Diederik Hentenaar

100 Chapter 4 Second, irrespective of the bone defect morphology, a resective approach was chosen with the aim to evaluate the single influence of mechanical implant surface debridement. In some cases (i.e., 3/4 wall or circumferentially bone defect) a regenerative approach could have been a more successful therapy. However, at the start of this study, research data comparing the outcomes of resective and regenerative approaches in a randomized clinical trial was scarce and did not (and still does not) per se favor a regenerative approach (Tomasi et al 2019). Third, recent microbiological research using metagenomic techniques have revealed a microbiological profile of peri-implantitis which appears more diverse than previously thought (Charalampakis and Belibasakis 2015). Therefore, other microorganisms which we did not target with the qPCR technique in our study might be important in the etiology and disease progression of peri-implantitis. At last, considering the low number of cases showing therapy success a subanalysis on confounding factors (e.g. implant surface, implant position, buccal keratined gingiva, type of suprastructure, history of periodontitis and smoking) appeared not feasible. To conclude, within the limitations of the present study, cleansing of the implant surface using erythritol air-polishing seems as effective as the use of saline-soaked cotton gauzes in terms of clinical, radiographical and microbiological effect during the surgical resective treatment of peri-implantitis. The overall treatment success of air-polishing as single debridement method in a resective surgical approach however remains low. To improve the treatment success and prevent disease recurrence on the short term studies evaluating new potential (combination of ) strategies are needed.