Effect of Enamel Matrix Derivative or Hyaluronic Acid on Non-Surgical Treatment of Peri-Implantitis

Peri‐implantitis is considered a growing public health problem in implant dentistry dueto its higher prevalence and non‐linear accelerating progression pattern. Hence, it isimperative to apply effective treatment strategies to manage this pathological condition.The existing evidence has shown unpredictable therapeutic strategies forperi‐implantitis. Conventional non‐surgical treatment procedures based on the removal ofbiofilm accumulation and debridement/instrumentation of the implant surface haveexhibited limited disease resolution and persistent inflammation following therapy.Therefore, the application of adjunctive chemotherapeutic bioagents may provide greaterdisease resolution and reduce the need for surgical treatment.The application of EMD as an adjunctive measure in peri‐implantitis treatment has beensuggested to provide favorable outcomes by accelerating wound healing, reducinginflammation, having antimicrobial and antiseptic effects, and osteopromotive features.Although some studies exhibited clinical and radiographic efficacy of EMD in augmentativeand non‐augmentative surgical management of peri‐implantitis, there is no study in theavailable literature analyzing the effects of flapless application of EMD in non‐surgicaltherapy of peri‐implantitis. Cross‐linked HA, which has recently been recognized as afeatured adjuvant chemotherapeutic bioagent, has also been shown to have beneficialeffects in periodontal wound healing and soft and hard tissue regeneration. The use ofhigh‐molecular‐weight HA has been demonstrated to alter bacterial colonization in theadvanced stage of peri‐implantitis. However, there is limited evidence about thetherapeutic effect of cross‐linked HA in peri‐implantitis management.The hypothesis of the study is that the application of EMD and cross‐linked HA adjunct tonon‐surgical therapy could lead to superior outcomes compared to non‐surgical therapyalone in peri‐implantitis treatment. The null‐hypothesis (H0) is that no statisticallysignificant difference in terms of the mean change of probing depth (PD) values after 12months would be detected among all the study groups.The aim of the present randomized controlled clinical study is to compare the clinical,radiographic, and patient‐centered efficacy of adjunctive application of either enamelmatrix derivative (EMD) or hyaluronic acid (HA) gel in conjunction with non‐surgicaltherapy compared to non‐surgical therapy alone following a 12‐month healing period.