Voltage-tunable plasma-activated water: a strategy for combating peri-implantitis via dual-path biofilm disruption and vascular regeneration.

OBJECTIVES

Peri-implantitis therapy requires both effective biofilm eradication and subsequent tissue regeneration. This study aimed to develop a voltage-gated plasma-activated water (PAW) system with switchable bioactivities to address these dual needs and evaluate its efficacy for potential application in peri-implantitis management. MATERIALS AND

METHODS

PAW was generated using a dielectric barrier discharge system across a voltage spectrum of 33–46 kV. Its antibacterial activity was assessed against Porphyromonas gingivalis and multi-species biofilms on titanium surfaces, quantified via colony-forming unit (CFU) counts and visualized using scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). The pro-angiogenic potential was evaluated through endothelial cell viability, migration, and tubule formation assays.

RESULTS

High-voltage PAW (46 kV, 30 min) achieved a > 6.0-log reduction of P. gingivalis and induced structural collapse of multi-species biofilms. In contrast, low-voltage PAW (36 kV, 15 min) significantly enhanced endothelial cell viability to 118.5% [116.8-120.2] (padj = 0.003), and accelerated both cell migration and tubulogenesis.

CONCLUSIONS

This study demonstrates that PAW’s biological functionality can be precisely tuned via modulation of activation voltage. The same platform can be switched between a potent antibacterial state and a pro-regenerative state, enabling adaptive bioactivity suited to the staged therapeutic requirements of peri-implantitis. CLINICAL RELEVANCE: The voltage-gated PAW system presents a promising, affordable strategy for dual-phase peri-implantitis therapy. It offers clinicians a potential non-antibiotic tool to first disinfect implant surfaces and then promote vascular healing, which is critical for improving clinical outcomes in implant dentistry.