Clinical Oral Investigations

, Volume 23, Issue 4, pp 1921–1930 | Cite as

Clinical evaluation of non-surgical cleaning modalities on titanium dental implants during maintenance care: a 1-year follow-up on prosthodontic superstructures

  • Kristina Emily Schmidt
  • Thorsten Mathias Auschill
  • Anton Sculean
  • Nicole Birgit ArweilerEmail author
Original Article



To investigate tissue health around implants with newly attached superstructures over 12 months of preventive maintenance appointments and instrumentation when necessary.

Material and methods

In a randomized, split-mouth study 32 implants (8 participants with 4 implants each) received followed-up care every 3 months after superstructure attachment. Implants and superstructures were randomly assigned to four treatment groups and treated if necessary: (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) rubber cup polishing (CON). Probing depths (PDs), bleeding on probing (BOP), modified gingival (mucosal) bleeding index (GBI) around implants, and full-mouth Plaque Control Record (PCR) were measured every 3 months. Clinical attachment levels (CALs) and height of keratinized mucosa (KM)/gingival margins (GMs) for implants/teeth and PD, BOP, and GBI for teeth were documented at baseline, 6 months, and 12 months. Matrix metalloproteinase 8 (MMP-8) and periopathogens were measured at baseline and 12 months.


Participants exhibited minimal signs of periodontal inflammation with statistically significant PD improvement (3.0 ± 0.2 to 2.8 ± 0.3 mm; p = 0.022) and overall CAL (4.3 ± 0.8 to 4.0 ± 0.7 mm; p = 0.048) after 1 year. Implants showed no statistically significant differences (p > 0.05) between or within groups at baseline or 12 months for any parameter, except MMP-8 decreased significantly for PS (14.50 ± 17.58 to 4.63 ± 7.56 ng; p = 0.044), and after 12 months, PCR showed a significant difference between TC and PS (p = 0.018).


Treatment was necessary as inflammation was observed around newly placed superstructures within the first year of maintenance care. All tested treatment modalities yielded comparable clinical improvements.

Clinical relevance

Early assessment and diagnosis of mucositis and regular maintenance can promote long-lasting implant health.


Titanium dental implants Maintenance Individualized care Oral hygiene Biocompatibility 


Funding source

This is a continuation of a study [18] that was financially supported by an unrestricted grant from the Oral Reconstruction Foundation (previously Camlog Foundation; Grant CF41203), Basel, Switzerland. The design, documentation, and analyses of this study were carried out independently. No financial conflict of interest exists between the authors and any previous funding received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Medical Ethics Committee, Philipps-University Marburg in Germany (no. 159/12) and conducted in accordance with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice guidelines as well as the Declaration of Helsinki.

Informed consent

All participants gave their informed consent prior to their inclusion in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PeriodontologyPhilipps-University MarburgMarburgGermany
  2. 2.Department of PeriodontologyUniversity of BernBernSwitzerland

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