Page 9 - Academy of Osseointegration (AO) Academy News Vol 36, No 1 2025

Peri-implantitis: The electrolytic alternative
By: Philippe Khayat, DDS, MSD, Academy News Editorial Consultant; and AO Fellow Mehrdad Favagehi, DDS, MS, and Academy News Editor-in-Chief
Editor’s note: Implant surface treatment is a topic of interest for anyone interested in management of peri-implantitis. The electrolytic approach represents a new way to treat implant surfaces. Dr. Philippe Khayat is an editorial consultant for Academy News and he has been using the electrolytic alternative to implant surfaces treatment in France. Academy News conducted an interview with Dr. Khayat about this new treatment approach.
AN: What scientific evidence is there to show that a previously contaminated implant surface can be
reosseointegrated?
PK: Decontamination of an infected implant surface is part of a strategy aimed at reconstructing
new bone around a failing implant. If this new bone is formed in direct contact with the decontaminated surface, this is referred to as reosseointegration. This biological phenomenon has been observed in several preclinical studies, and well-organized systematic reviews have been published1,2. So yes, a previously contaminated surface can be reosseointegrated.
AN: I understand reosseointegration can be obtained in the animal model. However, one
could argue that the pathological situation, in this case, experimental peri-implantitis, is artificially induced
and that this model may not accurately replicate clinical situations. Do we have human studies showing reosseointegration?
PK: Clinical data is difficult to obtain. Histological analysis requires that a patient with peri-
implantitis agrees to block removal of a successfully treated implant! Despite these obvious difficulties, five clinical studies (case reports) have been published3–7,
all demonstrating that a previously exposed implant surface can be successfully decontaminated and reosseointegrated. Various decontamination techniques were used including EDTA gel, H2O2, laser, and the electrolytic method. They all appear to be effective.
AN: Is there a consensus regarding a preferred decontamination protocol?
PK: Numerous protocols have been described. The best information can be found in a recent 36-page
review co-authored by top specialists and researchers in this field8. Here are their conclusions:
Mechanical strategies alone are insufficient for efficient implant surface decontamination, so use of adjunctive measures is encouraged. Implantoplasty demonstrates clinical effectiveness in resective and combined therapy. However, narrow and internal connection implants may not
be adequate candidates given the added risk of implant fracture. Titanium brushes are effective in disrupting heavy calculus deposits, while air abrasion devices are effective in eliminating soft deposits with minor surface alterations. Adjunctive chemical agents, particularly H2O2 and citric acid, have been shown to optimize decontamination by diluting bacterial concentrations, destroying the organic components of the bacteria and eliminating endotoxins. Adjunctive pharmacological agents, particularly tetracycline hyclate, may further contribute to surface decontamination by reducing the bacterial load. Lasers
are effective in surface decontamination, particularly Er:YAG and Er,Cr:YSGG, with a limited deleterious effect on implant surface topography. Lastly, use of the electrolytic method has proven effective in biofilm disruption and reosseointegration, but independent data demonstrating its clinical effectiveness are sparse.
At this stage, in the absence of a clear consensus, it appears that several decontamination protocols are effective. One of them, the electrolytic method is relatively new. It was developed by GalvoSurge Dental, a Switzerland-based manufacturer. In 2018, Nobel Biocare and GalvoSurge announced their collaboration with leading universities and researchers to establish treatment protocols for implant care and long-term maintenance.
In 2021, electrolytic decontamination was officially
made widely available to the profession, and in 2023, GalvoSurge Dental was acquired by the Straumann Group.
Because it is a recently developed procedure, many publications do not include the electrolytic method in their evaluations or reviews, and most existing studies on this topic have been authored or co-authored
by developers of this method7,9–12. However, three independent studies have been published recently.
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Dr. Philippe Khayat
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