GalvoSurge revolutionizes decision making and therapy of peri-implantitis

August 31, 2022

Dr Florian Rathe presents GalvoSurge®, a revolutionary device that helps in your peri-implantitis treatment.

Finding a treatment concept for peri-implantitis

Multiple attempts have been made to find a treatment concept for peri-implantitis, however in the long term, all these attempts showed only limited success (1). Thus, peri-implantitis has been described as an irreversible condition (2). It has been described, that surgical intervention is indicated as soon as crater-like defects can be diagnosed (3). However, since there was no sufficient measure of implant surface decontamination without damaging the surface and with that, changing the biological characteristics, the biological perquisites of a defect regeneration and re-osseointegration were not given. This has changed with the invention of a non-ablative cleaning measure introduction GalvoSurge.

Galvosurge technology explained

The Sprayhead of the Galvosurge device must be in contact with the implant to charge the implant negatively and provide a cleaning solution, which also must be in contact. Thus, a full-thickness flap must be raised, and granulation tissue must be removed. Water is converted into OH- and H+ ions by electrolysis. The H+ ions penetrate the biofilm, approaching the negatively charged surface. At the surface, they take up an electron and raise upwards as hydrogen bubbles, which blast the biofilm of the implant. One full cycle of 2 minutes must be performed per implant to ensure complete decontamination as seen in Fig. 1 (4).

Figure 1 Good — Figure 1. Implant surface
(a) covered by a subgingival biofilm, (b) after cleaning with GalvoSurge.

The surface bioactivity is even improved by the removal of the carbon atoms through the cleaning method by converting a formerly hydrophobic implant surface back into a hydrophilic one. This seems to improve both the cell attachment of bone cells and the re-osseointegration (5,6)

If hard deposits are not too thick, GalvoSurge is able to decontaminate the hard deposits as well, so that bone will grow on the calculus as observed in Fig. 2 (7). However, the question remains whether full re-osseointegration is mandatory to get sustainable long-term results.

Figure 2 Good — Figure 2. Human histology
New bone formation (NB) with reosseointegration to the implant surface and bone on growth on calculus (c) (7)

Patient selection and prognosis

It appears that moderately rough implant surfaces exposed to the supracrestal environment are more prone to experience reinfection with reinfection rates between 47% after 5- and 77% after 3 years, and although machined implant surfaces perform a little better (41% after 3 years), they still have unacceptably high recurrence rates (8,9). Preliminary data of implants with a complete re-osseointegration up to the implant shoulder which was followed over a mean period of 20.2 months showed a recurrence rate of only 7.6%. For comparison, Heitz-Mayfield et. al described a recurrence rate of 19% after 12 months of follow-up (8). Seemingly, the augmentability of the peri-implant defect limits sustainable therapeutic success.

Therefore, diagnostics should focus on the prognosis of complete defect regeneration, including site-specific as well as patient-specific factors that have an impact on the treatment outcome (10). First and foremost, the implant position should be evaluated. If the implant is malpositioned, it should be explanted because bone regeneration is not feasible in the long term. If the implant is well positioned, the next site-specific factor that should be evaluated is the defect anatomy. It has a major impact on the extent of bone regeneration (11). Patient-specific factors like smoking or diabetes should also be considered for the evaluation of the prognosis.

Treatment protocol

Once the decision has been made to treat the infected implant, the appropriate surgical technique should be chosen depending on the defect anatomy. Better results could be achieved if healing is allowed under primary wound closure. Therefore, implant-supported restorations should be removed two weeks prior to surgery to allow the soft tissue to heal (Fig. 3).

The cement-retained restoration which cannot be removed should be trephined and become screw retained. Sufficient restorations can be rescrewed after healing but insufficient ones must be renewed. Patients who developed once peri-implantitis will be susceptible to recurrence of the disease, therefore they must be enrolled in a maintenance program at the conclusion of the surgical therapy.

With the help of GalvoSurge the condition of peri-implantitis can be changed from irreversible to reversible in certain circumstances. However, decontamination with GalvoSurge does not replace meticulous treatment planning and a high standard of surgical skills.

Figure 3 Good — Figure 3. Healing after implant-supported restoration removal

Authored by:

Florian Rathe

Periodontist and FOR Emerging Leader

Florian Rathe, DDS, MSc is a periodontist and implantologist with a specialist practice in Forchheim Germany. He is one of the 12 Emerging Leaders that started the ELP this year and are on track to complete the program by the finish of 2023. During the program, aspiring leaders will have the chance to have an immersive clinical experience in 2 internationally renowned centers of excellence and to develop themselves through workshops on communications, presentation skills, research, and digital photography. Emerging leaders will also gain opportunities to talk to leaders in the field and join them on stage. All thanks to the ELP!

If you're interested in learning more about Dr. Florian Rathe's research and about peri-implantitis, you should check out the FOR Emerging Leader Program Mainstage Presentation at the Envista Summit, Hilton Vienna Park, on Friday, the 9th of September from 16 - 17.30 CET or join the Envista Summit virtually to view it live or on-demand.

About the ELP and FOR's 12 Emerging Leaders

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References

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Heitz-Mayfield L, Salvi G, Mombelli A, Loup P-J, Heitz, F, Kruger E, Lang N. Supportive peri-implant therapy following anti-infective surgical peri-implantitis treatment: 5-year survival and success. Clin Oral Impl Res 2018;29:1-6.
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Schlee M, Wang HL, Stumpf T, Brodbeck U, Bosshard D, Rathe F. Treatment of Periimplantitis with Electrolytic Cleaning versus Mechanical and Electrolytic Cleaning: 18-Month Results from a Randomized Controlled Clinical Trial. J Clin Med 2021;10: 1-12