# Peri-Implantitis Therapy Using Surgical Methods:
###### Abstract  
This study is a systematic review evaluating published literature on the effect of surgical treatments on peri-implantitis. Various databases were selected for the literature search on the topic. The considered primary clinical parameters were changes in probing pocket depth (PPD), bleeding on probing (BoP), radiographic bone change, plaque score, signs of infection, and implant loss. Five research studies comprising 20 or more sample sizes (patients) with minimal two-year follow-up after surgical treatment were selected, based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. In all five studies, PPD and BoP were significantly reduced compared to those before intervention. However, there was no significant variation in the patients treated with open flap debridement, citric acid decontamination, and subepithelial connective tissue graft. The highest reduction of BoP was recorded in the study utilizing regenerative surgical therapy, deproteinized bovine bone mineral containing 10% collagen, the derivative of enamel matrix, and doxycycline. According to the two-five-year follow-up of this systemic review, surgical treatment, including bone substitute material, showed clinical improvement in the reviewed studies, compared to that before intervention; however, there was no statistical significance in the clinical outcome of the selected studies. Keywords:dental implants; implant; dentistry; implant survival; implantoplasty; peri-implant surgery; peri-implantitis; osteeoplasty +
Footnote †: journal: Medical  
Peri-implantitis can also be caused by several implant-related factors. Implant design and its surface features might also contribute to the progression of peri-implantitis [10]. Implants with very rough surfaces, such as some plasma-sprayed or hydroxyapatite-coated implants with arithmetic mean surface roughness (Sa) of \(>\)2 ug, can significantly increase the incidence of peri-implantitis [13; 14; 15]. Some implant technical problems, such as a fractured abutment screw, can cause soft tissue problems, such as a draining sinus [10]. Thus, to manage peri-implantitis, it must be diagnosed correctly. Also, peri-implant tissues must be systematically and regularly monitored to determine whether the peri-implant tissues are healthy or not and to evaluate the severity of the disease [10]. There are several treatment methods for peri-implantitis; however, the main strategies for the disease treatment are based on the treatments used for periodontal infections as microbial biofilm has a similar role in the development of both peri-implantitis and periodontitis [16]. The best strategy for the treatment of plaque-induced peri-implant inflammatory diseases is prevention as peri-implantitis does not cause a predictable response to treatment [9]. Some strategies to prevent implant-associated infection include (i) immobilizing antimicrobial peptides of the implant surface that kill bacteria directly on contact, and (ii) promoting the attachment of gingival epithelial cells to the surface of titanium implants through the surface coating of the implant by peptides, which can strongly bind to the cell surface receptors of human gingival epithelium cells [17]. The gingival epithelium cells work as a physical barrier and prevent bacterial colonization on the titanium implant surface [17]. The treatment of peri-implantitis is difficult, mainly due to the difficulty in the decontamination of the roughened and threaded surfaces of exposed implants [9]. For this reason, surgical treatment is required for peri-implantitis therapy. Various therapeutic techniques mainly based on the treatments used for periodontitis teeth have been used for peri-implantitis therapy. One of these methods is surgical therapy, where a combination of non-surgical methods, such as laser therapy and drug therapy along with rejective and/or regenerative procedures, is used [3].