Surgical therapy for peri‐implantitis management: a systematic review and meta‐analysis

Abstract

Aim Peri‐implantitis is a common cause of late implant failure. Studies have investigated different treatment strategies. The effectiveness of these modalities, however, remains unclear. This study aimed to evaluate the success of surgical peri‐implantitis treatment using clinical and radiographic parameters. Material and methods A systematic review of published literature was employed. Key words were selected to conduct an electronic search using four databases for literature on human clinical studies. Meta‐analyses were carried out for clinical probing, pocket depth and radiographic bone level. Results A total of 16 papers met the inclusion criteria. Four treatment modalities to supplement mechanical debridement were identified: (i) apically repositioned flap, (ii) chemical surface decontamination, (iii) implantoplasty, and (iv) bone augmentation. Inconsistent results were evident which were dependent on several treatment‐independent factors. No clinical benefits were identified for the additional use of surface decontamination, while limited evidence demonstrated improvement of clinical and radiographic outcomes after implantoplasty. The effect of bone augmentation appeared limited to ‘filling’ radiographic defects. Conclusions The outcomes of the currently available surgical interventions for peri‐implantitis remain unpredictable. There is no reliable evidence to suggest which methods are the most effective. Further randomised‐controlled studies are needed to identify the best treatment methods.

Effect of implant cleaning on titanium particle dissolution and cytocompatibility

“…Peri‐implantitis is a prevalent disease with limited effective treatment strategies 1 . Its etiology is considered to be akin to that of periodontitis, 2 therefore existing peri‐implantitis treatments target titanium‐bound biofilms.…”

“…These findings are important in that they raise vigilance regarding the potential adverse events related to the use of mechanical treatments for implant surface cleaning. There is a need to perform an in‐depth investigation of the suitability of existing mechanical treatments around implants, because there is currently no clear guideline on how to perform preventive cleaning of dental implants or detoxify implant surfaces in the context of peri‐implantitis 1 . Nonetheless, there is a critical gap in knowledge because existing studies have only assessed Ti wear particles that are generated by direct mechanical abrasion of Ti implants 12 .…”

Surgical management of peri‐implantitis: A narrative review

“…Surgical treatment of peri‐implantitis may be indicated in an attempt to resolve inflammation and stabilise bone loss. However, there is no consensus as to the most effective surgical treatment option for peri‐implantitis and operator preference may be the primary factor in treatment selection 5 …”

The use of non‐surgical interventions in patients with peri‐implantitis; a systematic review and meta‐analysis

“…"Surgical techniques" include: surgical access to allow instrumentation and decontamination of the implant surface, apically repositioned flaps (ARF), implantoplasty and attempted re-osseointegration using bone augmentation techniques 7 . Non-surgical management (NSM) employs a variety of mechanical/physical modalities without surgical access (e.g.…”