Abstract
OBJECTIVE: This study aims to identify risk factors for peri-implantitis in patients with implant-supported restoration, and explore the efficacy of subgingival sandblasting in modulating peri-implant microecology, so as to provide a basis for optimizing clinical management. METHODS: Ninety-six patients with early peri-implantitis treated from July 2022 to July 2024 were enrolled as the inflammation group and randomly subdivided into control, glycine-based subgingival sandblasting, and erythritol-based subgingival sandblasting groups (n = 32/group). Clinical outcomes were compared. Additionally, 102 patients without inflammation post-implant-supported restoration were selected as the non-inflammation group for independent risk factor analysis. RESULTS: Univariate analysis showed that peri-implantitis was related to 9 factors such as lower educational level, smoking, and diabetes (P < 0.05). Multivariate analysis further confirmed higher educational level (OR = 0.408) and regular dental cleaning (OR = 0.34) as protective factors, while implant sevice time ≥ 5 years (OR = 4.614) and insufficient keratinized mucosa width (OR = 3.267) as independent risk factors (all P < 0.05). Subgingival sandblasting (glycine/erythritol) significantly reduced plaque index (PLI), bleeding index (BI), and inflammatory factors (IL-6, IL-1β; P < 0.05). The erythritol group demonstrated superior long-term anti-inflammatory efficacy (e.g., IL-1β: 4.43 versus glycine 6.02 at 6 months; P < 0.001), though probing depth (PD) improvements attenuated beyond 6 months. Both subgingival sandblasting groups reported significantly higher patient satisfaction scores for aesthetic appearance and functional characteristics than controls (P < 0.05). CONCLUSION: Peri-implantitis arises from interactions among oral hygiene, anatomical factors, and systemic conditions. Subgingival sandblasting effectively controls peri-implantitis progression by disrupting plaque biofilm and suppressing inflammation, with erythritol offering extended anti-inflammatory benefits. Sustained clinical outcomes needs adjunctive maintenance therapy alongside subgingival sandblasting. CLINICALTRIALS.GOV IDENTIFIER: NCT06998160(25th/April/2025) https://register.clinicaltrials.gov/prs/beta/records SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-025-06945-9.