Surgical Treatment of Cases with Peri-implantitis. A Qualitative Study

The aim of the present study was to observe the outcome of resective and regenerative surgical procedures in combination with systemic antibiotic therapy in peri-implantitis cases.

Method:

Nine patients with the diagnosis peri-implantitis were recruited to this prospective case series. Both smokers and nonsmokers were included. The subjects received a 2 to 4-week comprehensive hygienic phase prior to clinical, microbial and radiographical baseline examination. Surgical treatment was initiated only in cases with a full-mouth plaque score less or equal to 25 %. Antibiotic therapy was based on microbiological analysis. The flap procedure was aimed at pocket reduction through resective bone contouring, or by osseous regeneration in cases of confined osseous 2-3 wall bony defects ≥4 mm. During flap surgery, the implant surface debridement was performed with titanium curettes and a newly introduced titanium brush.

Result:

The primary outcome variable probing depth (PD), showed significant reduction for all sites from baseline to 6 months (p < 0.05). PD ranged from 5.2 mm to 7.7 mm at baseline and from 2.2 mm to 2.8 mm at 6 months. A non-significant bone gain of 0.7 mm and 0.3 mm were measured at mesial (p = 0.139) and distal surfaces at 6 months (p = 0. 314). The Spearman’s rank correlation test revealed strong and significant associations between mesial and distal PD reductions and bone gain in mesial (R = 0.706; p = 0.034) and distal (R = 0.678; p = 0.045) sites from baseline to 6 months.

Conclusion:

This qualitative study has shown that resective as well as regenerative surgical approaches in conjunction to systemic antibiotics are associated with short-term successful treatment of peri-implantitis. The titanium brush might be a promising supplement to implant surface debridement during flap surgery.