Introduction
Peri-implantitis remains one of the most significant biological complications associated with dental implants, characterized by inflammation of the peri-implant mucosa and progressive bone loss. If left untreated, this condition can ultimately lead to implant failure. Traditional treatment protocols, including mechanical debridement, antiseptic rinses, and regenerative procedures, often have faced limitations in effectively removing biofilm from the complex microgeometry of implant surfaces.
The introduction of GalvoSurge® electrolytic cleaning technology represents an advancement in the non-invasive decontamination of dental implants. By using a low electrical current and an electrolytic solution to generate hydrogen bubbles, GalvoSurge® lifts and detaches the biofilm without mechanically altering the implant surface. In my practice, this innovation has led to more predictable outcomes in peri-implantitis therapy, and it is also increasingly integrated into contemporary treatment protocols.
This case report presents the management of a peri-implantitis in a 64-year-old female patient with a previously placed implant in region #21. The treatment included mechanical debridement, implant decontamination with GalvoSurge®, guided bone regeneration (GBR) using autologous and xenogeneic grafts, and comprehensive soft tissue management. The successful integration of GalvoSurge® into the surgical workflow highlights its role as a valuable adjunct in achieving long-term clinical stability and preserving the patient’s existing prosthetic restoration.
Initial situation
A 64-year-old female patient with a medical history of hypertension and a stroke in 2016, currently taking antiplatelet drugs (ASS 100 [aspirin]) and antihypertensive therapy (ramipril) was referred to our practice. She was a non-smoker and had no known allergies.
The patient presented with complaints of discomfort and inflammation in the area of implant #21. Her main request was implant retention with healthy osseous and gingival conditions. She mentioned that esthetics was not her primary concern, but rather implant preservation.
Her dental history included the placement of a dental implant in September 2018 in region #21, with guided bone regeneration (GBR). The patient followed the recommended postoperative care. In February 2019, a second surgical procedure was performed to expose the implant, assess the integration, and finalize the restoration. The implant was found to be stable, and the restoration was completed. There was no history of periodontal disease.
The clinical examination revealed good oral hygiene and satisfactory plaque control. Signs consistent with peri-implantitis were observed around implant #21, including suppuration, bleeding on probing, and increased probing depths (MV: 7 mm, V: 6 mm, DV: 6 mm, DP: 4 mm, P: 5 mm, MP: 4 mm). In addition, the periodontal Screening Index (PSI) was 0-4-1-1-2-1.
The radiographic analysis showed progressive bone loss around implant #21, with approximately 3–4 mm of mesial and distal bone resorption. Bone quality and volume in the remaining areas appeared adequate.
The prognosis of the remaining teeth was very good based on both clinical and radiographic evaluation. A diagnosis of peri-implantitis at implant #21 was established, with clinical and radiographic evidence of progressive bone loss and inflammation, and no systemic or local contraindications to potential surgical or regenerative treatment.
According to the ITI SAC Classification, the case was categorized as advanced to complex, both surgically and prosthodontically, due to the need for regenerative procedures and the involvement of esthetically sensitive areas.
Treatment planning
The treatment workflow included:
- The prosthesis was removed 2 weeks before non-surgical therapy, and a cover screw was inserted.
- Non-surgical basic supportive periodontal therapy: Bacterial Anti-Septic Protocol Plus (BAS +).
- Surgical treatment: GalvoSurge®, GBR using autologous bone chips, cerabone® plus and Jason® membrane.
- Second-stage surgery.
- Prosthetic rehabilitation with screw-retained crown on implant #21.
- Follow-up visits for control.
Surgical procedure
The patient preparation included a single-dose antibiotic prophylaxis with 2 g of amoxicillin administered 1 hour preoperatively. Intravenous sedation with Dormicum® (midazolam) was used in combination with local anesthesia, articaine 4% solution with an epinephrine solution (Ubistesin™ forte, 1:100,000), to ensure patient comfort (Figs. 3,4).
A full-thickness mucoperiosteal flap was raised with one distal releasing incision, intentionally placed to avoid scars and any tension in the esthetic zone (Figs. 5,6).
The flap provided sufficient access to the surgical area while preserving the interdental papillae and maintaining soft tissue integrity. Once the flap was elevated, granulation tissue was observed surrounding the implant and was carefully removed using mechanical debridement with carbon curettes (Figs. 7-10).
The prosthetic component was removed (Fig. 11), and the implant was prepared for GalvoSurge® decontamination. The patient was informed about the characteristic salty taste of the GalvoSurge® cleaning solution prior to application. The spray head was then attached to the internal connection of the implant. The electrolytic cleaning was initiated. The cleaning solution is passed through with a very low voltage for two minutes. Hydrogen bubbles are formed and lift the biofilm from the implant surface (Figs. 12-14).
The implant surface was decontaminated, including threads, undercuts, and microstructures (Fig. 15). The bone defect was assessed, and the site was now suitable for GBR. Autogenous bone was collected in the distal operating field to be used for the augmentation procedure (Fig. 16).
A sterile cover screw was placed. GBR was then performed using a combination of autologous bone chips, cerabone® plus, and a Jason® membrane (Figs. 17–20). The membrane was secured with buccal fixation pins and palatal sutures to ensure stability and support long-term volume maintenance.
Flap closure was performed at the surgical site, ensuring tension-free adaptation of the soft tissues (Figs. 21,22).
A control radiograph was taken, and the findings were satisfactory (Fig. 23).
Provisionalization was performed directly, using a removable denture, adapted with a splinted, bonded tooth to maintain esthetics and function during healing.
At the 14-day follow-up visit, sutures were removed. Healing was uneventful, and the surgical site appeared clinically healthy (Figs. 24,25).
In the second stage of surgery, a buccally transferred flap was performed to ensure a keratinized gingival band on the buccal side during the procedure (Figs. 26,27).
The crestal gingiva was then transferred to the buccal area (Figs. 28-32). A healing abutment was placed and sutures were closed (Fig. 33).
After the second stage of surgery, a follow-up radiograph was taken, and everything appeared to be in good condition. The healing abutment was properly positioned, and the implant was stable and well integrated (Fig. 34).
Two weeks following the second-stage surgery, the healing process progressed uneventfully. There were no complications, and the soft tissue adapted well, showing no signs of infection (Figs. 35, 36).
Prosthetic procedure
The time from surgery to the delivery of the final prosthesis was 4 months. The definitive restoration consisted of a screw-retained monolithic zirconia crown placed over a titanium base abutment. Fabrication of a new prosthesis was not necessary, as the existing one could be reinserted. Occlusion was carefully adjusted, and follow-up appointments confirmed stable soft tissue conditions with no clinical complications.
At 6 months after reinserting the prosthesis, clinical evaluation showed healthy peri-implant soft tissues. Probing depths were within normal limits, and bleeding on probing and suppuration were absent (Figs. 37,38).
The patient was also satisfied with the esthetic outcome, and the radiograph showed that the tissues surrounding the implant were in good condition (Figs. 39, 40).
At the 12-month follow-up visit, all clinical parameters remained within normal limits (Fig. 41).
Treatment outcomes
The use of GalvoSurge® in conjunction with GBR around implant #21 resulted in stable and healthy peri-implant soft tissue contours. At follow-up appointments, both clinical and radiographic findings confirmed successful integration and long-term stability of the implant. The patient expressed high satisfaction with the esthetic and functional outcome.
Author’s testimonial
The therapy worked very well, and the patient could be sent back to the referring dentist with stable hard and soft tissues. GalvoSurge® therapy itself is simple, but the surgical demands on bone augmentation and soft tissue management should not be underestimated. 12 months postoperatively, the clinical and radiographic conditions were stable.
The patient and the referring dentist were very satisfied. The implant was free of inflammation, and the major advantage was that no new prosthetics had to be made. The existing prosthetics could be reinserted.