Diederik Hentenaar

81 Erythritol air-polishing in surgical peri-implantitis treatment INTRODUCTION Implant surface decontamination and/or debridement is considered a critical component for the successful surgical treatment of peri-implantitis (Sanz, Chapple, Working Group 4 of the VIII European Workshop on Periodontology, 2012). Over the last decade, various interventions (i.e., chemical, mechanical or light-mediated) have been studied to eliminate the biofilm and resolve inflammation (Garaicoa-Pazmino, Sinjab, Wang, 2019; Ramanauskaite, Obreja, Schwarz, 2020). However, no clinical, radiographical and microbiological data favors any cleansing approach (Khoury, et al., 2019). To determine the superiority of a decontamination and/or debridement method, clinical studies are needed (Koo, et al. 2019). In order to assess the influence of a debridement method, a randomized clinical trial (RCT) focusing on a single intervention, not using augmentive or adjunctive therapy, is recommended (Esposito, Grusovin, Worthington, 2012; Khan, et al. 2020). Thus far, only a limited number of studies evaluated their implant cleaning protocol in such a way. These studies mainly focused on the effects of chemical agents such as chlorhexidine and phosphoric acid (de Waal, et al., 2013; de Waal, et al., 2015; Hentenaar, et al., 2017) or laser therapy (Papadopoulos, et al., 2015), but not on mechanical debridement methods. Although these studies showed significant reductions in implant surface microbial load, no significant clinical benefits of one method over another were found. Since its introduction around 1945, the use of air-polishing devices have recently gained popularity in the field of dentistry (Petersilka, 2011). The cleaning potential of an air-polisher is based on the kinetic energy of abrasive powder particles, mixed in a spray with water and compressed air. Positive results in terms of cleaning efficacy, surface change and biocompatibility were found in in-vitro studies, comparing glycine air-polishing to other debridement methods (e.g., hand instrumentation and laser therapy) (Louropoulou, Slot, Wismeijer, 2014; Moharrami, et al., 2019). In addition, evaluation of different implant surface cleansing methods in an ex-vivo study, showed that air-polishing was superior to chemical decontamination (Pranno, et al., 2020). However, limited clinical research on the use of air-polishing as a single decontaminating method in treatment of peri-implantitis has been performed thus far. Just recently, superior effects to plastic curettes (reduction in PPD) but equal to titanium brush or implantoplasty were described (Toma, Brecx, Lasserre, 2019, Lasserre, Brecx, Toma, 2020). These results however came from studies with small sample sizes, short follow- up and the use of a single air-polishing powder (i.e. glycine). 4