Inflammation and loss of attachment around dental implants (i.e. peri-implantitis) has become a growing concern within the field of dental implantology [1,2,3,4,5,6,7]. Peri-implantitis is a microbial infection-driven soft tissue inflammation with loss of bony attachment around an implant. Peri-implant mucositis is the precursor of peri-implantitis, as gingivitis is for periodontitis [8]. It is clearly shown that daily infection control performed by the patient and regular professional maintenance of dental implants is important to prevent the progression of mucositis to peri-implantitis [9,10,11,12]. In advanced cases, peri-implantitis may lead to implant loss.

The current view is that most cases of peri-implantitis are unmanageable without surgical intervention. However, the stage of disease progression at which surgery is necessary remains undefined, and limited scientific evidence is available regarding surgical methods that hinder the progression of the disease over time. Because peri-implantitis surgery often involves a high level of patient morbidity, the development of non-surgical and less-invasive treatment methods is of interest for both patients and the dental community. Currently used methods for non-surgical implant debridement include titanium curettes, plastic or carbon fibre curettes, ultrasound, air-polishing and lasers. No particular non-surgical treatment for peri-implantitis resulting in superior outcomes is however supported by sufficient scientific evidence [13, 14]. Furthermore, some procedures have been suggested to cause more problems rather than improving peri-implant health [15]. The crux is to intervene and to treat the inflammation without causing further problems that may contribute to the progression of peri-implant attachment loss. For example, leaving remnants of an instrument could cause a foreign body reaction, which may accelerate disease progression and attachment loss [16]. Similarly, using an ultrasonic steel tip may induce damage to the titanium surface whereas a nylon tip may result in melted material remnants on the implant surface [17]. In a recent study by Eger et al. [15], it was reported that debridement of titanium surfaces with an ultrasonic device may release titanium particles that was shown to induce a pronounced inflammatory response which caused osteoclastogenesis. The use of ultrasonic devices on titanium surfaces may thus aggravate peri-implantitis rather than resolve the situation.