What is this about

This case report illustrates the clinical management of peri-implantitis using GalvoSurge®^® for implant surface decontamination.

• Shows the step-by-step use of GalvoSurge®^® to remove biofilm and promote re-osseointegration.
• Describes the surgical protocol and clinical outcomes following regenerative treatment.
• Highlights the potential of GalvoSurge®^® as a minimally invasive alternative for managing peri-implant infections and preserving implant stability.

Introduction

Dental implants are now a well-established option for oral rehabilitation. However, biological complications such as peri-implant mucositis and peri-implantitis are increasingly common and, if left untreated, can compromise esthetics, function, and implant stability, potentially leading to implant loss. Effective decontamination of the implant surface remains one of the greatest challenges in peri-implantitis management. The electrolytic method has recently emerged as a promising approach for removing biofilm from titanium surfaces through electrolysis without altering the implant’s microstructure. In vitro studies have demonstrated that the electrolytic method can completely eliminate mature biofilm and even promote re-osseointegration of previously infected implants. Clinical data, though still limited, report favorable outcomes, including stable bone gain and minimal inflammation over 18 months. The following clinical case illustrates the use of GalvoSurge^® for implant surface decontamination, combined with guided bone regeneration, to successfully manage peri-implantitis and restore peri-implant tissue health.

Initial situation

This case report concerns a 79-year-old Caucasian male in good general health, with no systemic conditions, a non-smoker, and not on any medication. Around 20 years earlier, the patient had received four implants in the posterior mandible, two in each quadrant.

The patient showed stable periodontal health and attended regular follow-up visits, maintaining good oral hygiene with consistently low plaque indices.

Despite primary prevention of peri-implant diseases, including routine professional removal of supra- and submarginal plaque biofilm and ongoing oral hygiene reinforcement, the implants in sites #47 and #37 presented signs of peri-implantitis (Fig. 1).

According to the literature, several risk factors are associated with the development of peri-implant diseases. These include a history of periodontitis, poor plaque control, lack of compliance with supportive peri-implant maintenance programs, rapidly progressing periodontitis (grade C), probing depths of ≥ 5 mm on the remaining dentition, and insufficient keratinized mucosa (KM).

In this case, the patient’s history of periodontitis places him at increased risk for peri-implantitis compared with individuals without such a background. The implants also exhibit a minimal amount of KM. Furthermore, one could speculate that he had already lost teeth #46, #47, #36, and #37 due to periodontal complications, and that self-performed hygiene in this area was more difficult for the patient.

The screw-retained prosthetic restorations were removed, and healing abutments were placed to provide optimal access for subsequent electrolytic decontamination (Figs. 2,3).

Clinically, the peri-implant mucosa was edematous, with suppuration and bleeding on probing, and probing depths ≥ 9 mm (Figs. 4,5).

Periapical radiographs revealed peri-implant bone resorption and a circumferential defect around implants #37 and #47 (Figs. 6,7).

Treatment planning

Initial treatment included a professional hygiene session and implant site decontamination using mechanical methods (gentle ultrasonic approach) and local antiseptics (chlorhexidine). This initial step is carried out one week prior to surgery in order to minimize soft tissue inflammation.

The configuration and depth of the infra-osseous defect determine the therapeutic approach. In this case, the peri-implant defect presented a crater-like morphology, classified as a class Ic defect according to the definition by Monje et al., corresponding to a contained defect with four bony walls and good regenerative potential.¹

Therefore, regenerative surgeries were planned for both quadrants on the same day to reduce the overall treatment cost and to meet the patient’s preference for minimizing the number of appointments.

Surgical procedure

After anesthesia, a full-thickness flap was raised, and releasing incisions were made to improve visibility of the peri-implant defects (Fig. 8). Healing abutments were removed to allow subsequent use of the GalvoSurge^® device for electrochemical decontamination (Fig. 9).

Granulation tissue within the bone defect was carefully removed using metal curettes, and the implant surface was inspected and any residual hard deposits gently removed with the same curettes (Figs. 10,11).

Implant surface decontamination was then performed using the electrolytic method (GalvoSurge^®, Straumann Group, Basel). The electrolytic device head was placed in direct contact with the implant collar, allowing the removal of the biofilm. Hydrogen bubble formation at the implant surface confirmed the mechanical detachment of the biofilm (Figs. 12,13).

After two minutes of electrolytic decontamination, the bony defect was filled with a 50:50 mixture of xenograft and autogenous bone harvested from the mandibular oblique ridge using a bone scraper (Fig. 14).

The grafted site was covered with a resorbable collagen membrane, and the site was closed without tension using 5/0 polytetrafluoroethylene (PTFE) sutures (Figs. 15-21).

The same procedure was performed for the contralateral implant at site #37 (Figs. 22–29).

The transmucosal implants were left uncovered, and an intraoral radiograph was taken (Figs. 30,31).

The patient was instructed on postoperative oral hygiene: rinsing with 0.2% chlorhexidine digluconate starting on the second postoperative day twice daily for two weeks, brushing with a soft surgical brush, and avoiding any interdental cleaning for two weeks. Antibiotic therapy was prescribed (amoxicillin, 500 mg three times a day for seven days).

At the two-week follow-up, healing was uneventful; however, a soft tissue dehiscence was observed between the two implants. (Fig. 32-34).

This was an expected complication due to the quality of the soft tissue, which remained inflamed despite non-surgical therapy. This finding is consistent with reports from other authors who observed similar healing patterns.^2,3

Prosthetic procedure

At six weeks post-surgery, the soft tissues had completely healed, and the prostheses were re-screwed onto the implants (Fig. 35-37).

A six-week period is generally sufficient for functional reloading of implants that are already osseointegrated, as bone healing is not the primary concern in such cases.

At the one-year follow-up, intraoral radiographs were taken, showing successful bone fill of the defects and reestablishment of bone levels. Probing depths around both implants were ≤ 4 mm, with no bleeding on probing or suppuration (Figs. 38-41).

The following images correspond to the baseline, postoperative, and one-year follow-up periods of the left and right implants (Figs. 42–47).

These clinical and radiographic results remained stable over time, and measurements at the three-year follow-up showed no signs of inflammation on implants #47 and #36 (Figs. 50-53). A slight mucositis was noted on implant #37 (Fig. 51), despite the patient’s inclusion in a strict implant maintenance program (SPIC).⁴

The recently published EFP guidelines^5,6 do not provide a definitive recommendation on the frequency of follow-up visits for patients treated for peri-implantitis. Nevertheless, considering the patient’s periodontal risk profile, follow-up visits were advised at least every six months.