**9.4 Mechanical therapy**

The bleeding from the site can be controlled either with piezoelectric scalers as well as with hand instruments [71]. The manual curetting of the area can be done using special curettes made of Teflon, carbon, plastic, and titanium curettes than the conventional curettes to protect the implant surfaces [72, 73]. The efficiency of the ultrasonic curettage can be supplemented with the air polishing systems [74–77]. Though the abrasive air polishing medium can modify the surface of implants, the cell response and healing were compromised probably due to the contamination of the implant surface [74, 76]. The extent of re-osseointegration of titanium implants after air polishing therapy has been reported between 39 and 46% with increased clinical implant attachment and pocket depth reduction [75]. The air polishing systems such as hydroxylapatite/tricalcium phosphate, hydroxylapatite, glycine, titanium dioxide, water and air, phosphoric acid can be used depending on the surface topography of implants [74, 77].
