Surgical treatment of peri-implantitis – Consensus report of working group 4

Abstract

The following consensus report is based on four background reviews (Keeve et al., Implant Dent 2019 28(2): 177–186; Ramanauskaite et al., Implant Dent 2019 28(2): 187–209; Koo et al., Implant Dent 2019 28(2): 173–176; Sculean et al., Implant Dent 2019 210–216). The surgical treatment of peri‐implantitis is indicated in the cases where the first choice of treatment, the non‐surgical one, failed with recurrence of bleeding and suppuration. The aim of this review was to systematically screen the literature for possible surface decontamination techniques and material during surgical treatment, the surgical regenerative and non‐regenerative treatments of peri‐implantitis, radiological and clinical outcomes, the importance of the presence of fixed and or keratinised peri‐implant gingiva, and to determine predictable therapeutic options for the clinical surgical management of peri‐implantitis lesions. Existent clinical, radiographic and microbiological data do not favour any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Using implantoplasty in surgical non‐regenerative treatment leads to a significant decrease in bleeding on probing and probing depth, and may result in improvement of clinical and radiographic parameters, up to 3 years after surgery compared with mechanical debridement alone. Surgical augmentative peri‐implantitis therapy resulted in improved clinical and radiographic treatment outcomes compared with the baseline in the majority of studies with 6 months to 7–10 years of follow‐up. There is no evidence to support the superiority of a specific material, product or membrane in terms of long‐term clinical benefits. The best treatment modality to improve the width of keratinised attached mucosa and bleeding and plaque scores, and to sustain the peri‐implant marginal bone level, is the use of an apically positioned flap combined with a free gingival graft.

Surgical treatment of peri‐implantitis defects with two different xenograft granules: A randomized clinical pilot study

“…Most recent studies evaluating reconstructive approaches in the treatment of peri‐implantitis used a non‐submerged healing approach and did not report any adverse events in terms of healing (Aghazadeh et al., 2012; Jepsen et al., 2016; Matarasso et al., 2014; Renvert et al., 2018; Roccuzzo et al., 2017). Despite the lack of evidence to support one mode of healing versus the other, the submerged post‐operative wound closure allows healing in a protective environment and when it is feasible, it is preferred over the non‐submerged healing (Khoury et al., 2019).…”

Nonsurgical Treatment of Peri-Implantitis: Case Series

“…Treatments alternative (surgical and nonsurgical) were proposed, which would have implied the use of different antibacterial products and specific instruments/device [18,19].…”

Repeated Exposure of Nanostructured Titanium to Osteoblasts with Respect to Peri-Implantitis

“…Currently, no method for the treatment of implants affected by peri-implantitis has been standardized. The basic principle of treatment is based on either removal of or trying to save failing implants depending on the area of affected surface [10,11]. The difference of re-osseointegration potential between contaminated and new implants was described by Levin et al [12].…”