Reconstructive Surgical Therapy of Peri-implantitis
Condition: Peri-Implantitis
MeSH terms: Peri-Implantitis
Study type: Observational

Summary: 
      Various treatment protocols of peri-implantitis involving surgical therapies with open flap
      debridement procedures, resective or reconstructive modalities have been documented to
      achieve variable success. Surgical non-reconstructive approaches have been suggested to have
      limited effectiveness in terms of the resolution of inflammation in the long term. Therefore,
      much more interest has been intensified regarding the efficacy of biomaterials used in
      reconstructive approaches. The aim of this study was to investigate the 3-year
      clinical/radiographic outcomes of reconstructive surgical therapy of peri-implantitis using a
      bone substitute combined with two different bioresorbable barrier membranes, either collagen
      membrane (CM) or concentrated growth factor (CGF). A total of 52 patients who had at least
      one implant diagnosed with peri-implantitis and needed to be scheduled for reconstructive
      therapy of a peri-implant infrabony defect were included. Peri-implantitis case was defined
      as increased probing depth (PD) compared to previous examinations with bleeding on probing
      (BOP) and/or suppuration and radiographic evidence of peri-implant bone loss beyond crestal
      bone level changes resulting from initial bone remodeling. The patients were randomly
      assigned to receive a bone substitute filling in combination with either CM or CGF. Intrabony
      components were filled with a bone substitute (BioOss spongiosa granules; Geistlich,
      Wolhusen, Switzerland) and covered with a CM (Bio-Guide, Geistlich Biomaterials) or CGF
      membrane. The plaque index (PI), gingival index (GI), BOP, PD, clinical attachment level
      (CAL), mucosal recession (MR) and radiographic vertical defect depth (VDD) values were
      evaluated at 1 and 3 years postoperatively.
    

Detailed description: 
      Peri-implantitis is a plaque-associated pathological disease affecting the soft and/or hard
      tissues surrounding a dental implant and clinically characterized by bleeding on probing
      (BOP) and/or suppuration (Supp), increased probing depths (PDs) and/or mucosal marginal
      recessions (MRs) in addition to radiographic marginal bone loss (MBL) compared to previous
      examinations. Considering the increasing numbers of patients undergoing restorative treatment
      through dental implants and the corresponding increase in the prevalence of peri-implantitis,
      it is imperative to perform effective treatment methods for the management of these
      conditions. On the basis of evidence, the most reliable and predictable treatment of
      peri-implantitis has not yet been described, moreover, if the disease is left untreated, it
      progresses in a non-linear accelerating manner. Hence, peri-implantitis has been considered
      to be a major, unpredictable and growing problem for clinicians.

      Various treatment protocols of this challenging problem involving non-surgical approaches and
      surgical therapies with open flap debridement procedures, resective surgeries, or
      reconstructive modalities, which include the use of bone substitutes with or without a
      membrane, decontamination methods of implant surfaces, antimicrobial prescriptions whether to
      use submerged or non-submerged techniques, have been proposed. Although non-surgical
      interventions have been reported to be effective in reducing BOP and PDs in peri-implantitis
      sites, these therapies have appeared to be unpredictable for the management of
      peri-implantitis, especially in most severe cases. As another treatment option, surgical
      non-reconstructive approaches, i.e. open flap debridement and surface decontamination alone,
      have been suggested to have limited effectiveness in terms of the resolution of inflammation
      for the long-term outcomes. Therefore, much more interest has been intensified regarding the
      efficacy of biomaterials used in reconstructive approaches. Several surgical augmentative
      therapy studies, including the use of bone substitutes with or without barrier membranes have
      demonstrated significant clinical and radiographic improvements for at least 3 years,
      especially in well-contained (three- or four-wall) intrabony defects. A systematic review
      evaluating long-term outcomes of reconstructive therapy for the management of
      peri-implantitis showed a mean PD reduction of 3 mm and a radiographic gain of 2.4 mm in bone
      level. However, as indicated by the last EFP Workshop, no evidence to support the superiority
      of a specific material, product or membrane in terms of long-term clinical outcomes of a
      reconstructive approach has been found. It has been strictly recommended that identification
      of peri-implantitis therapy success and disease resolution in the long-term management are
      required to allow adequate assessment of stable treatment outcomes.

      Because of many studies indicating that growth factors have provided to transiently stimulate
      cells locally, accelerate angiogenesis, promote proliferation, differentiation, and
      regeneration, the additional use of them in the management of peri-implantitis has been
      proposed to improve the clinical outcomes and enhance soft and hard tissue regeneration. A
      recent systematic review and meta-analysis has been suggested that growth factors might be
      associated with better outcomes with regard to PD and BOP, whereas, they did not reveal
      statistically significant evidence for yielding additional benefits in the treatment of
      peri-implantitis. A randomized clinical trial (RCT) on the reconstructive surgical treatment
      of peri-implantitis evaluating concentrated growth factor (CGF) used as a bioresorbable
      barrier membrane in combination with a bone substitute, was performed recently by our study
      group and demonstrated significant improvements in both clinical and radiographic assessments
      at 1-year follow-up. Nevertheless, there is scarce information in the literature regarding
      the predictability and long-term stability of autologous growth factors in peri-implantitis
      management.

      It is, therefore, the aim of this study to investigate the 3-year clinical/radiographic
      outcomes of reconstructive surgical therapy of peri-implantitis using a bone substitute
      combined with two different bioresorbable barrier membranes, either collagen membrane (CM) or
      CGF, and moreover, to identify prognostic indicators influencing the long-term reconstructive
      surgical treatment outcome using a multilevel statistical model.
    

Intervention name(s): bioresorbable membrane
Intervention type(s): Device
Intervention description(s): reconstructive surgical treatment of peri-implant bone defects
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Presence of bleeding on probing (BOP) and/or suppuration (SUP) on gentle probing, and a
        radiographic marginal bone loss (MBL) ≥ 2 mm based on baseline radiographs taken at the
        time of prosthesis delivery with increased probing depth (PD) compared to previous
        examinations.
      
Keywords: peri-implantitis; biomaterials; surgical treatment