Published case study of a non-surgical workflow in an inflammatory environment

Non-Surgical Workflow

Disclaimer: Magdent MED is CE marked for enhancing osseointegration. The protocol described below refers to non-surgical peri-implant tissue maintenance and is based on published clinical and preclinical evidence. This indication is considered off-label. The clinician is responsible for complying with local regulations and ethical frameworks when applying this protocol in daily practice.

Research: “A novel nonsurgical therapy for peri-implantitis using focused pulsed electromagnetic field: A pilot randomized double-blind controlled clinical trial,” Yaniv Mayer, Juan Khoury, Jacob Horwitz, Ofir Ginesin, Luigi Canullo, Eran Gabay, Hadar Z. Giladi.; Bioelectromagnetics, Volume 44, Issues 7-8, in 2023, on pages 144-155.

1. Case Selection & Pre-Treatment Considerations

Use the MED in non-surgical implant maintenance cases where biologic support of healing, inflammation modulation, and peri-implant tissue stabilization are desired, without indication for surgical intervention. The MED is intended as an adjunct to standard mechanical debridement and not as a replacement for established non-surgical care.

Appropriate cases include

Early to moderate peri-implant inflammation
Residual pockets following implant restoration
Sites with radiographic bone loss not exceeding approximately 5 mm
Implants with retrievable restorations
Patients enrolled in periodontal maintenance programs

Contraindications

Cardiac pacemakers or active implantable electronic devices
Ongoing systemic antibiotic therapy or chronic NSAID use
Medications significantly affecting bone or soft tissue healing
Untreated generalized periodontal disease
Heavy smoking habit (more than 10 cigarettes per day)

2. Implant Status & Access

The implant must be restored or restorable with access to the implant chamber. The MED cannot be placed if the implant is submerged or if soft tissue coverage prevents exposure of the device. Ensure that the implant connection is compatible with the MED system prior to treatment.

Confirm implant connection compatibility prior to treatment.
Restore or adjust the restoration so access to the implant chamber is atraumatic.

3. Mechanical Debridement & Site Preparation

Step-by-step preparation:

Administer local anesthesia as required.
Remove the suprastructure: • Screw-retained restorations: unscrew and remove • Cemented restorations: section carefully to allow atraumatic removal
Perform thorough mechanical debridement of the implant surface using non-metallic instruments such as Teflon-coated curettes and rotary brushes while avoiding damage to the implant surface or alteration of the implant geometry.
Irrigate thoroughly and ensure the implant chamber is free of debris before placing the MED.

4. MED Activation & Placement

Activation (outside the mouth)

Remove the MED vial from the sterile tray.
Place the vial into the Magdent activation socket.
Press the activation button: • Blue blinking for approximately 3 seconds indicates activation • Blue solid light confirms the MED is active and ready for placement
Once activated, remove the MED from the vial and transfer directly to the clinical field.

Placement

Ensure the implant chamber is dry and clean.
Seat the MED using the supplied 1.25 mm hex driver, maintaining alignment with the implant long axis.
Tighten by hand until passive seating is achieved, then apply restorative torque up to 10 Ncm (do not exceed).
Reposition and, if needed, suture the soft tissues around the MED, ensuring there is no occlusal interference.

5. Immediate Post-Treatment Instructions

The MED remains active for approximately 30 days and can stay in place until re-evaluation or prosthetic reinstallation.
Avoid electric toothbrushes during the first 30 days; encourage gentle manual brushing around the MED.
If using a provisional prosthesis, provide adequate relief to prevent contact with the MED.

6. Follow-Up Protocol

At 2 weeks

Inspect peri-implant soft tissue maturation, verify the MED remains fully seated, and confirm absence of acute inflammation.

At 4 weeks (30 days)

Remove the MED, reassess probing depths and bleeding on probing, and consider a second MED in moderate or persistent inflammatory cases.

At 8-12 weeks

Reassess tissue stability, compare radiographs if needed, and proceed with final prosthetic restoration once clinical stability is achieved.

A second MED may be placed after 30 days in moderate to severe inflammatory cases or when clinical findings suggest additional biologic support would be beneficial.

7. Biological Rationale

PEMF delivered by the MED modulates the peri-implant environment and justifies its use as a biologic adjunct in maintenance care.

Shifts inflammatory cytokines toward a pro-healing profile.
Supports osteoblast activity and bone remodeling.
Promotes angiogenesis and maturing soft tissues.
Influences peri-implant biofilm behavior in experimental conditions.

Professional Support

For clinical or technical questions, contact: info@magdentmed.com