The Adjunctive Effect of a Titanium Brush in the Non-Surgical Treatment of Peri-Implantitis

Inclusion Criteria: * Adult patients with ≥18 years of age. * Ability to understand all the study procedures and to comply with them along the entire study period. Ability and willingness to give written informed consent. * An adequate level of oral hygiene (plaque index ≤ 25%) (O'Leary et al., 1972). * Treated periodontal disease. * Presence of at least one titanium implant with peri-implantitis \[i.e., presence of bleeding and/or suppuration on gentle probing with probing depth of ≥6 mm, and progressive bone loss. In the absence of initial radiographs, a bone level ≥2 mm apical to the most coronal part of the intrabony portion of the implant will be used as threshold of disease (Romandini et al., 2021)\]. * Horizontal and vertical peri-implant bone defects. * Implant function time ≥ 1 year. * Presence of ≥2mm of keratinized peri-implant mucosa. * Screw-retained single and multiple restorations. Exclusion Criteria: * Untreated periodontitis. * Smokers \> 10 cigarettes per day. * Local or systemic diseases that would interfere with routine periodontal therapy (i.e., uncontrolled diabetes mellitus, cancer, HIV, chronic high-dose steroid therapy, metabolic bone disease, radiation, immunosuppressive disease, hepatic dysfunction, immunosuppressive disease, autoimmune disease). * Pregnant or lactating women. * Previous surgical and non-surgical treatment of affected implants at least 12 months prior to the beginning of the study. * Radiographic peri-implant bone loss \> two-thirds. * Mobility of the implant. * Known allergy or intolerance to macrolides. * Use of systemic antibiotics during the last 3 months. * Need of endocarditis prophylaxis.