The CLEAN&SEAL® concept was set to enhance the outcomes in non-surgical therapy of mucositis and shallow peri-implantitis defects. The method combines the mechanical instrumentation of the implant surfaces with chemical debridement supported by application of Chloramines (PERISOLV®) into the peri-implant pockets. After such intensified instrumentation, the pocket will be sealed by applying the hyaluronic acid (HYADENT BG, REGEDENT AG, CH). The efficacy of the concept in treating mucositis was clinically approved and clinical trials comparing this approach with just mechanical treatment are available. The recently published research focused on the biological impact of HYADENT BG on periodontal regeneration. Both, a pre-clinical study and an RCT trial clearly confirmed sufficient contribution of HA in formation of new periodontal attachment histomorphometrically and clinically, respectively.

The therapy of deep peri-implant infrabony defects deserves a surgical approach to be the successful insufficient resolution of inflammation and concomitant new peri-implant bone formation. Therefore, we proposed a combination of the Clean and Seal concept and open flap access extended by GBR for regeneration of the missing bone attachment. The grafting material introduced for this purpose is the ossifying ribose cross-linked collagen matrix, a xenograft of porcine origin (OSSIX® Volumax, REGEDENT GmbH, DE) The reliable evidence from the pre-clinical trials and human histological observations proved the probability of this xenograft to ossify. In our series of clinical cases applying surgical CLEAN&SEAL® and GBR concepts, we regularly observe the reconstitution of missing peri-implant bone attachment at the radiographic level after a healing period of 6 to 12 months. The reconstructed sites appear clinically healthy without signs of bleeding and the patients report valuable desensitization of marginal mucosa by masticatory loading and at performing oral hygiene procedure.