Peri-implantitis surgery does not begin with bone graft placement. It begins with removing the inflamed granulation tissue occupying the peri-implant defect.
Thorough surgical degranulation improves visibility, exposes the contaminated implant surface and creates better conditions for implant surface decontamination and regenerative treatment. Without this step, inflammatory tissue may obstruct the defect and compromise the placement of bone grafts or barrier membranes.
What Is Peri-Implantitis?
Peri-implantitis is a plaque-associated inflammatory disease affecting the tissues around a dental implant. Unlike peri-implant mucositis, which is limited to the surrounding soft tissue, peri-implantitis involves progressive loss of supporting bone.
As the disease advances, the bone defect may become filled with granulation tissue containing inflammatory cells, microorganisms, connective tissue and tissue debris.
This tissue can:
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Hide the true morphology of the bone defect.
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Restrict access to the implant surface.
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Reduce visibility during surgery.
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Interfere with subsequent regenerative procedures.
When non-surgical therapy does not resolve inflammation, surgical treatment may be required to gain direct access to the implant surface and surrounding bone defect. The European Federation of Periodontology’s clinical guideline recommends a structured treatment approach based on disease severity, defect characteristics and patient-related factors.
What Is Surgical Degranulation?
Surgical degranulation is the removal of inflammatory granulation tissue and soft-tissue debris from a peri-implant bone defect after flap elevation.
Its main objectives are to:
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Expose the full extent of the peri-implant defect.
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Improve access to contaminated implant threads.
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Remove inflamed tissue systematically.
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Preserve healthy supporting bone.
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Prepare the site for further decontamination or regeneration.
Removing granulation tissue is also necessary for accurately assessing defect configuration. Radiographs can indicate the presence of bone loss, but the complete morphology often becomes apparent only after flap elevation and tissue removal.
Why Must Degranulation Be Completed Before GBR?
Guided Bone Regeneration, or GBR, requires a properly prepared surgical site.
Placing regenerative material into a defect that still contains inflammatory tissue does not address the underlying contamination. Before bone grafting, the clinician must obtain adequate visibility, remove diseased tissue and gain access to the implant surface.
A properly degranulated defect supports:
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More thorough implant surface cleaning.
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Better adaptation of grafting materials.
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More accurate membrane placement.
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Stable blood-clot formation.
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Improved wound management.
This biological principle also applies to degranulation in Guided Tissue Regeneration (GTR), where inflammatory tissue should be removed before grafting materials and barrier membranes are placed.
Reconstructive treatment may be considered for suitable intra-osseous peri-implant defects, but the decision should depend on defect morphology and other clinical factors. Current evidence does not support treating every peri-implantitis defect with the same regenerative approach.
How Does the MR.Bur Degranulation Kit Support This Stage?
The Mr.Bur Degranulation Kit is designed for the degranulation phase of peri-implantitis surgery.
It contains four extra-coarse diamond burs with different working diameters:
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RAXL10 — 1.0 mm
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RAXL25 — 2.5 mm
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RAXL30 — 3.0 mm
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RAXL35 — 3.5 mm
The different sizes allow clinicians to match the instrument to the width, depth and accessibility of the peri-implant defect.
The burs also feature a extra-long neck intended to improve access to deep or confined surgical areas while reducing obstruction from the handpiece head.
Which Degranulation Bur Should Be Used?
RAXL10: For Narrow or Confined Defects
The 1.0 mm bur is suitable when precision and access are the main priorities.
It may be selected for:
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Narrow peri-implant defects.
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Deep intrabony areas.
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Interproximal access.
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Instrumentation around implant threads.
Its smaller working diameter helps clinicians enter confined areas without unnecessarily widening the surgical field.
RAXL25: For Routine Degranulation
The 2.5 mm bur provides a practical balance between access and tissue-removal efficiency.
It may be useful for:
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Moderate peri-implant defects.
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General surgical degranulation.
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Controlled removal of inflammatory tissue.
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Sites with reasonable visibility and access.
RAXL30: For Broader Defects
The 3.0 mm bur offers a larger working surface for defects containing more extensive granulation tissue.
It may be considered for:
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Moderate-to-large defects.
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Broader areas of inflammatory tissue.
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Sites where increased debridement efficiency is required.
RAXL35: For Wide Surgical Sites
The 3.5 mm bur is intended for larger defects where access is less restricted.
Its broader surface may reduce the number of instrument passes required, but it should only be selected when the defect provides sufficient working space.
Why Do Multiple Bur Sizes Matter?
Peri-implant defects vary considerably in shape and size. A narrow interproximal defect cannot be approached in the same way as a wide circumferential lesion.
As a general principle:
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Smaller burs provide greater precision in confined areas.
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Larger burs improve efficiency in wider defects.
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Bur selection should follow defect morphology rather than speed alone.
Beginning with the instrument that offers the safest access can help preserve healthy bone and improve surgical control.
Clinical Principles for Controlled Degranulation
Rotary degranulation should be performed with careful technique. Clinicians should use:
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Copious sterile irrigation.
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Light and controlled pressure.
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Continuous instrument movement.
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Clear visibility of the working area.
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Systematic removal of inflammatory tissue.
Once the granulation tissue has been removed, the defect should be reassessed before proceeding with implant surface decontamination, bone graft placement or membrane application.
Clinical Takeaway
Successful peri-implantitis regeneration begins with site preparation—not with the graft itself.
Meticulous surgical degranulation removes inflammatory tissue, reveals the true bone defect and provides direct access to the contaminated implant surface. This establishes the foundation for subsequent decontamination and regenerative procedures.
By combining multiple bur diameters with an extra-long neck and extra-coarse diamond surface, the Mr.Bur Degranulation Kit allows clinicians to adapt their instrumentation to different defect morphologies while maintaining access, visibility and control.
Frequently Asked Questions
Is degranulation always necessary during peri-implantitis surgery?
When granulation tissue occupies the surgical defect, it must be removed to expose the implant surface, evaluate defect morphology and prepare the site for further treatment.
Can bone grafting be performed immediately after degranulation?
Bone grafting may follow degranulation and implant surface treatment when the defect morphology and clinical conditions are suitable for a reconstructive approach.
Does the largest bur provide the best result?
No. Larger burs may be more efficient in wide defects, but smaller burs provide better precision in narrow or deep areas. Selection should be based on access and defect morphology.
What is the purpose of the long bur neck?
The longer neck improves access to deeper defects and helps reduce visual obstruction from the surgical handpiece head.
Can the Mr.Bur Degranulation Kit be used outside peri-implantitis surgery?
According to the supplied product information, the kit may also be considered for periodontal surgery, apicoectomy, cystectomy, root-fragment removal and surgical-site preparation before bone grafting.
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