Regenerative Surgical Therapy of Peri-implantitis: An Umbrella Review of Answered/Unanswered Questions and Future Perspectives

Abstract

Purpose: To systemically summarize current knowledge about regeneration of peri-implant defects based on available systematic reviews.Materials and Methods: A systematic search for review articles published between 2010 and 2020 in four databases was conducted. Only systematic reviews and meta-analyses were included. Based on the available literature, five questions of clinical importance on indication for regenerative approaches, surgical technique, methods of decontamination, outcome of therapy and adjunctive use of biological factors were formulated and answered.Results: The electronic search resulted in 312 studies, from which 264 studies were published between 2010 and 2020. Finally, 18 systematic reviews and one consensus report were chosen. Data of the included studies were based on 58 to 840 implants. Data on over 4.904 implants were assessed. From the 19 studies that were included, 15 assessed the outcome of regenerative therapy; three, the surgical protocol of regenerative therapy; two, the use of laser in regenerative therapy; and one, the additional use of growth factors in regenerative peri-implant therapy. Three studies assessed more than one topic.Conclusions: In general, a partial bone fill can be expected in 85% of regenerative procedures. Regeneration leads to a mean of 57% of greater bone fill, compared to open flap surgery only. Defect configuration plays a crucial role in the outcome, whereas the role and extent of benefit of different surgical protocols are still not clear.

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

“…Implantoplasty is primarily recommended for implants or aspects of implants with a modified surface (i.e., in contrast to turned, non-modified surfaces), and at those aspects of the implant, where due to the morphology of the bone defect regeneration cannot be expected. Specifically, implantoplasty should be primarily performed at implants with horizontal bone loss and/or buccal/oral dehiscences, but not at those aspects facing intrabony or crater-shaped defects, as these should be subject to augmentative procedures (31). Based on laboratory studies (32,33), depending on the type of burs and polishing instruments used, mean R a (arithmetic mean roughness) and R z (averaged roughness) values ranging from 0.32 to 0.98 µm and from 1.87 to 6.86 µm, respectively, can approximately be achieved after implantoplasty.…”

A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities

“…There is a need to identify the obstacles to effectively and predictably regenerate peri‐implant tissues from biologic and biomechanical viewpoints to develop meaningful research strategies and evidence‐based treatment protocols (Solderer & Schmidlin, 2020 ). While most work in this field focuses on biomaterials and related surgical topics, the primary aim of this manuscript is to discuss relevant biological and biomechanical challenges of treating peri‐implantitis based on the surgical biological regeneration principles.…”