Mechanical Debridement of a Peri-Implant Osseous Defect With a Novel Titanium Brush and Reconstruction With Porous Titanium Granules: A Case Report With Reentry Surgery

Introduction: The scientific evidence for one specific treatment strategy for peri-implant osseous defects is scarce. It will be important to develop methods for efficient decontamination of ailing implants and for reconstruction of lost peri-implant osseous attachment. Access for instrumentation of narrowperi-implant defects is difficult, and to the best of our knowledge, this case report describes, for the first time, the use of a novel titanium brush for mechanical debridement of the implant surface and the defect. Histologic evidence that porous titanium granules (PTGs) support reosseointegration has recently been reported. Case Presentation: A healthy female patient had two implants placed for prosthetic rehabilitation of teeth #21 and #23. In conjunction with second-stage surgery, a buccal osseous defect was disclosed at the most anterior implant. The narrow and deep defect was debrided with a novel titanium brush, chemically decontaminated with 3% H2O2, and filled with PTGs. In conjunction with second-stage surgery, after 6 months of submerged healing, the peri-implant defect was almost completely healed, with only a 3 mm osseous defect remaining at the coronal part of the implant. The PTG bone replacement graft appeared completely integrated in new bone, with no signs of loose particles. At clinical and radiographic examinations, 24 months after surgical treatment, no signs of inflammation or reoccurring bone loss were seen. Conclusion: To the best of our knowledge, this case report demonstrates, for the first time, that debridement with a titanium brush, 3% H2O2, and reconstruction with PTGs is a potential treatment modality of narrow peri-implant osseous