Peri-implantitis was suggested [1] as an infectious and pathological site-specific disease in surrounding peri-implant tissues.

At the 6th European Workshops on Periodontology, consensus was made on the definitions related to the peri-implant diseases, peri-implant mucositis and peri-implantitis, respectively [2].

Peri-implant mucositis describes an established inflammatory lesion in the soft tissue while peri-implantitis also affects the supporting bone [3].

The prevalence of peri-implantitis affects 20% of patients [4]. A vast number of different treatment protocols for peri-implantitis have been suggested through the years [5, 6].

Today there is no consensus regarding the most effective intervention. Current general understanding among both clinicians working in the field and within the research community is that surgical exposure of the implants and removal of the granulation tissue seem to be necessary [2]. A surgical strategy with or without bone recontouring to accomplish pocket elimination to optimize infection control seems to work in many cases [7].

In some selected cases with peri-implant bone loss, it may be considered to reconstruct the lost osseous lesion. The current scientific evidence available in the literature for the efficacy of reconstructive and surgical strategies in treating peri-implantitis is, however, limited [8].

Porous titanium granules (PTGs, Natix®, Tigran Technologies AB, Malmö, Sweden) were initially used in orthopaedics for stabilization of hip prostheses to enhance bone regeneration [9, 10].

Regarding oral and maxillofacial surgery, PTG was introduced as a bone graft substitute for use in sinus lifts [11].

A porous titanium granule is 700–1000 μm in diameter. The total titanium surface of the ultra-porous granules is approximately 2 cm² [12], which provides a significant blood-to-titanium contact area. Titanium has also been demonstrated to be a potent activator of the blood coagulation system with thrombus formation, which may be interesting from the perspective of bone healing and osseous growth [13].

In 2011, Wohlfahrt et al. presented human histological support that re-osseointegration of a contaminated dental implant with peri-implantitis was biologically possible. Grafting of a peri-implant defect with PTGs may lead to newly formed bone both in close connection with the graft material as well as with the contaminated implant surface [14].