Diederik Hentenaar

99 Erythritol air-polishing in surgical peri-implantitis treatment bicarbonate; 40-60 μm) and smaller particles (i.e. eryhtritol; 14μm and glycine; 25μm) have shown to exert beneficial effects in in-vitro studies. Where larger particles may seem to provide a greater cleaning capacity, they do cause more alterations of the implant surface (crater-like defects on smooth surfaces, rounding or removal of sharp edges on rough surface). Although smaller particles on the other hand only cause almost no observable change of the implant topography at SEM analysis, they might have a reduced capacity to remove implant contaminants (Matsubara, et al., 2020). However, these smaller particles are more likely to reach areas in the rough implant surface inaccessible by larger particles. Hence, to which extent these different effects impact on peri-implant health recovery remain to be found. In addition to powder difference, implant thread geometry and apically facing thread parts were found to impact the air-polishing decontaminating efficacy (Sanz-Martín et al. 2021). The most effective biofilm removal could be achieved in implants having low thread pitch and low thread depth values and on the non-apical facing parts. Also implant defect morphology might be an important factor contributing to a successful outcome (Tuchscheerer et al. 2021). The group by Tuchscheerer, et al. showed that although glycine air-polishing was significantly more efficient in a surgical simulated setting than in a non-surgical setting, in none of the bone defects an entirely clean surface could be achieved. Significant difference appeared between bone defects of 30° (8.26 ± 1.02% color remnant) and 60° (5.02 ± 0.84% color remnant) which might suggest that less wide (intraosseous) bone defects might leave more biofilm remnants as trigger for peri-implant inflammation. Taken together, a positive influence of erythritol air-polishing on the reduction of inflammatory parameters could be expected on the short term (up to 1 year). As single decontaminating approach it does however not seem to improve the clinical outcome more than saline soaked gauzes. Therefore saline rinsing still might be regarded the gold standard for implant surface decontamination. Hence, when not already present in a daily practice, it seems questionable if one should invest in an expensive mechanical treatment method/device. Nevertheless, the use of an air polisher could be regarded the most easy to handle device when trying to decontaminate the implant surface in a surgical approach and thus advocated when present. Moreover, RCTs evaluating the use of erythritol air-polishing in combination with chemical decontamination are needed. The present study has some limitations. First, optimal accessibility of the peri-implant bone defect might not have been reached in all cases considering that cemented restorations were not removed prior to the surgical intervention. Hence, the implant surface might have been insufficiently cleaned. 4