An interview with Dr. Paul Weigl

What is this about?

• The interview explains how Straumann GalvoSurge®, an electrolytic cleaning system, tackles peri-implantitis by decontaminating and hydrophilizing titanium implant surfaces.
• Dr Paul Weigl traces the innovation’s 12-year research path, comparing its mode of action with brushes, curettes, lasers, and other conventional therapies.
• Readers learn the clinical workflow, surgical skills required, and criteria for choosing GalvoSurge-assisted regeneration versus implant explantation.

Dr. Weigl, during your long career at the Dental Clinic of the University of Frankfurt, you have led and advanced numerous R&D projects in the field of implantology. Peri-implant infections are among the most feared complications in implantology, for which there seem to be no easy solutions. Please give us a glimpse behind the scenes: How did the idea of an electrolytic cleaning process for titanium implants come about?

Paul Weigl: Peri-implant infections have been a concern for dentists and implantologists for quite some time, both academically and in practice. This is hardly surprising when we look at the prevalence figures for peri-implantitis: depending on the case definition, the figures range from around 40 to 60 percent—and that with more than one million implants placed annually in Germany and an estimated five to six million in Europe [4-6]. Together with my colleague Dr. Dipl.-Ing. Holger Zipprich, we first tried out many methods and approaches to restore implant surfaces contaminated with biofilms to their original condition – i.e., as they were immediately after unpacking an implant. From his training as an engineer, Dr. Zipprich was also familiar with the process used primarily in the automotive industry of immersing large metal sheets in an electrolytic bath and cleaning the surface perfectly by applying an electric current. There, and in fact throughout the sheet metal industry, metal parts are cleaned electrolytically—an industrial process that has been working very well for over 100 years. The crucial question now was whether a biofilm adhering to rough titanium implant surfaces could be removed electrolytically. To answer this question, Dr. Zipprich took a very pragmatic and efficient approach: he had an implant fixed buccally with the help of a fixed orthodontic appliance so that the entire surface was exposed to the oral environment. As expected, after a few days the implant was completely covered with biofilm. He was able to completely remove the biofilm from the implant electrolytically using a standard battery – and thus the first proof of function was achieved. As a very advantageous side effect, we also found that the rough surfaces became hydrophilic again.

This ingenious idea ultimately led to a revolutionary solution, and the Galvosurge system was described as a “game changer” in the dental press. How long ago were these very first experiments in the laboratory, and how did the success story continue?

Paul Weigl: Those first steps were taken more than twelve years ago. This was followed by more than seven years of intensive research work in an interdisciplinary team consisting of implantologist Dr. Urs Brodbeck, implantologist and specialist in reconstructive dentistry from Switzerland, specialist in implantology and plastic periodontology PD Dr. Dr. Markus Schlee from Forchheim, and scientist and dentist Dr. Christof Ratka. Together, we succeeded in bringing the Galvosurge system, our innovative solution for the effective cleaning and hydrophilization of implants, to market. The approval, market launch, and production of the GalvoSurge medical device required the capital-intensive founding and establishment of a medical device manufacturer. This company was completely acquired by the renowned Straumann Group in May 2023. The effectiveness of the method has already been proven in in vitro, animal, and clinical studies over the past few years [7-10]. Of course, research is continuing.

The market already offers titanium brushes, curettes, laser treatments, powder jet procedures—to name just a few examples of solutions for peri-implantitis therapy. How does GalvoSurge differ from other procedures, and what works better with the galvanic electrolytic cleaning method?

Paul Weigl: All of the products you mentioned attempt to remove the germ-laden biofilm from the outside. However, these ablative methods can only reduce the number of germs. Implant threads and undercuts are difficult to access, and it is also difficult to remove bacteria from the microstructures of the implant surface. In addition, the implant surface is damaged by brushing, scraping, or grinding. In a procedure known as implantoplasty, the exposed implant thread in the mouth is ground down and the surface is then polished. Both of these methods also remove the biofilm. The smoothed surface allows the peri-implant soft tissue to reattach, thereby restoring an inflammation-free seal against the oral environment. However, unlike GalvoSurge, this method does not hydrophilize the titanium surface. This makes reintegration of the polished implant surfaces more difficult. Galvosurge works differently: ions penetrate the biofilm and hydrogen bubbles dissolve it. A control unit is used to negatively charge the surface of a titanium implant, and electrolysis splits water molecules into OH and H+ ions. When H+ ions are attracted to the negatively charged implant surface, they penetrate the bacterial biofilm on the implant. Hydrogen bubbles form at every point on the implant surface, detaching the biofilm [11-14].

Sounds clinically complex – is it?

Paul Weigl: What sounds complicated is actually quite simple in practice: First, the implant abutment is removed so that the GalvoSurge spray head can be placed on the internal connection of the titanium implant. Then the electrolytic cleaning begins, during which the exposed implant surfaces are rinsed with an electrolyte solution through which a very weak electric current with very low voltage flows. After about two minutes, the hydrogen bubbles produced during electrolysis completely remove the biofilm from the implant surface—even from all clinically difficult-to-reach areas and from every crater or pore in the microstructure. The threads and microstructure are thus decontaminated without damaging the surface structure of the implant. In addition, the process can be used on almost all titanium implants. Another major advantage is the superhydrophilic surface created by GalvoSurge, which promotes re-osseointegration of the implant.

That sounds like a foolproof method for treating peri-implantitis. So is Galvosurge the long-awaited solution and a game changer?

Paul Weigl: The application of GalvoSurge is definitely “child's play”. However—and I want to emphasize this—sustainable peri-implantitis therapy includes further steps immediately following cleaning and hydrophilization to avoid the risk of rapid recurrence: namely, surgical regenerative therapy! After using Galvosurge, the rough implant surface is still exposed to the oral cavity and the peri-implant bone defect has not disappeared. To achieve the treatment goal of re-osseointegration, the bone defects must be treated with bone replacement materials and/or autologous bone and require soft tissue surgery, which can be challenging in some cases, to ensure covered healing. The surgical part is therefore demanding, as it requires experience in the use of augmentation techniques and materials and in the placement of membranes. The treating physician must be able to mobilize flaps and perform secure wound closure. These are crucial factors that are necessary for the success of peri-implantitis therapy with GalvoSurge.

Please summarize: How important is Galvosurge for effective peri-implantitis treatment?

Paul Weigl: GalvoSurge is the first, albeit crucial, step in regenerative peri-implantitis therapy with the aim of re-osseointegration. This means that the status quo prior to peri-implantitis should be restored.


Does this mean that simply removing the biofilm is not sufficient for sustainable peri-implantitis therapy? What does this mean in concrete terms for practice and for practitioners?

Paul Weigl: Correct. Simply removing the biofilm from a rough implant surface is not enough. Rather, complete regeneration of the osseous defect in combination with re-osseointegration of the previously contaminated implant surface is crucial for success! To ensure successful treatment, the following procedure should be followed: At the beginning of the procedure, the prosthetic superstructure and the implant abutment must be removed. A flap elevation is then performed and the granulation tissue is removed. After completing the two-minute electrolytic cleaning and hydrophilization, the site is optimally prepared for subsequent regenerative therapy with re-osseointegration. Complete regeneration of the peri-implant bone defect eliminates inflammation, minimizes the risk of peri-implantitis recurrence, and provides long-term protection against implant loss. It follows that mastery of certain surgical techniques is a decisive factor in the long-term success of peri-implantitis therapy with Galvosurge. Otherwise, recurrence is to be expected.


What requirements should GalvoSurge users meet, and what skills should they have?

Paul Weigl: Galvosurge users should have experience in regenerative work or be trained in regenerative therapy, for example as a specialist in periodontology, a specialist dentist in oral surgery, or an oral and maxillofacial surgeon. Alternatively, they should have studied surgical techniques intensively as part of their training and have undergone further training. It is important to compare the training programs offered by different providers in order to find the right one for surgical regenerative therapy. In other words, if Galvosurge users can treat alveolar ridge defects, they can successfully perform peri-implant therapy, and GalvoSurge represents a milestone in this field.


What role do general dentists who are not experienced in oral surgery or who do not perform regenerative and surgical procedures in their own practice play?

Paul Weigl: They play a crucial role, because it is the general dentists who initiate the entire process! First, they must recognize the disease and the need for action and be able to make the correct diagnosis. To do this, it is essential to know when the mucositis is reversible and when peri-implantitis is already present. Secondly, it is important to determine the extent to which the implant can be retained and when explantation is the best option for the patient. On the one hand, this is a decision that must be made on an individual basis, but there are also clear indications for implant removal. The anatomy of the defect, the implant position, and the restoration are decisive factors here.


I would like to pick up on that: When is explantation preferable to regenerative therapy?

Paul Weigl: In principle, GalvoSurge followed by regenerative therapy can, in the best case, restore the status quo prior to peri-implantitis. However, it cannot eliminate all risk factors for peri-implantitis. In other words, if risk factors remain, peri-implantitis is highly likely to recur. An impressive example of this is when the implant position is the cause of bone loss because the implant was placed too far buccally or is otherwise incorrectly positioned – in this case, explantation should be performed. Even purely horizontal bone loss cannot currently be predicted to regenerate. Therefore, the use of GalvoSurge is not advisable in this case. The classification of the regeneration potential of peri-implant defects introduced in the literature [15] is helpful in deciding whether an implant can be treated successfully with GalvoSurge in combination with regenerative therapy or whether it should be explanted. RP1 defects, which are characterized by a typical bowl-shaped defect in which the crestal defect margin is at the level of the implant shoulder, have the best chance of success and regenerate completely in a predictable manner.

Let's return to the important role of general dentists, who initiate the entire process in the first place...

Paul Weigl: …and, above all, are able to assess the implant-prosthetic restoration in this regard. Therefore, the following applies: Thirdly, the condition of the implant prosthesis should be assessed as a factor influencing the recurrence of mucositis/peri-implantitis. Is the design of the restoration too bulky and possibly a contributing factor? Recent studies increasingly show that the shape of the abutment-crown complex – in particular the exit angle formed by it – has a clinically relevant influence on the development of mucositis [16,17]. Here, I recommend classifying prosthetics as sufficient, insufficient but modifiable, and insufficient. If necessary, a temporary restoration must be created for the duration of the peri-implantitis therapy and a new implant prosthesis must then be fabricated. Dentists should clearly communicate these points to their patients. GalvoSurge offers a practical option for saving the implant and avoiding explantation, either in your own practice or by referral to a specialist colleague. I appeal to all colleagues to adopt this interdisciplinary approach, as it is the key to clinical success—as is the case for many successful treatment approaches and solutions in medicine, this also applies to practical and sustainable peri-implantitis therapy with GalvoSurge.

Thank you very much, Dr. Weigl, for your openness and interesting comments.

Key takeaways

• GalvoSurge removes biofilm in roughly two minutes via low-voltage electrolysis, producing a superhydrophilic surface that promotes re-osseointegration.
  
• Lasting success demands follow-up regenerative bone and soft-tissue surgery plus thoughtfully designed prosthetics to minimize recurrence.
  
• By combining precise case selection with interdisciplinary care, dentists can often save implants, reducing medical complications and economic costs.