It has been previously stated that the alteration of the implant surface during cleansing may attenuate biocompatibility [29]. However, several clinical studies revealed the considerable treatment effect even though there was certain expected damage on the implant surface [7, 34]. Therefore, it is assumed that the most important consideration for treating peri-implantitis in the clinical setting should be to improve the cleansability of any instrumentation to effectively remove biofilms irrespective of implant surface alteration.

In the present study, the gauze soaked in saline, rotary stainless steel instrument, and air abrasive demonstrated significantly greater cleansability to remove biofilms compared with the ultrasonic scaler on rough and machined surface implants. Generally, gauze soaked in saline appeared to possess the best cleansability among all the tested decontamination methods although there was no significant difference among the three methods with the greatest cleansability (G, Rot, Air). In the analysis between the two surfaces, surface characteristics significantly influenced total CFU counts between rough and machined surface implants when testing the control and gauze soaked in saline and ultrasonic scaler. Overall, machined surface implants tended to show lower CFU counts than rough surface implants apart from those treated with the Er:YAG laser.

Charalampakis et al. [23] examined the effectiveness of mechanical and chemical decontamination methods using titanium disks contaminated intraorally. They employed four decontamination methods: gauze in saline, chlorhexidine, delmopinol, and an essential oil mixture. The authors discovered there was no significant difference in CFU counts among the four methods. In the present study, our findings were in line with their report regarding the difficulty of removing biofilms from contaminated titanium surfaces. Even mechanical decontamination with a chemical agent did not yield any significant difference in CFU counts in their study. It has also been revealed that chemical agents in conjunction with mechanical debridement on contaminated implants could not augment a significant treatment effect [24]. This is one of the reasons why we focused on mechanical decontamination methods to cleanse the contaminated implant surfaces.