## 4 Discussion  
Complete elimination of bacterial biofilms from the surface of an implant in peri-implantitis is difficult to achieve. Surgical therapeutic approaches such as mechanical treatment, antiseptic treatment, and antibiotic treatment to eliminate infectious bacteria in the surrounding peri-implant tissues, as well as photodynamic treatment and laser application of peri-implantitis in humans, have shown some positive results, but a long-term evaluation has yet to be determined. In peri-implantitis treatment, it has become standard practice to locally administer antiseptics and/or antibiotics to patients with  
Figure 5: Antimicrobial effect of bioactive healing abutment, paper disc, and titanium disc: (**A**) clindamycin; (**B**) tetracycline. mild-moderate infections, which are largely the most frequent in clinical practice. Antiseptic or antibiotic drug-loaded devices, such as gels, chips, polymeric fibers, or microcapsules, can be used to treat infections. Various antibiotics and antiseptics have been incorporated into these devices, including tetracycline, gentamycin, doxycycline, chlorhexidine, and metronidazoleae. Most recent reports have suggested the possibility of incorporating tetracycline antibiotics on the surface of titanium dental implants with the use of polylactide nano-fibers or gentamicin with the use of nanoparticles of Fibroin protein derived from silkworm larvae. Slow release and local antibacterial properties for antibiotics used this way have been proven. The used surface engineering methods did not interrupt the osteoblast adhesion processes on the implant surface. Unfortunately, a high torque of 35 N/cm\({}^{2}\) and friction during the embedding of the implant into the bone can lead to destruction and inefficiency of the created surface. Similarly, antibiotic release using this method does not extend beyond 7 days and there is no possibility of reapplication [28; 29]. The surfaces of titanium implants have been coated, by some authors, with non-specific antibiotic products, which are supposed to disrupt the sedation of planktonic bacteria in the implant surface. The antibacterial effect of silver nanoparticles in chitosan and hyaluronic acid can last up to 14 days in laboratory conditions; however, unsatisfactory mechanical properties of the described surfaces have been reported, as well as the cytotoxic effects of silver particles, the release of which can disrupt implant osseointegration [30]. Rat studies have shown a significant reduction of the growth of _S. aureus_ strains when using titanium implants with a gel coating containing vancomycin, with lower osteolysis observed around the implant. This tendency was sustained for up to 3 weeks [31]. Compared to the described techniques, use of the proposed BHA is practically unlimited when it comes to duration and it can be repeated frequently, even with a change in treatment factor. Peri-implantits mostly develops not in the first days after implantation but more often as a complication after the implant has integrated. Thus, the described solution has more benefits than implant surface engineering. Successful attempts at implant surface engineering have been described by the modification of implant connectors. Doxycycline applied electrochemically on the connector surface reduced both biofilm deposition and _S. epidermidis_ culture growth for 24 h [32]. Implant connector modification methods are, in the opinion of the authors, the closest method to the one proposed. BHA is a type of healing abutment called a healing cap. In the case described by [PERSON] et al. [33], the cap was covered with doxycycline. Despite the theoretical possibility of unscrewing a cap covered with doxycycline, it is not possible to change the type or dose of the drug. It is not possible to reapply the product unless the cap is replaced. Reapplication requires the antibiotic to be reapplied electrochemically, which is not possible in clinical conditions.