# Peri-Implantitis Therapy Using Surgical Methods:
###### Abstract
The basic principles of surgical therapy comprise the removal of the peri-implant osseous defect by osteotomy, osteoplasty, and decontamination of the implant surface [1]. Implantoplasty is also a surgical treatment in peri-implantitis, where the supracestral implant surface is smoothened and polished [18]. Recent research reported by [PERSON] and [PERSON] [19] showed that surgical pocket elimination and recontoruing of bone combined with plaque control prior- and post-surgery in patients with the active peri-implant disease, represented an effective treatment. Another surgical method is implantoplasty that proved to be effective as a surgical treatment method. [PERSON] et al. [20] compared the therapeutic effects of implantoplasty and peri-implant respective surgery only on the marginal implant bone loss through a three-year follow-up radiographic assessment. The results demonstrated that implantoplasty was a promising strategy for the treatment of peri-implant infections and peri-implantitis progression. The results also demonstrated that marginal implant bone loss significantly decreased after resective surgery with implantoplasty compared to that of resective therapy only. [PERSON] et al. [3] also demonstrated that resective surgical therapy could be a recommended therapy for peri-implantitis. Ostectomy and osteoplasty in combination with implantoplasty can also effectively reduce or even stop the progression of peri-implantitis. However, as this strategy is associated with increased postoperative recessions, it is not appropriate for every situation, particularly in highly aesthetic sensitive areas [3]. In addition, [PERSON] et al. [21] confirmed that the application of an anti-infective protocol, including surgical access, the decontamination of the implant surface, and systemic antimicrobials continued by a strict post-operative protocol could be effective in the peri-implantitis treatment. In this study, open flap debridement and the decontamination of implant surface in combination with adjunctive systemic amoxicillin and metronidazoleae were used for the treatment of moderate to advanced peri-implantitis. The regenerative approach is another effective surgical treatment technique that has been studied in recent literature [22], while resective surgical therapy might be useful in re-osseointegration in only minor superficial defects [3]. However, full regenerative and re-osseointegration are required to achieve a functional and long-term survival implant with aesthetic outcome [3]. Various experimental research has been conducted according to the principles of guided bone regeneration (GBR) to assess the application effect of different grafting material and/or resorbable membranes. The results of animal studies performed by [PERSON] et al. [23] in dogs showed that the therapeutic outcomes between GBR and GBR \(\pm\) graft combinations were not significantly different; therefore, GBR procedures seem to be a predictable treatment for the peri-implant defects induced by plaque infection. Additionally, numerous studies [24; 25] have considered the treatment of peri-implantitis in humans using regenerative approaches. The results of a retrospective study [26] demonstrated that the periodontal flap with osteoblast (47%) and bone replacement materials (20%) were the most widely used operative intervention, respectively. The results of this study also indicated that the cumulative success rate for both procedures was 69%, which significantly decreased in patients due to various risk factors (e.g., smoking, periodontal disease, and poor oral hygiene). The efficacy of the peri-implantitis treatment was reduced by severe periodontitis, severe marginal implant bone loss, poor oral hygiene, and low compliance [26]. The research question that comes to mind is 'what is the most effective surgical treatment technique in eliminating peri-implantitis? Researchers have different opinions on using surgical intervention; however, the best possible approach is not very clearly described.