Mucositis and Peri-Implant Disease Treatment with Chitosan and Titanium Brushes: A Systematic Review.

Background/

Objectives

Peri-implant diseases, including mucositis and peri-implantitis, pose significant clinical challenges due to their inflammatory nature and potential for progressive bone loss. These conditions, primarily driven by bacterial biofilm accumulation, require effective management to prevent further tissue destruction and maintain implant longevity. This systematic review aimed to determine whether the use of chitosan or titanium brushes in the surgical or non-surgical treatment of peri-implant mucositis or peri-implantitis provides clinical advantages-particularly reductions in probing pocket depth (PPD) and bleeding indices-compared to conventional decontamination protocols.

Methods

The review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024489556). A comprehensive electronic search was conducted in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials in December 2024 and updated on 9 November 2025, using predefined Boolean equations. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool.

Results

The initial and updated searches identified a total of 7470 records, of which nine studies met the inclusion criteria-seven randomized controlled trials and two prospective case series. Among them, five investigated chitosan brushes and three examined titanium brushes. Chitosan brushes showed significant intra-group improvements in PPD and bleeding indices, and titanium brushes demonstrated favorable results in surgical protocols, particularly when combined with regenerative therapies. However, inter-group comparisons revealed no statistically significant superiority of either device over conventional methods.

Conclusions

Chitosan and titanium brushes are safe and effective tools for implant surface decontamination in peri-implant disease management but do not exhibit clear clinical superiority. The current evidence supports their use as adjunctive devices within standardized treatment protocols. Further large-scale randomized controlled trials with extended follow-up are warranted to strengthen the evidence base and define their clinical role.