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At the 4-month analysis both test groups showed reduced bone loss when compared to naturally healing sockets. However, the 2 grafting materials were not able to preserve the alveolar crest, and a reduction close to 30% in the estimates was registered after healing.

Peri-implantitis is an infectiousinflammatory process affecting soft and hard tissues surrounding osteointegrated dental implants, and it is always preceded by untreated implant mucositis. Clinically, periimplantitis is associated with bleeding, suppuration, and progressive loss of the implant supporting bone. 1 The prevalence of peri-implant mucositis and peri-implantitis is reported to range from 19% to 65% and 1% to 47%, respectively. 2 The inconsistency of literature when describing periimplantitis makes it difficult to define univocal criteria of diagnosis. In occasion of the 2016 consensus meeting on peri-implantitis in Rome, it was stated that it is impossible to define periimplantitis as a unique entity with precise etiology. 3 According to the authors, the best way to diagnose periimplantitis was to assess a progressive marginal bone loss in several radiographs taken during the follow-up. This finding could be integrated by the positivity to bleeding on probing and to probing depth $6 mm. However, those factors, if taken alone, are poor predictors of disease. It is accepted that the main causative factor for peri-implantitis is the presence of pathogenous bacteria, but its clinical course might depend on other modifying factorsdpositive anamnesis for periodontitis, smoking habits, systemic conditions, and prosthesis fallacy. 4,5 The bacterial flora associated to peri-implantitis was found to be similar to that of periodontitis, consisting mainly of gram-negative anaerobes. 6 Therefore, the mechanical disruption of the biofilm and the reduction of the oral bacterial load account for the avant-garde of the army against

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