Abstract
Background: Peri-implantitis is the leading cause of implant failure, with a reported prevalence of 22-45%. Effective removal of bacterial biofilm from the implant surface is critical to non-surgical therapy. This study aimed to assess the efficacy of different implant surface cleaning methods across various bone defect configurations, considering operator experience. Methods: Thirty-six dental implants were coated to simulate biofilm, mounted in resin blocks with bone defects of varying geometries, and covered with silicone to simulate soft tissue. Three operators with differing levels of experience treated the implant surfaces using four instruments: a titanium curette (TiCu), ultrasonic scaler (US), titanium brush (TiBr), and air abrasion with erythritol (AirPo). Each combination was tested in triplicate. Implants were photographed and analyzed with dedicated software to quantify cleaning efficacy. Results: The expert dentist achieved the highest average cleaning efficacy (36.6%). The most effective tools were the titanium brush (37.2%) and ultrasonic scaler (35.0%), followed by the titanium curette (28.1%) and air-abrasion (22.9%). The first two instruments were the least operator-dependent. Among the defect types, the 60° defect was the easiest to clean. Complete implant surface decontamination was not achieved in any scenario. Conclusions: Ultrasonic scalers and titanium brushes demonstrated the highest and most consistent cleaning efficacy, independent of operator skill level. Sixty-degree defects were the most amenable to cleaning. These findings underscore the need to tailor decontamination approaches based on defect geometry and to consider combining non-surgical methods with adjunctive or surgical interventions, which may ultimately enhance clinical decision-making and improve treatment outcomes.