A Mini Review on Non-augmentative Surgical Therapy of Peri-Implantitis—What Is Known and What Are the Future Challenges?

Abstract

Non-augmentative surgical therapy of peri-implantitis is indicated for cases with primarily horizontal bone loss or wide defects with limited potential for bone regeneration and/or re-osseointegration. This treatment approach includes a variety of different techniques (e.g., open flap debridement, resection of peri-implant mucosa, apically positioned flaps, bone re-contouring, implantoplasty, etc.) and various relevant aspects should be considered during treatment planning. The present mini review provides an overview on what is known for the following components of non-augmentative surgical treatment of peri-implantitis and on potential future research challenges: (1) decontamination of the implant surface, (2) need of implantoplasty, (3) prescription of antibiotics, and (4) extent of resective measures.

Titanium implant surface roughness after different implantoplasty protocols: A laboratory study

“…Treatment of peri‐implantitis remains a challenge and often includes surgery, ranging from open flap debridement to resective and reconstructive approaches (Figuero et al, 2014 ; Ramanauskaite et al, 2021 ; Renvert & Polyzois, 2015 ; Schwarz et al, 2022 ). In the case of implants with a modified (structured) implant surface, the surgical approach can be combined with implantoplasty (IP) (i.e., the mechanical modification of the implant surface, including the removal of the implant threads and smoothening of the implant surface, by means of rotating instruments), which—despite the favorable results presented in clinical studies (Bianchini et al, 2019 ; Englezos et al, 2018 ; Romeo et al, 2005 , 2007 )—remains a controversial procedure (Bertl & Stavropoulos, 2021 ; Stavropoulos et al, 2019 ).…”

“…IP is considered the only decontamination method that completely removes the biofilm (Bertl & Stavropoulos, 2021 ; El Chaar et al, 2020 ). Importantly, IP is supposed to improve soft tissue integration at the exposed implant surface and facilitate better/easier plaque removal (Azzola et al, 2020 ; Beheshti Maal et al, 2020 ; Schwarz et al, 2017 ).…”

Implantoplasty and the risk of fracture of narrow implants with advanced bone loss: A laboratory study

“…Implantoplasty (IP) is an adjunct procedure to surgical peri‐implantitis treatment and involves the mechanical removal of the implant threads and structured (modified) implant surface; apart from efficiently removing the biofilm, IP aims in creating a relatively smooth implant surface, which is less prone to (re‐)infection and/or easier to decontaminate (Azzola et al, 2020; Bertl & Stavropoulos, 2021; Burgueño‐Barris et al, 2021; El Chaar et al, 2020; Stuani et al, 2021). IP was presented about 15 years ago in a small scale randomized controlled clinical trial (RCT), suggesting clinical efficacy (Romeo et al, 2005, 2007).…”

“…In this study, implants with a modified surface subjected to resective surgery and IP showed no additional peri‐implant marginal bone loss over a period of 3 years postoperatively; in contrast, implants treated with resective surgery only, lost about 1.5 mm of bone within 2 years post‐operatively. Recent reviews of the available clinical studies (mostly case series with relatively limited number of implants) present overall positive results in regard with the efficacy of IP (Beheshti Maal & Verket, 2021; Bertl & Stavropoulos, 2021; Lima et al, 2021).…”