Surgical treatments of peri-implantitis

Purpose: To review the literature on the surgical treatment of peri-implantitis. Materials and methods: The potentially relevant literature was preliminarily assessed via scoping searches to find the most appropriate search terms and the most efficient Boolean search algorithm. The present authors identified 33 reports on subjects with osseointegrated implants, with a pathological condition compatible with the definition of 'peri-implantitis', describing the surgical treatment with a follow-up of at least 6 months. Results and conclusions: The 14 case reports, 10 case series and 9 papers on 6 comparative studies illustrate the diversity of approaches and the current uncertainties concerning the surgical treatment of peri-implantitis. All current approaches include the elevation of a mucoperiosteal flap and the removal of the peri-implant inflammatory granulation tissue. Surfaces have been subjected to cleaning with carbon or plastic curettes, ultrasonic scalers, air-polishing devices using sodium bicarbonate or glycine powder, to irradiation with hard or soft laser light, implantoplasty and/or the application of acids or various antimicrobial agents. The majority of protocols include the systemic administration of an antibiotic and chlorhexidine rinses. Autogenous bone, allogenic decalcified freeze-dried bone, xenogenic bone mineral, phytogenic calcium carbonate, hydroxyapatite or tri-calcium phosphate have been used in an attempt to fill peri-implant defects and regenerate bone. Expanded polytetrafluoroethylene, collagen, and resorbable synthetic membranes have been placed to cover the area. The currently available evidence does not allow any firm specific recommendations for the surgical therapy of peri-implantitis. The following elements of therapy seem to be beneficial: surgical access by a full-thickness flap, thorough cleaning of the contaminated implant surfaces, systemic administration of an antibiotic and oral chlorhexidine rinse. The stabilisation of the defect with a bone substitute may also be advantageous. Keywords: peri-implantitis, review, surgical treatment