Early peri-implantitis: mechanical debridement alone holds up — adjuncts show no significant edge

Peri-implantitis is one of the most clinically demanding conditions in implant dentistry. Despite a growing body of literature, there is still no consensus on which nonsurgical decontamination protocol offers the best outcomes. This multi-arm randomized controlled trial by Eraydin-Tufek and colleagues set out to compare five different nonsurgical approaches in patients with early peri-implantitis, addressing a genuinely unresolved clinical question.

Eighty implants from 26 patients were randomly assigned to one of five treatment groups: mechanical instrumentation alone (MI); MI combined with chlorhexidine irrigation (MI+CHX); MI combined with ozone application (MI+OZ); MI combined with glycine powder air abrasion (MI+GPAA); and glycine powder air abrasion as monotherapy (GPAA alone). Clinical outcomes — probing pocket depth (PPD), bleeding on probing (BOP), and modified plaque index (mPI) — were recorded at baseline, 3 months, and 6 months. Data were analyzed using linear mixed-effects models to properly account for the clustering of multiple implants within the same patient, a methodological choice that strengthens the statistical validity of the results.

All five treatment modalities produced statistically significant improvements across all clinical parameters over the 6-month follow-up. No group remained static. The numerically greatest reductions in PPD, BOP, and mPI were consistently observed in the MI+GPAA group, suggesting that the combination of mechanical debridement and glycine powder air abrasion may offer an additive benefit. However — and this is the critical point — no statistically significant differences were detected between groups. The trial was not powered to detect small intergroup differences, and the relatively short follow-up limits conclusions about long-term stability.

From a clinical standpoint, these findings carry a clear and pragmatic message: in early peri-implantitis, nonsurgical mechanical instrumentation alone can achieve meaningful short-term improvements, and no adjunctive approach tested here — chlorhexidine irrigation, ozone, or air abrasion — demonstrated clear superiority over MI alone. The MI+GPAA combination deserves attention as a potentially more effective protocol, but larger trials with longer follow-up are needed to confirm whether the numerical advantage translates into a clinically and statistically meaningful difference.

For the practicing implantologist, this study reinforces the foundational role of thorough mechanical debridement while leaving the door open for glycine powder air abrasion as a valuable adjunct — particularly given its biocompatibility profile and the absence of adverse effects on implant surfaces. It also implicitly questions the routine use of chlorhexidine irrigation as a standard adjunct, at least for early-stage lesions where mechanical control alone may be sufficient.