## 1 Introduction  
Dental implants are nonbiologic devices surgically placed into jawbones to replace missing teeth. It is estimated that over 2 million dental implants are installed annually, and this number is expected to rise further over the next few years [1]. The peri-implant environment is a unique ecosystem [2], where the implant surface contacts the bone tissue by a phenomenon of incorporation called osseointegration. An osseointegrated implant is a sign of healthy and long-standing implant [3]. Unfortunately, this delicate ecosystem is continuously affected by different threats (e.g., biological, mechanical), leading to the loss of osseointegration. Peri-implantitis is the clinical sign of perturbations in the osseointegration; it is characterized by inflammation of the peri-implant connective tissue and by the progressive bone resorption, eventually associated with suppuration and bleeding until implant loss [4]. Bacterial plaque hosted in the oral cavity is still considered as the main risk factor for its onset [5]. Indeed, once bacteria biofilm accumulates on the implant surface, the inflammation leads to tissue destruction, and a greater implant surface is exposed, which becomes accessible to more pathogens [6], worsening the disease. Current evidence supports that peri-implant infection, caused by bacteria from dental biofilm, is the main cause of implant loss [7; 8]. Therefore, the primary aim of peri-implantitis treatment is to remove the microbial biofilm [9], a crucial step for the survival of the implant [10]. Nonsurgical approaches for the treatment of peri-implant disease have been proved to be reliable in reducing clinical signs of peri-implant inflammation (e.g., bleeding on probing--BoP), although with limited capability to achieve complete disease resolution [11]. Surgical treatment of peri-implantitis includes access flap, removal of granulation tissue, implant surface decontamination and either guided bone regeneration (GBR) or pocket elimination resection [12]. In both approaches, implant surface decontamination is essential for the successful treatment of peri-implantitis. This can be achieved either chemically, using topical application of antiseptics [13] or antibiotics, or mechanically, using either air polishing abrasives or other available mechanical devices for biofilm removal with or without the combination of adjunctive antimicrobial agents [14]. This process has to be supported also by domiciliary compliance of patients in performing a good quality oral hygiene [15]. Today, the clinical setting is lacking reliable protocols as which regimens are the most effective in implant debridement while safeguarding the implant structure [16; 17]. In this sense, air-powder abrasive treatment has shown interesting results [18; 19]. It is based on the release of abrasive powder into a stream of compressed air to remove biofilm from the implant surface, and it is successfully employed in the treatment of peri-implantitis. However, there is still poor evidence on its effectiveness and adverse effects [20]. A range of abrasive powders are available, including sodium bicarbonate, amino-acid glycine salt, aluminum trioxide and calcium carbonate [21]. Lately, the use of the larger-particle size of sodium bicarbonate powder (65 \(\upmu\)m) was shown to be more effective in biofilm removal but too abrasive to both teeth and implants surfaces. This led to the introduction to the market of a smaller-sized, amino-acid based particle, glycine (25 \(\upmu\)m), as a less aggressive treatment option [22; 23; 24; 25]. More recently, a smaller-sized particle powder, erythroid (14 \(\upmu\)m), and a mixture of glycine and triclcium phosphate [26; 27] were utilized in implant decontamination. Erythritol is a natural sugar alcohol obtained through the reduction of erythrose [28]. It was noticed to be promising in removing biofilm, both in in vivo and in vitro studies [29; 30].