Surgical Reconstructive Therapy for the Management of Peri-implantitis: An AAP/AO Systematic Review and Network Meta-analysis

Purpose: Reports on the occurrence of peri-implant diseases date back nearly two decades. Despite the attempts taken toward the management of this disease, the literature still lacks a common remedy for predictable treatment. This best evidence consensus review was conducted in preparation for the joint consensus between the American Academy of Periodontology (AAP) and the Academy of Osseointegration (AO) to systematically analyze the clinical research in the field of surgical reconstructive therapy for peri-implantitis. Materials and Methods: A detailed systematic search was conducted to identify eligible clinical research reporting the outcomes of surgical reconstructive therapy for periimplantitis. The retrieved nonrandomized studies were analyzed descriptively, while the data from randomized control trials (RCTs) were fit to a series of mixed models that analyzed the individual components of the study arms and rendered treatments for the outcomes of probing pocket depth (PPD) reduction, radiographic marginal bone level (Rx MBL) gain, reduction in bleeding on probing (BoP) and suppuration (SUP), as well as mucosal recession (MREC). Results: A total of 18 reports on RCTs were eligible for quantitative assessment (635 patients, 687 implants). The results indicated that surgical reconstructive approaches for peri-implantitis (based on 319 patients and 345 implants), when compared to a nonreconstructive treatment modality (ie, open flap debridement alone based on 316 patients and 342 implants), was effective in reducing PPD, minimizing MREC, as well as increasing Rx MBL gain. However, there was no additional benefit from employing a reconstructive approach regarding the outcomes of BoP and SUP reduction. Several other baseline covariates such as site (initial PPD, MBL, and BoP) and systemic factors (eg, smoking) were also found to significantly impact the therapeutic outcomes. Mechanical decontamination methods as well as individual components of the augmentation approach were also found to significantly affect the outcomes. Conclusions: Within the limitations of this study, it was demonstrated that the surgical treatment of infrabony peri-implantitis defects can lead to PPD reduction, MREC reduction, and Rx MBL gain and was found to be superior to nonreconstructive treatment. However, there were no significant differences between the two modalities of therapy for the outcomes of BoP and SUP. Reconstructive therapy may provide a suitable approach for managing peri-implantitis–related infrabony defects.