Fig 1 - uploaded by Andrea Roccuzzo
Content may be subject to copyright.
Lower left molar ceramic crown on a TPS implant, placed 8 years before, showing excessive probing depth and pus (Patient 25).
Source publication
Objectives:
The aim of this study was to evaluate the long-term results of the surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC).
Material and methods:
The original population consisted of 26 patients with one crater-like defect, around either sandblasted and...
Context in source publication
Context 1
... and 16 females; mean age: 60 AE 7.9 years; four smokers), who presented a single peri-implantitis crater-like lesion with a PD of ≥6 mm and no implant mobility, were consecutively treated from those attending the principle investigator's private office (special- ist periodontal practice, northwestern Italy), in the period January 2008-June 2009 ( Fig. ...
Citations
... 13 The impact of implant surface features on implant survival and success rates following surgical treatment of peri-implantitis has been previously highlighted by various authors. 15,16 Bone grafting with deproteinised bovine bone mineral (DBBM) and 10% collagen showed varying implant survival rates with sandblasted and acid-etched implants exhibiting an 80% survival rate compared to 55% for titanium plasma-sprayed implants over a 7-10year follow-up period. Implantoplasty involves smoothing supracrestal implant threads and exposed rough surfaces to aid biofilm removal and minimise its adherence during the maintenance phase. ...
... In particular, DBBM with 10% collagen alone has received much positive attention in the last years by several authors. 15,16,21,24,25,26,27,28 Furthermore, some studies have reported that the use of a barrier membrane might enhance the risk of early complications, primarily soft-tissue dehiscence and exposure of the membrane/ graft. 29,30 It was beyond the remit of the review to provide indications related to the impact of the flap design and surgical management on the treatment outcome. ...
As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.
... A difference in the number of implants with BOP and SOP was observed between the groups. A plausible reason could be the significantly higher number of implants with a non-modified surface in group B. The impact of surface characteristics has been analysed in several studies (Albouy et al., 2011;Roccuzzo et al., 2017). In two RCTs on the topic, no additional clinical benefits (azithromycin, 250 mg  2 at day of surgery + 250 mg  1 per day during an additional 4 days) (Hallström et al., 2017) except for a positive effect on a subgroup with modified surfaces (amoxicillin 750 mg  2 per day, commencing 3 days prior to surgery, during 10 days) (Carcuac et al., 2016) were observed. ...
Aim
To study the clinical, radiographic and microbiological outcomes after surgical treatment of peri‐implantitis, with or without adjunctive systemic antibiotics.
Materials and Methods
Eighty‐four patients (113 implants) with peri‐implantitis were randomized into three groups (A, amoxicillin and metronidazole; B, phenoxymethylpenicillin and metronidazole; or C, placebo). Treatment included resective surgery and implant surface decontamination with adjunctive antibiotics or placebo. Primary outcomes were probing pocket depth (PPD) reduction and marginal bone level (MBL) stability. Secondary outcomes were treatment success (defined as PPD ≤ 5 mm, bleeding on probing [BOP] ≤ 1site, absence of suppuration on probing [SOP] and absence of progressive bone loss of >0.5 mm), changes in BOP/SOP, mucosal recession (REC), clinical attachment level (CAL), bacterial levels and adverse events. Outcomes were evaluated for up to 12 months. The impact of potential prognostic indicators on treatment success was evaluated using multilevel logistic regression analysis.
Results
A total of 76 patients (104 implants) completed the study. All groups showed clinical and radiological improvements over time. Statistically significant differences were observed between groups for MBL stability (A = 97%, B = 89%, C = 76%), treatment success (A = 68%, B = 66%, C = 28%) and bacterial levels of Aggregatibacter actinomycetemcomitans and Tannerella forsythia , favouring antibiotics compared to placebo. Multiple regression identified antibiotic use as potential prognostic indicator for treatment success. Gastrointestinal disorders were the most reported adverse events in the antibiotic groups.
Conclusions
Adjunctive systemic antibiotics resulted in additional improvements in MBL stability. However, the potential clinical benefits of antibiotics need to be carefully balanced against the risk of adverse events and possible antibiotic resistance.
... 99 Surface roughness might also impact the success of peri-implantitis treatment, as some studies showed that outcomes were improved in implants with non-modified surfaces compared to their modified counterparts. 16,40,48 Peri-implantitis tends to advance at a faster rate and with more residual inflammation on rough coated surfaces than on machined implants. 16,40,48 Within this meta-analysis, no sub-analyses comparing rough or machined implant surfaces or bone-and tissue-level implants were conducted due to a lack of sufficient data. ...
... 16,40,48 Peri-implantitis tends to advance at a faster rate and with more residual inflammation on rough coated surfaces than on machined implants. 16,40,48 Within this meta-analysis, no sub-analyses comparing rough or machined implant surfaces or bone-and tissue-level implants were conducted due to a lack of sufficient data. The impact of reduced keratinised mucosa width (< 2 mm) was also discussed as a potentially significant factor influencing the final outcomes of implants treated with reconstructive treatment modalities. ...
Purpose: To assess the implant failure rate and clinical and radiographic outcomes of implants affected by peri-implantitis that received surgical treatment. Materials and methods: A systematic search was conducted of three databases (PubMed, Embase and Cochrane Library) to identify studies that examined implant failure and biological outcomes after surgical peri-implantitis treatment, including ≥ 10 patients and reporting on a follow-up period of at least 12 months. Data and risk of bias were assessed qualitatively and quantitively. Surgical modalities were subdivided into reconstructive, non-reconstructive and combined. Meta-analyses were performed for implant failure, marginal bone level and probing pocket depth at 12 and 36 months with the respective subset of available data for each time and endpoint. Results: A total of 45 studies with 3,463 treated implants were included in the quantitative evaluation. Meta-analyses revealed low implant failure rates of 1.2% (95% confidence interval 0.4%, −2.1%) and 4.2% (95% confidence interval 1.0%, −8.8%) at 12 and 36 months, respectively. No significant difference between the subgroups was observed at 12 months. At 36 months, reconstruct-ive modalities showed a significantly lower implant failure rate (1.0%; 95% confidence interval 0.0%, 5.0%; P = 0.04, χ 2 (1) = 4.1) compared to non-reconstructive modalities (8.0%; 95% confidence interval 2.0%, 18.0%). The mean probing pocket depth was 3.71 mm (95% confidence interval 3.48, 3.94 mm) at 12 months and 3.63 mm (95% confidence interval 3.02, 4.24 mm) at 36 months. The mean marginal bone loss was 3.31 mm (95% confidence interval 2.89, 3.74 mm) at 12 months and 2.38 mm (95% confidence interval 1.01, 3.74 mm) at 36 months. No significant differences between the modalities were observed for bleeding on probing after either of these time points. Cumulative interventions during supportive therapy were reported in 9% of the studies. Conclusion: Surgical treatment of peri-implantitis results in a low implant failure rate in the short and medium term. No differences were noted between the different interventions with regard to failure rate. Surrogate therapeutic endpoints were improved after treatment, without significant differences between the different modalities. Therapeutic success and/or disease resolution and cumulative interventions during supportive therapy are seldom reported in the literature, but limited long-term outcomes are documented consistently.
... Enhanced clinical improvements were observed in the two regenerative treatment groups, which is line with the scientific literature to date. Some studies like the ones by Roccuzzo et al. (2011Roccuzzo et al. ( , 2017 have demonstrated greater improvements in clinical parameters following regenerative interventions. They treated single intrabony PI defects with a xenograft around TPS and SLA implants. ...
... SLA implants, meanwhile, showed a mean PPD reduction of 3.2 mm at 12 months and 3.4 mm at 7 years. In addition, there was a 35% reduction in BOP at 12 months and 60% at 7 years for the TPS group and 62.5% at 12 months and 67.5 at 7 years for the SLA group (Roccuzzo et al., 2011(Roccuzzo et al., , 2017 No statistically significant changes in bone levels from baseline to 12 months were revealed in any of the treatment groups. When applied to the clinical scenario in everyday practice, a gain of 1 mm in peri-implant bone levels following regenerative surgery would usually be clinically significant, particularly when combined with significant reductions in probing depths and inflammation (Herrera et al., 2023). ...
Objectives
In this study, the aim was to investigate the medium‐ to long‐term impact of peri‐implantitis treatment upon clinical parameters and implant stability quotient values and to ascertain if magnetic resonance frequency analysis can be used as a diagnostic tool to demonstrate postoperative healing following treatment of peri‐implantitis.
Materials and Methods
A total of n = 26 patients ( n = 86 implants) diagnosed with peri‐implantitis were recruited for this prospective cohort study and four different treatment modalities were used. Baseline measurements of a number of clinical parameters as well as implant stability measurements in the form of ISQ were recorded. These measurements were repeated at 6, 12, and 24–36 months following treatment. Analysis of variance was performed for all implants treated as well as separately for each treatment modality. A regression model was also used to determine factors affecting ISQ measurements over time.
Results
Treatment of peri‐implantitis resulted in significant improvements of both average PPDs and BOP ( p < .0001 and p < .01). ISQ values marginally improved initially for all treatment modalities, but improvement was only maintained for 2–3 years in treatment modalities I (+1.28), III (+1.49), and IV (+2.92). There was a statistically significant negative linear correlation between average PPD and the ISQ values recorded both at baseline ( r = −.618, p < 0.0001) and at 2/3 years ( r = −.604, p < 0.0001).
Conclusion
Over the 2–3‐year follow‐up period, all four treatment modalities led to improved clinical and radiographic peri‐implant parameters but implant stability posttreatment, as indicated by the fact that the recorded ISQ scores remained stable. As a result, use of MRFA as an adjunct to the traditionally used periodontal and radiographic tools for the evaluation of postoperative implant stability following the treatment of peri‐implant disease cannot be recommended.
... In another study, the long-term results of regenerative therapy using a bone graft in patients with peri-implant bone loss resulted in implant loss without adequate osseointegration in some patients. 12 Attempts have been made over the last several years to resolve periimplantitis, but a standard treatment protocol has not been established. 13 To fundamentally solve the decontamination and regenerative issues of dental implants, the implant surface must be remodeled. ...
... Up-to-date literature [26,27] shows a considerable number of studies regarding protocols for the treatment of peri-implantitis in standard-length implants, while description of procedures to treat short and ultra-short implants, especially supporting single crowns, is still very scarce [28,29]. Plus, studies reporting long-term maintenance following reconstructive surgical therapy of peri-implantitis are limited [30][31][32][33][34] and have conflicting results [35]. Nevertheless, it was suggested [36,37] that after reconstructive surgical protocols, improved clinical and radiographic outcomes can be obtained and revealed as stable over time around standard-length implants if low plaque and bleeding scores are controlled using effective and frequent oral hygiene procedures. ...
... The proposed treatment, including open-flap debridement, chemical and mechanical decontamination of the implant surface, bone grafting, and transgingival healing without the use of membranes, was effective in arresting disease progression, achieving high implant survival and good clinical and radiographic conditions. Even if data from current studies seem to indicate that disease progression could be delayed in the long term for most treated implants, a percentage of them can instead show recurrence or progression of peri-implantitis after treatment [31]. ...
... Current literature presents a large amount of data stating that implants may be affected by peri-implantitis, and a fair number of studies discussed the possibilities of reconstructive treatments on standard dental implants [26][27][28][29][30][31][32][33][34]45]; on the other hand, there is a lack of reliable evidence for effective and codified protocols for the treatment of peri-implantitis around short implants, especially when supporting single crowns. In this proposal, it was recently demonstrated that short and ultra-short implants locking taper implants with a plateau design are not immune to peri-implantitis [12], which represents a critical issue considering that moderate bone loss could be definitively harmful around an implant with reduced length. ...
Peri-implant infections, in the absence of adequate treatment, can finally lead to premature loss of the implant. Among targeted protocols recently proposed for the treatment of peri-implant bone defects, and in the case of short implants, reconstructive surgery represents a recommended option. The purpose of this study was to evaluate the outcomes, in terms of maintenance, of a reconstructive treatment for peri-implantitis in locking-taper plateau-design single-crown implants, followed for 5 years after surgery. A retrospective evaluation was conducted in 20 patients treated with access flap surgery, concomitant chemical and mechanical surface decontamination, and bone grafting (using a self-hardening mixture of bone substitutes and biphasic calcium sulfate without the use of membranes). Of the 21 implants assessed, 9 were 8 mm-length, and 12 were 6 mm-length. Implant loss and treatment success were, respectively, 0% and 80.95% after 5 years from surgery. All parameters related to bone levels and soft tissue conditions significantly improved after 3 years and remained stable at the 5-year follow-up. The proposed protocol, followed by an effective supporting periodontal therapy, demonstrated the maintenance of the function of all implants, providing adequate stability during the healing process after surgery and limiting the onset of disease recurrence.
... 86 Considering the similar success criteria based on the combination of clinical and radiographic outcomes, at 5 to 7 years after reconstructive peri-implantitis therapy, treatment success was achieved in 51.1% and 58.3% of implants with smooth and moderately rough surfaces whereas at implants with modified surfaces, treatment success was documented in 14.3% of the implants after 7 years. [92][93][94][95][96] With respect to the postoperative soft tissue level changes, reconstructive approaches yielded significantly lower soft tissue mucosal recession compared to open flap debridement (WDE = -1.35 mm, P = .038). ...
Peri-implant diseases define bacterial-plaque-induced inflammatory conditions affecting implant-surrounding tissues, classified as peri-implant mucositis and peri-implantitis. Peri-implant mucositis characterizes an inflammatory lesion that resides in the soft-tissue compartment, whereas at peri-implantitis sites, the lesions also feature progressive loss of implant-supporting bone. Inflammation resolution of and disease progression arrestment are the main therapeutic endpoints of peri-implant diseases treatment. The present position paper presents the current evidence and clinical recommendations of the European Association for Osseointegration for the treatment of peri-implant diseases. Mechanical biofilm removal along with the reinforcement of patient-administered oral hygiene is considered the standard treatment for managing peri-implant mucositis. It is recommended to assess the outcomes of peri-implant mucositis treatment 2 to 3 months after therapy, and in the absence of treatment success, a repeated intervention should be considered. Peri-implantitis treatment should follow a stepwise treatment approach, starting with a non-surgical treatment, and if not sufficient, followed by the surgical intervention. Surgical peri-implantitis therapies encompass non-reconstructive, reconstructive, and combined treatment modalities. Implantoplasty may be advocated for the treatment of supracrestal peri-implant defects, whereas reconstructive therapy is indicated at peri-implantitis sites featuring intra-osseous defects with a depth of ≥ 3 mm. Adjunctive reconstructive measures may be beneficial in enhancing radiographic defect fill and maintaining postoperative soft-tissue levels, which may have a great impact in aesthetic cases. The adjunctive use of systemic antibiotics during surgical therapy does not seem to improve the clinical outcomes. Regular supportive peri-implant therapy with biofilm removal should be an integral part of the treatment protocol of peri-implant diseases. In the presence of advanced bone loss at implants that do not play a strategic role in masticatory function, implant removal may be immediately considered.
... Along these lines, it is worthwhile to note that implant surface characteristics appear to influence the outcomes of surgical periimplantitis treatment, with less predictable outcomes of reconstructive therapy obtained for moderately rough-surfaced implants compared to rough-surfaced implants. 35 Furthermore, more favorable nonreconstructive peri-implantitis treatment outcomes and reduced risk for disease recurrence following therapy were reported for implants with nonmodified surfaces compared to modifiedsurfaced implants. 36,37 In this analysis, except for two studies, most of the treated implants had modified surfaces, whereas one study did not specify implant surface characteristics. ...
Guided bone regeneration (GBR) at peri‐implantitis‐related bone defects involves the placement of bone‐filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR‐supported reconstructive measures as well as their potential superiority compared to non‐GBR‐supported treatment strategies for bone defects at peri‐implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long‐term (≥12 months) clinical efficacy of GBR‐supported reconstructive surgical therapy for peri‐implantitis‐related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non‐GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow‐up periods limited to 12 months should be considered.
... Consideration must, however, be given to whether this is the most suitable material It should be noted that, depending on success criteria, the longterm treatment success over 5 years is varying remarkably. 96 Although decontamination is a central measure for bone regeneration, there is broad agreement that different mechanical and chemical methods can be used equally. ...
Introduction:
Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss.
Methods:
A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review.
Results:
Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique.
Conclusion:
The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.
... Además, 1 ensayo clínico controlado (24) , concluyó que la limpieza electrolítica en conjunto con aire abrasivo, no demuestra ningún beneficio adicional, que, al utilizar la limpieza electrolítica sola, además, este método permite la reintegración del implante tratado a los tejidos circundantes; se consideró un nivel de evidencia 1-, por la probabilidad de sesgo por falta de cegamiento. Mientras que, 1 meta análisis (12) , 1 revisión sistemática (21) , un estudio clínico no randomizado (20) , y un estudio no controlado (22) relacionaron la terapia de apoyo posterior al tratamiento de periimplantitis con una mayor sobrevida del implante, con un nivel de evidencia 1+, ya que la mayoría de los estudios primarios de la revisión y el meta análisis no eran de tan alta calidad, sin embargo, existe una tendencia hacia un mismo resultado, y todos llegan a la misma conclusión, por lo que hay una moderada probabilidad de establecer una relación causal entre la terapia de apoyo y la sobrevida del implante posterior al tratamiento de periimplantitis. ...
... Sin embargo, sería recomendable que futuros estudios de periimplantitis consideraran un registro del período de seguimiento. En nuestra revisión, la mayoría de los estudios seleccionados tenían un corto periodo de seguimiento (6 meses aproximado), con la excepción de 1 estudio (22) con un seguimiento de 7 años. Heitz-Mayfield (7) , indica que los estudios deberían tener un seguimiento de al menos 5 años o más para evaluar la recurrencia de la enfermedad. ...
Objetivo:
Esta revisión sistemática tiene como objetivo identificar los factores pronósticos y/o determinantes del éxito del tratamiento de la periimplantitis.
Materiales y métodos:
Se realizó una búsqueda bibliográfica estructurada y exhaustiva para identificar referencias relevantes en las bases de datos MEDLINE (PubMed), Scielo y Springerlik. La estrategia de búsqueda se realizó combinando los términos periimplantitis con factores pronósticos y / o determinantes del éxito del tratamiento como MeSH y texto libre combinando con los operadores booleanos AND y OR. Se utilizó la clasificación de SIGN (Scottish Intercollegiate Guidelines Network) para analizar el nivel de evidencia.
Resultados:
De los 239 artículos revisados, 17 cumplieron con los criterios de selección para el análisis cualitativo de la evidencia.
Conclusiones:
El tipo de implante (macro y microgeometría) y la morfología del defecto, los cuales dificulta el acceso a las superficies contaminadas, son factores que influyen en el resultado del tratamiento de la periimplantitis. No hay evidencia sobre el método de descontaminación más eficaz. Las condiciones generales como la diabetes mellitus y la presencia de enfermedad periodontal activa afectan el resultado del tratamiento, así como la frecuencia de un programa de mantención de higiene profesional postquirúrgica, la cual mejora la sobrevida del implante.
