to identify significant predictors of implant‐site BOP through mixed generalized linear regression.Results: After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4–42.3] vs. 48.7 [95% CI 46.5–51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant‐sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).Conclusions: NSPI + CHX showed better results compared to placebo in implant‐sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM‐treated patients.

This study evaluated, in vitro, the effects of different instrumentations used in the treatment of peri-implantitis on implant surfaces coated with hydroxyapatite or titanium plasma spray (TPS). There were 14 cylindrical rough implants used, including 7 hydroxyapatite and 7 TPS coated. Split in 2 parts for a total of 24 experimental surfaces, implants were treated with a stainless-steel curette, plastic curette, ultrasonic scaler tip, and air-powder-water spray. There was 1 hydroxyapatite and 1 TPS implant used as controls. Profilometry and scanning electron microscopy were used to examine instrumented surfaces for variations in surface topography. All experimental procedures determined changes on tested rough implant surfaces. Such alterations were related to the implant coating material, and the procedure consisting in coating removal and/or leveling of surface roughness. Although a plastic curette and air-powder-water spray induced less implant surface alterations, these instrumentations left deposits on the surface that may affect, in vivo, the tissue healing process.

Aim: To evaluate the clinical outcomes of moderate intrabony defects treated with minimally invasive non‐surgical technique (MINST) with or without adjunctive delivery of cross‐linked hyaluronic acid (xHyA) gel.Materials and Methods: Forty‐two patients with 42 interdental intrabony defects were randomly assigned to test (MINST + xHyA) or control procedures (MINST alone). Probing depth (PD), clinical attachment level (CAL), gingival recession (GR) and bleeding on probing (BOP) at the treated sites were assessed at baseline and at 3 and 6 months. Full‐mouth plaque score (FMPS) and full‐mouth bleeding score (FMBS) were recorded at baseline and after 6 months. Radiographic evaluation was performed at baseline and after 6 months, assessing the defect fill (DF) and radiographic defect angle (RDA). The primary outcome variable was PD change.Results: Thirty‐eight patients completed the trial without any adverse events. At 6 months, a statistically significant improvement (p < 0.05) was measured in all clinical parameters except GR (p > 0.05). However, no statistically significant differences were found between the experimental and control procedures (p > 0.05). Statistically significant differences between the test and control sites were observed at 3 months for PD and CAL changes (p < 0.05). The DF change was statistically significant when comparing experimental and control procedures at 6 months (p < 0.05). Both procedures failed to show statistically significant differences in terms of RDA changes at 6 months (p > 0.05).Conclusion: Within their limitations, the present results indicate that (a) treatment of intrabony defects with MINST, with or without application of xHyA gel, resulted in statistically significant improvements in the investigated clinical parameters at 3 and 6 months after therapy, and (b) although the adjunctive use of xHyA gel to MINST improved the clinical outcomes compared with MINST alone up to 3 months, statistically significant differences were not observed at 6 months. The study protocol was registered in ClinicalTrial.gov (NCT05188898).