Voltage-Tunable Plasma-Activated Water: A Strategy for Combating Peri-Implantitis via Dual-Path Biofilm Disruption and Vascular Regeneration

Objectives: Peri-implantitis therapy requires both effective biofilm eradication and subsequent tissue regeneration. This study aimed to develop a voltage-gated plasma-activated water (PAW) system with switchable bioactivities to address these dual needs and evaluate its efficacy for potential application in peri-implantitis management. Materials and Methods: PAW was generated using a dielectric barrier discharge system across a voltage spectrum of 33–46 kV. Its antibacterial activity was assessed against Porphyromonas gingivalis and multi-species biofilms on titanium surfaces, quantified via colony-forming unit (CFU) counts and visualized using scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). The pro-angiogenic potential was evaluated through endothelial cell viability, migration, and tubule formation assays. Results: High-voltage PAW (46 kV, 30 min) achieved a >6.0-log reduction of P. gingivalis and induced structural collapse of multi-species biofilms. In contrast, low-voltage PAW (36 kV, 15 min) significantly enhanced endothelial cell viability to 118.3 ± 5.2%, and accelerated both cell migration and tubulogenesis. Conclusions: This study demonstrates that PAW's biological functionality can be precisely tuned via modulation of activation voltage. The same platform can be switched between a potent antibacterial state and a pro-regenerative state, enabling adaptive bioactivity suited to the staged therapeutic requirements of peri-implantitis. Clinical Relevance: The voltage-gated PAW system presents a promising, affordable strategy for dual-phase peri-implantitis therapy. It offers clinicians a potential non-antibiotic tool to first disinfect implant surfaces and then promote vascular healing, which is critical for improving clinical outcomes in implant dentistry.