The effects of conventional and electrolytic surface decontamination methods on early wound healing in terms of clinical parameters and biochemical markers in the treatment of peri-implantitis

Objective: Peri-implantitis is a disease that involves the progressive loss of supporting bone together with an inflammatory condition of the supporting tissues around the implant. Clinically, peri-implantitis is characterized by a probing pocket depth greater than 6 mm, accompanied by bleeding on probing and/or suppuration, along with inflammatory destruction of the surrounding alveolar bone. Peri-implantitis currently affects the majority of patients who have received implant therapy. In recent times, clinical studies and treatment approaches have remained insufficient in fully treating peri-implantitis. Studies have shown that decontamination of the implant surface using various treatment methods cannot be achieved completely with any single method. However, recent studies have demonstrated that complete implant surface decontamination can be achieved through electrolytic surface cleaning. Since electrolytic surface cleaning provides complete surface decontamination in the early stages of peri-implantitis treatment, it is thought to accelerate wound healing and prolong early recolonization. The aim of this study is to investigate the effects of peri- implantitis treatment using electrolytic surface cleaning on early wound healing in terms of clinical parameters and biochemical markers (uPA and PAI-1), and to compare it with conventional mechanical decontamination methods currently used in peri-implantitis treatment. Materials and Methods: Panoramic and periapical radiographs were taken along with baseline clinical parameters from patients diagnosed with peri-implantitis and who had completed non-surgical treatment. In addition, clinical parameters were measured and peri- implant sulcular fluid (PISS) samples were collected from the patients. Subsequently, flap surgery was performed. In the control group, implant surface decontamination was carried out using ultrasonic instruments during the conventional surgical procedure, whereas in the test group, electrolytic surface cleaning was performed in combination with flap surgery. The surgical site was closed using 5/0 prolene sutures. PISS samples were then collected on postoperative days 6, 9, 30, and 90. Clinical measurements were repeated on days 30 and 90. The levels of plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1) in the collected PISS samples were analyzed using the ELISA method. Results: The mean age of the participants was 48.3 years. Fifty percent of the participants were female (n=10), and fifty percent were male (n=10). Among the 20 patients included in the study, 10 were allocated to the control group and 10 to the test group. A total of 32 implants were treated, 16 in the control group and 16 in the test group. No statistically significant differences were observed between groups regarding clinical parameters and biochemical markers obtained following surgical treatments (p>0,05). In the control group, v the SCD value decreased from 6.7 mm to 3.0 mm, and in the test group, it decreased from 6.7 mm to 3.3 mm. Although no statistically significant intergroup differences were observed for SCD, there were significant intragroup differences compared to baseline (p<0.001). The volume of PISS increased during healing following peri-implant surgery (p<0.001), while the intergroup difference approached statistical significance (p=0.055). The total amount of uPA in PISS did not differ significantly between groups across the measurement time points (p=0.346). However, there were significant intragroup differences between measurements taken on days 6 and 9 compared to those taken at baseline, and on days 30 and 90 (p=0.015). The total amount of PAI-1 in PISS also did not differ significantly between groups (p=0.846). However, measurements taken on days 6 and 9 showed statistically significant differences compared to baseline, and to days 30 and 90 in both groups (p=0.018). Conclusion: Surgical treatment of peri-implantitis resulted in significant clinical improvements regardless of the surgical method applied. The electrolytic surface cleaning method did not provide an additional clinical benefit compared to the mechanical surface cleaning method currently used in peri-implantitis treatment. Since the biochemical markers uPA and PAI-1 showed changes consistent with the healing process, they have the potential to be used as biochemical indicators for monitoring the treatment of the disease. Keywords: Peri-Implantitis, Electrolysis, Regeneration, Biological Markers, Wound Healing This thesis study was approved by the Ethics Committee of Medical and Health Sciences Research at Başkent University (Project no: D-KA 22/16).