Titanium Brush Research Articles

Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial.

Objectives: To compare the efficacy of three mechanical procedures for surgically treating peri-implantitis. Materials and Methods: In a randomized, prospective, parallel-group study, 47 patients with peri-implantitis were treated with (a) plastic curettes (n = 15 patients, 25 implants), (b) an air-abrasive device (Perio-Flow®, n = 16 patients,22 implants), or (c) a titanium brush (Ti-Brush®, n = 16 patients, 23 implants). Patients were assessed for the following measures at three timepoints (baseline, and three and six months after surgery): plaque index, bleeding on probing, gingival index, probing pocket depth (PPD), relative attachment level, and bone loss. Treatment outcome was considered successful when the implant was still present with PPD ≤ 5 mm, no bleeding on probing, and no further mean bone loss ≥ 0.5 mm. Results: A greater reduction of gingival index and PPD was observed in the titanium brush group than in the other groups at six months (P < 0.001). Relative attachment level decreased from baseline in each group at three months but was more marked in the titanium brush group (P < 0.001). At six months, there was less bone loss in the titanium brush group than in the plastic curette group (P < 0.001; linear mixed model and Kruskal–Wallis). A successful outcome was observed in 22% of implants in the plastic curette group, 27% in the Perio-Flow® group, and 33% in the Ti-Brush® group. Conclusions: The titanium brush and glycine air-polishing device were more effective than the other methods, but treatment success remained low. Combining mechanical procedures with antimicrobials and/or antibiotics might be a more effective strategy and warrants careful investigation.

The effect of five mechanical instrumentation protocols on implant surface topography and roughness: A scanning electron microscope and confocal laser scanning microscope analysis.

To evaluate in vitrothe changes in implant surface topographyand roughness of commercial implants after instrumentation with five decontamination protocols. Seventy-two titanium implants with a sandblasted and acid-etched (SLA) surface were placed 5mm supra-crestally. Five groups of twelve implants were instrumented with the following protocols: a metal scaler tip (SCAL), a thermoplastic scaler tip (PEEK), a round titanium brush (RBRU), a tufted brush with titanium bristles (TNBRU), and a glycine-based air-powder abrasive (GLYC). A sixth group with untreated implants was used as control. Scanning electron microscope and confocal laser scanning microscope were utilized to evaluate the changes in the implant surfaces. The SCAL caused pronounced macroscopic alterations and damage of the implant surface, the PEEK left remnants of the plastic tip in the implant surface, and both titanium brush groups flattened the thread profile, while minimal alterations were observed in the GLYC. When compared to the control group, the roughness parameters (Sa) in the buccal aspect increased in the thread area of SCAL, and a minor reduction was observed in the PEEK while in the other groups, these values remained unchanged. In the valley areas, however the RBRU, TNBRU, and GLYC experienced a significant reduction (smoothening) indicating different accessibility of the decontamination protocols to the thread and valley. Similarly, the buccal aspects had more pronounced changes than those in the palatal aspect. Within the limitations of this in vitro investigation, the tested protocols induced different macroscopic alterations and surface roughness changes that varied in the thread and valley area.

The adjunctive effect of a titanium brush in implant surface decontamination at peri-implantitis surgical regenerative interventions: A randomized controlled clinical trial.

To evaluate an additional mechanical approach, a titanium brush, in the implant surface decontamination performed during the regenerative surgical therapy of peri-implantitis. A randomized double-blinded clinical trial, with a 1-year follow-up, was carried out. After a hygienic phase, peri-implantitis-affected implants were randomly assigned to a control or to a test group. In the control group, implant surface was decontaminated both mechanically and chemically with 3% H2 O2 and plastic ultrasonic scalers, respectively, while in the test group, a titanium brush was also applied. Intrabony defects in both groups were filled with an alloplastic material (β-tricalcium phosphate and hydroxyapatite) and covered with a collagen membrane. The primary outcome was the reduction in probing pocket depth (PPD) at the deepest site. Thirty patients were included, 15 in each group. At 12months, reduction in PPD was 4.87 (standard deviation [SD] 1.55) mm and 2.85 (SD: 1.91) mm, respectively (p=0.009). The correspondent figures for residual PPD were 3.6 (SD: 0.91) and 4.92 (SD: 1.26) mm, respectively (p=0.007). The additional use of a titanium brush during regenerative treatment of peri-implantitis resulted in statistically significant benefits in terms of PPD reduction after 12months.

Effects of Titanium Curette, Air Polishing and Titanium Brush on Implant Surface Roughness Using Scanning Probe Microscopy

Background: In peri-implant mucositis and peri-implantitis, inflammation extends to peri-implant tissue, which is associated with bone loss and can cause implant failure. To regain peri-implant tissue health, debridement and cleaning of implant surface without damaging it must be performed prior to any other treatment. Thus, this study aimed to assess the effect of titanium curette, air polishing and titanium brush on implant surface roughness. Methods: In this in vitro, experimental study, 2 SNUC titanium implants with 6 mm diameter and 10 mm length were sectioned into 10 pieces. Implant pieces were randomly divided into 4 groups (n=5) for polishing with titanium curette, air polishing, titanium brush and no intervention (control group). Surface roughness was determined under a scanning probe microscope (SPM) by measuring Ra and Rz parameters. Data was analyzed using Kruskal-Wallis and Mann-Whitney tests at significance level (α) of 0.05. Results: Ra and Rz values of the four groups were not significantly different (P=0.002). Air polishing group showed the lowest surface roughness and titanium curette group showed the highest surface roughness followed by titanium brush group, compared to control group. Conclusions: Air polishing group showed the lowest surface roughness compared to control group but an appropriate debridement technique should be chosen based on the treatment chosen for periimplantitis.

In Vitro Comparison of the Efficacy of Peri-Implantitis Treatments on the Removal and Recolonization of Streptococcus gordonii Biofilm on Titanium Disks.

Objective: To compare the efficacy of four commonly used clinical procedures in removing Streptococcus gordonii biofilms from titanium disks, and the recolonization of the treated surfaces. Background: Successful peri-implantitis treatment depends on the removal of the dental biofilm. Biofilm that forms after implant debridement may threaten the success of the treatment and the long-term stability of the implants. Methods: S. gordonii biofilms were grown on titanium disks for 48 h and removed using a plastic curette, air-abrasive device (Perio-Flow®), titanium brush (TiBrush®), or implantoplasty. The remaining biofilm and the recolonization of the treated disks were observed using scanning electron microscopy and quantified after staining with crystal violet. Surface roughness (Ra and Rz) was measured using a profilometer. Results: S. gordonii biofilm biomass was reduced after treatment with Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05), but not plastic curette (p > 0.05), compared to the control group. Recolonization of S. gordonii after treatment was lowest after Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05 vs. control), but there was no difference between the plastic curette and the control group (p > 0.05). Ra and Rz values ranged from 1–6 µm to 1–2 µm and did not differ statistically between the control, plastic curette, Perio-Flow, and TiBrush groups. However, the implantoplasty group showed a Ra value below 1 µm (p < 0.01, ANOVA, Tukey). Conclusions: Perio-Flow®, TiBrush®, and implantoplasty were more effective than the plastic curette at removing the S. gordonii biofilm and preventing recolonization. These results should influence the surgical management of peri-implantitis.

Use of TiBrush for surface decontamination at peri-implantitis sites in dogs: Radiographic and histological outcomes.

The aim of the present study was to evaluate the efficacy on the healing of mechanical decontamination of infected implant surfaces performed with a titanium brush. Mandibular premolars and first molars were extracted bilaterally in six dogs. After 3months, two unsubmerged implants were installed on both sides of the mandible. Three months later, peri-implantitis was induced with ligatures for 3months and then removed. After 1month, surgical mechanical decontamination of the surfaces was performed either with a rotatory titanium brush or gauzes soaked in saline. Five month later, biopsies were retrieved. Evaluations on X-rays taken of the mesiodistal plane and on histological slides prepared in a buccal-lingual plane were performed. After the induction of peri-implantitis, a mean marginal bone loss of 2.6±0.6mm and 1.9±1.0mm was observed in the brush and gauze groups by X-ray, respectively. Five months after treatment, a mean gain of marginal bone of 0.6mm was obtained in both groups. The mean closures of the vertical and horizontal defects were 0.6mm and 0.6mm for the brush group, and 0.8mm and 0.5mm for the gauze group, respectively. Histologically, a loss of attachment at the buccal aspect of 2.2±0.9mm in the brush group and of 2.3±0.5mm in the gauze group was found. No statistically-significant differences were found after the treatment. Mechanical implant surface decontamination performed with a rotatory titanium brush resulted in a marginal bone level gain, yielding a low content of inflammatory infiltrate close to the marginal bone.

The effect of a decontamination protocol on contaminated titanium dental implant surfaces with different surface topography in edentulous patients

Objectives: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics.Materials and methods: Twelve implant pieces with an Osseotite® surface and 12 implant pieces with a Ti-Unite® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush™) and chemical (3% H2O2) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM.Results: Complete decontamination was achieved in five out of 24 implants (four Osseotite® and one Ti-Unite®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite® and 729.09 for Ti-Unite® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered.Conclusions: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H2O2) can achieve complete decontamination of implant surfaces in edentulous patients.

The effect of different cleaning methods on the surface and temperature of failed titanium implants: an in vitro study.

The aims of this in vitro study are to compare the efficacy of different cleaning methods in removing debris of failed implants and to detect thermal changes of the implants treated by various scaling instruments. Twenty-seven failed implants and two unused implants as control were included to this study-group 1: plastic curette (P), group 2: titanium curette (T), group 3: carbon curette (C), group 4: titanium brush (TB), group 5: Er:YAG laser (laser 1 (L1) 100mJ/pulse at 10Hz), group 6: Er:YAG laser (laser 2 (L2) 150mJ/pulse at 10Hz), group 7: Er:YAG laser (laser 3 (L3) 200mJ/pulse at 10Hz), group 8: ultrasonic scaler appropriate for titanium (US), group 9: air abrasive method (AA) + citric acid, and group 10: implantoplasty (I). The changes on the treated/untreated titanium surfaces and remnant debris were observed by scanning electron microscopy (SEM). Temperature of the implants before and after treatment was detected using a thermocouple. The use of air abrasive and citric acid combination and Er:YAG laser groups was found as the best methods for the decontamination of titanium surfaces of failed implant. When the hand instruments were compared, titanium curette was found better than both the plastic and the carbon curettes which leave plastics and carbon remnants on the titanium surface. The temperature was higher after hand instrumentation when compared to other experimental groups (p < 0.05). Within the limitations of the present in vitro model, it can be concluded that the best method for decontamination of the implant surface is the use of air abrasives and Er:YAG laser.

Peri-Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnosis, Clinical Implications, and a Report of Treatment Using a Combined Therapy Approach.

Abstract The clinical condition involving dental implants, characterized by soft tissue inflammation, bleeding, suppuration and rapid bone loss is widely known as peri implantitis. The main objective in the treatment of peri-implantis is to arrest the progression of the disease and at the same time to keep the dental implant in the mouth solving the inflammations signs of bleeding and pain. The aim of this paper is to highlight the effectiveness of the use of titanium brush and antimicrobial photodynamic therapy (aPDT) to decontaminate the implant surface, in association with regenerative procedures by means of autologous bone and demineralized bovine bone mineral (DBBM) in the treatment of peri-implantitis defects.

Electrochemical Treatment of Contaminated Titanium Surfaces in Vitro: An Approach for Implant Surface Decontamination

Bacterial contamination on titanium implants can cause inflammation and eventually implant failure. Currently used methods for decontamination of implants have demonstrated limited success. Metal surfaces can be disinfected electrochemically. However, the effect of electrochemical treatments on biofilm-contaminated titanium is largely unknown. We hypothesized that electrochemical treatments are able to safely remove organic contamination and bacteria from titanium implants without altering their surfaces. This study was designed to assess the electrochemical properties of bacteria-contaminated surfaces in order to develop new treatments to clean titanium. Surface morphology, composition, bacterial load, and electrochemical properties of polished titanium discs were analyzed before and after biofilm contamination and subsequent decontamination with various electrochemical methods. The effect of the combination of the electrochemical with titanium brush cleaning was also evaluated. Results were then analyzed and compared to baseline readings (prior to contamination) using repeated measures ANOVA. Biofilm contamination increased the levels of carbon, nitrogen, and live bacteria on titanium surfaces while reducing their open circuit potential and corrosion resistance. Optimized electrochemical treatments with alternating current (-2.3 mA, + 22.5 μA) and voltages (1.8 V), were bactericidal and able to completely decontaminate saliva-contaminated titanium surfaces within 5 min while preserving surface integrity and histological quality of mammalian tissues. Furthermore, with the aid of mechanical brushing, the optimized electrochemical treatment was able to achieve complete decontamination of biofilm-contaminated Ti surfaces. The electrochemical treatment seems to be promising and well worth investigating for the clinical management of peri-implant infections.

Cell Attachment Following Instrumentation with Titanium and Plastic Instruments, Diode Laser, and Titanium Brush on Titanium, Titanium-Zirconium, and Zirconia Surfaces.

The aim of this study was to evaluate the surface characteristics and gingival fibroblast adhesion of disks composed of implant and abutment materials following brief and repeated instrumentation with instruments commonly used in procedures for implant maintenance, stage-two implant surgery, and periimplantitis treatment. One hundred twenty disks (40 titanium, 40 titaniumzirconium, 40 zirconia) were grouped into treatment categories of instrumentation by plastic curette, titanium curette, diode microlaser, rotary titanium brush, and no treatment. Twenty strokes were applied to half of the disks in the plastic and titanium curette treatment categories, while half of the disks received 100 strokes each to simulate implant maintenance occurring on a repetitive basis. Following analysis of the disks by optical laser profilometry, disks were cultured with human gingival fibroblasts. Cell counts were conducted from scanning electron microscopy (SEM) images. Differences in surface roughness across all instruments tested for zirconia disks were negligible, while both titanium disks and titaniumzirconium disks showed large differences in surface roughness across the spectrum of instruments tested. The rotary titanium brush and the titanium curette yielded the greatest overall mean surface roughness, while the plastic curette yielded the lowest mean surface roughness. The greatest mean cell counts for each disk type were as follows: titanium disks with plastic curettes, titanium-zirconium disks with titanium curettes, and zirconia disks with the diode microlaser. Repeated instrumentation did not result in cumulative changes in surface roughness of implant materials made of titanium, titanium-zirconium, or zirconia. Instrumentation with plastic implant curettes on titanium and zirconia surfaces appeared to be more favorable than titanium implant curettes in terms of gingival fibroblast attachment on these surfaces.

Mechanical and chemical implant decontamination in surgical peri-implantitis treatment: preclinical "invivo" study.

The aim of the present study was to evaluate the effect of a titanium brush and chemical agents following surgical treatment of experimental peri-implantitis. Six implants were installed in the mandible of eight beagle dogs (unit of analysis) 3months after tooth extraction. Experimental peri-implantitis was induced 3months later. The defects were randomly allocated in three treatment groups: (a) TiBrush(™) +sodium hypochlorite+chlorhexidine (TBH), (b) TiBrush(™) +chlorhexidine (TB), (c) an ultrasonic device+chlorhexidine (US). The distal implant in each hemimandible was used as control, and no treatment was done. Clinical and histological measurements were performed after 3months of healing. All treatment procedures resulted in statistically significant improvements of all clinical parameters. Histomorphometrical analysis revealed no statistically significant differences between treatment groups in terms of woven bone height (primary outcome). However, there were differences between test and control groups in terms of inflammation, bone defect depth and bone refill without differences between TBH and TB groups. Resolution of peri-implantitis after access surgery and decontamination of peri-implant surfaces with TiBrush(™) with or without sodium hypochlorite is possible. However, the concomitant use of sodium hypochlorite has minor effect on treatment outcomes.

Experimental models for contamination of titanium surfaces and disinfection protocols.

The aim of this pilot study was to describe an invitro model of peri-implantitis microcosm for contamination of titanium surfaces and an invivo model for evaluating different disinfection strategies of titanium surfaces. Biofilms were grown invitro for 30days on sandblasted large-grit acid-etched (SLA) Ti discs (n=69) in a constant depth film fermentor (CDFF) associated with peri-implantitis conditions. Four Swedish loop rabbits were randomly allocated in three test groups (T1 , T2 , T3 ) and one control group (C). In group C, two sterile SLA Ti discs were implanted/fixed in each tibia. In the test groups (to evaluate the potential of different surface disinfection techniques), one sterile and three previously disinfected SLA Ti discs were placed following different disinfection protocols: group T1 : the discs were treated with a titanium brush - TiB; group T2 : the discs were treated with the combination of TiB and photodynamic therapy; and group T3 : the discs were treated with TiB and 1%NaOCl plus 0.2%CHX. Tensile strength test and qualitative histological analysis were performed on all 16 discs after 4weeks of healing. Thirty days following CDFF emulating peri-implantitis microcosm, all SLA Ti discs had a mean total viable aerobes and facultative anaerobes count of 8.06 log10 CFU/biofilm and anaerobes 8.32 log10 CFU/biofilm. Before implantation/fixation on the tibia, differences of log10 CFU/biofilm counts between control and test groups after post hoc adjustment were highly significant (P<0.001). In the invivo analysis, group C exhibited the highest tensile strength (67.60N [25.64-127.02]) and the histological sections revealed the presence of dense mature bone in direct contact with the disc surface. The analysis at the test groups showed that T2 presented with the highest tensile strength in comparison with the other two test groups. The invitro model used in this study provides a valuable and reproducible tool for evaluating the invitro dynamics of the peri-implantitis microcosm biofilm and for contaminating in a reproducible manner titanium surfaces. At the same time, the invivo model used in this study provides a standardised mode of evaluating disinfection modalities of previously infected titanium surfaces.

In vitro evaluation of peri-implantitis treatment modalities on Saos-2osteoblasts.

Mechanical treatment of the implant surface through surgical approach is recommended to control peri-implantitis. Few conclusive data exist about the physical and chemical properties of treated titanium surfaces and their biocompatibility towards osteoblasts. This invitro study aimed to evaluate four clinical procedures: plastic curette, air-abrasive device (Perio-Flow(®) ), titanium brush (Ti-Brush(®) ) and implantoplasty in terms of biocompatibility and osteogenic effect when cultured with Saos2. Titanium disks were treated with plastic curette, air-abrasive device (Perio-Flow(®) ), titanium brush (Ti-Brush(®) ) and implantoplasty. Their surface microtopography (SEM), chemical composition (EDX) and wettability were evaluated. After seeding with Saos-2, cell morphology (1h, 24h), viability (three and 6days) and alkaline phosphatase (ALP), osteoprotegerin (OPG) and osteocalcin (OCN) production (7days) were analyzed. Control, plastic curette, Perio-Flow(®) and Ti-Brush(®) groups presented complex microstructures including craters and micropits, whereas the implantoplasty group appeared much smoother (SEM). Titanium, oxygen, aluminium and carbon were identified as the main components in all disks with a decrease in the percentage of oxygen, carbon and an increase in the percentage of titanium in the implantoplasty group (EDX). Implantoplasty disks were also significantly more hydrophilic than the other ones, whose surfaces appeared hydrophobic. Saos-2 showed no morphological difference at 1h. At 24h, they appeared round shaped in all groups, except the implantoplasty group where the cells appeared stretched and elongated. Viability was similar in all groups, but significantly higher in the Perio-Flow(®) than the control group at day six. ALP, OPG and OCN protein expression at 7days was similar in all groups. Although implantoplasty was the only modality to modify the titanium surface morphology, composition and wettability, all treatment modalities promoted ALP, OPG and OCN production and appeared as valid approaches in terms of biocompatibility.

Conservative Surgical Treatment of a Peri-Implant Defect with Open Flap Debridement with a Rotating Titanium Brush: A Case Report of a 2 Year Follow-Up

Conservative Surgical Treatment of a Peri-Implant Defect with Open Flap Debridement with a Rotating Titanium Brush: A Case Report of a 2 Year Follow-Up

Effects of titanium brush on machined and sand‐blasted/acid‐etched titanium disc using confocal microscopy and contact profilometry

Mechanical techniques, including scaling with metal, plastic, or ultrasonic instruments, rubber cup polishing, air-powder abrasive system and brushing with a conventional or a rotating brush, have been used for the debridement of dental implants. Recently, rotating brushes with titanium bristles (titanium brush) have been introduced for the debridement of implant surface when peri-implant osseous defects occur. The purpose of this study was to evaluate the effects of a titanium brush on machined (MA) and sand-blasted and acid-etched (SA) titanium surfaces using scanning electron microscopy, confocal microscopy and profilometry. Moreover, correlations between the two quantitative evaluation methods (confocal microscopy and contact profilometry) were assessed. Both MA and SA discs were treated with rotating titanium brush at 300 rpm under irrigation for a total of 40 s. Roughness measurements were taken with confocal microscopy and surface profilometry. Then, the MA and SA surfaces were evaluated using scanning electron microscopy to determine the changes of the surface properties. Untreated MA surface demonstrated uniform roughness with circumferential machining marks, and scratch lines over the original surfaces were observed after treatment with the titanium brush. Similarly, the titanium brush produced noticeable changes on the SA titanium surfaces. However, this treatment with titanium brush did not significantly change the roughness parameters, including the arithmetic mean height of the surface (Sa) and the maximum height of the surface (Sz), in both MA and SA surfaces. Correlations between two evaluation methods showed a Pearson correlation coefficient of 0.98 with linear regression R(2) of 0.96. This study showed that the treatment with the titanium brush did not significantly change the roughness parameters, including Sa and Sz, in both MA and SA surfaces. Correlations between confocal microscopy and surface profilometry showed high correlation with a Pearson correlation coefficient of 0.98.

Rotating titanium brush for plaque removal from rough titanium surfaces – an in vitro study

The purpose of this study was the evaluation of the effectiveness of plaque removing of a new rotating brush made of titanium in comparison with the cleaning procedure with steel curettes. Plaque was collected by six volunteers for 48h. A total of 60 samples were randomly designated to two groups: the test group TiBrush and the control group with steel curettes. The residual plaque area (RPA) and the treatment time were determined as parameters. Scanning electron microscopy (SEM) was performed for detecting possible damages of the treatment procedures. The mean RPA within the TiBrush group (8.57±4.85%) was significant lower than in the control group (28.99±5.51%), while the mean treatment time was also significant lower in the TiBrush group (176.7±15.2sec) in comparison with the steel curettes (303.5±11.5sec). The outcomes of SEM analysis showed no surface alteration after TiBrush treatment. Within the limits of this study, this investigation concludes that TiBrush seems to be more effective in plaque removing capacity, while being gentler to the implant surface than the processing with steel curettes. These promising results could hold out an improvement of conventional periimplantitis treatment. Further studies are needed to prove these outcomes.

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 narrow peri‐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 defects.