Patients with surgically treated peri-implantitis enrolled in a maintenance program at the Specialist clinic, Institute for Clinical Dentistry, Dental Faculty, University of Oslo, will receive SPiT by the use of an oscillating chitosan brush (LBC, BioClean, Labrida AS, Oslo, Norway). Subjects with at least two not-adjacent implants of similar brand and defect configuration registered with suppuration or Bleeding index score 3-2 (Roos-Jansaker et al., 2007) on at least 1 of 6 surfaces (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) will be invited to participate in the current pilot study.~Baseline examinations and treatment:~Radiographs of the implants showing clear projections of the implant threads at the mesial and distal surfaces will be taken using standard Eggens holders~The following clinical registrations will be performed at six sites (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) of the included implants by the blinded examiner:~Suppuration: the presence or absence after light pressure against gingiva/mucosa or following gentle probing of the peri-implant pocket.~Plaque: the presence or absence recognized by running a probe across the marginal surface of the implant (Mombelli, van Oosten, Jr, & Lang, 1987).~Gingival bleeding: registered according to the Modified Sulcus Bleeding Index (mBI) (Mombelli et al., 1987).~PPD: recorded with a pressure- sensitive probe (20 g) (University of North Carolina probe, Aesculap, Braun, Tuttlingen, Germany).~Bleeding index score: measured at the implants after probing at six sites, and graded (0-3):~0 = no bleeding,~= spot bleeding,~= line bleeding~= profound bleeding within 30 seconds after measurement of PPD. Presence of keratinized mucosa: registered at the mid buccal site as adequate ≥2 mm, inadequate <2 mm (Moraschini, Luz, Velloso, & Barboza, 2017).~All included implants receive the following treatment:~Repeated oral hygiene instruction if needed Submucosal debridement with a chitosan brush (LBC, BioClean®, LABRIDA AS, Oslo, Norway) seated in an oscillating dental drill piece (ER10M, TEQ-Y, NSK Inc., Kanuma Tochigi, Japan) for 3 min followed by copious irrigation with sterile saline Supramucosal polishing using polishing paste and rubber cup Following treatment, if local anesthesia was not applied, the subjects will be asked to grade the level of pain experienced on a 10 cm visual analogue scale (VAS).~3-, 6- and 9 weeks following baseline At the 3-week follow up, an equal number of included implants are determined test- and control- by flipping of a coin.~At these time points, all implants are clinically examined by a blinded examiner and receive supramucosal polishing, but only test-implants receive submucosal debridement as described above (see figure 1) VAS scales are registered~12 weeks (3 month) following baseline At these time point, all implants are clinically examined by a blinded examiner and receive supramucosal polishing as well as submucosal debridement as described above (see figure 1) VAS scales are registered~16 weeks (4 month) following baseline All implants are clinically examined by a blinded examiner and receive supramucosal polishing, but only test-implants receive submucosal debridement as described above (see figure 1) VAS scales are registered~24 weeks (6 month) following baseline At these time point, all implants are clinically examined by a blinded examiner and receive supramucosal polishing as well as submucosal debridement as described above (see figure 1) VAS scales are registered~36 weeks (9 month) following baseline At these time point, all implants are clinically examined by a blinded examiner and receive supramucosal polishing as well as submucosal debridement as described above (see figure 1) VAS scales are registered Radiographs are taken according to the baseline examination~Figure 1: Timeline of the clinical trial
This pilot study is an interventional clinical study on the supportive peri-implant treatment (SPiT) necessary to maintain/ improve the clinical conditions surrounding a dental implant following surgical treatment of peri-implantitis. The focus of this pilot, double arm, split-mouth, single centre, controlled, randomised clinical study is to examine the effect of short-term increased frequency of a SPiT-protocol.