Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions.

This systematic review evaluates the efficacy of various implant surface decontamination methods for biofilm removal and their impact on reosseointegration in peri-implantitis treatment, based on preclinical animal and human biopsy studies as well as ex vivo, in situ, and in vitro investigations. Animal and human histologic evidence indicates that implant reosseointegration is possible following appropriate surface decontamination, with air-powder abrasive (APA) and laser therapies (notably erbium: yttrium-aluminum-garnet [Er: YAG] laser) most frequently associated with successful outcomes; however, no single method demonstrated clear superiority in vertical bone gain or bone-to-implant contact. Ex vivo and in vitro studies show that PEEK ultrasonic tips, APA, Er: YAG laser, and electrolytic cleaning achieve greater biofilm removal, while mechanical instruments such as titanium or stainless steel curettes, ultrasonic tips, and titanium brushes often cause significant surface alterations or leave material remnants. Chemical adjuncts combined with mechanical methods do not significantly enhance reosseointegration compared to mechanical decontamination alone. The review concludes that an ideal decontamination protocol effectively eradicates biofilm without altering implant surface integrity or leaving residues, with electrolytic cleaning, APA, and Er: YAG laser therapy best meeting these criteria.