Flapless Surgical Treatment of Peri-implantitis

Implant-supported restorations were unscrewed and modified if necessary (biofilm control). All the restorations were relocated at the end of each intervention session. After local anesthesia, a periodontal ultrasonic stainless-steel tip was used for supra- and sub-mucosal mechanical debridement. Next, a Columbia 4R/4L curette was used around the implant in a circular motion until a bone exposure of 2-3 mm was achieved. Mucosal curettage was simultaneously performed to remove the granulation tissue. After obtaining access to the implant surface, ultrasonic instrumentation was repeated and air polishing with an erythritol powder was applied submucosally with the aim of a periodontal probe. Hydrogen peroxide 3% was used to irrigate the implant surface for 2 minutes, followed by a rinse with saline. Oral hygiene instructions were given. Systemic antibiotics, when prescribed, were metronidazole or azithromycin