# Peri-Implantitis Therapy Using Surgical Methods:
## 4 Discussion  
Regarding the clinical parameters, all five studies demonstrated an improvement in the clinical condition after the treatment, i.e., the clinical parameters, such as PPD and BoP, decreased by 42.7% and 60.7%, respectively, in the studies at the end of follow-up compared to those of baseline. The highest reduction in PPD was reported by [PERSON] et al. [31], [PERSON] et al. [25], [PERSON] et al. [33], [PERSON] et al. [34], and [PERSON] et al. [32], by 60.7%, 44.8%, 37.9%, 37.5%, and 30.8%, respectively. [PERSON] et al. [33] used osteoplasty, implantoplasty, and apically positioned flap for surgical treatment, while [PERSON] et al. [31], [PERSON] et al. [25], and [PERSON] et al. [34] used bone substitute material and regenerative techniques. This could indicate that regenerative techniques might be as effective as surgical methods alone. Reduction in PPD along with RBG in the [PERSON] et al. study [31] demonstrated that using a combination of DBBMC, EMD, and doxycycline powder is effective as a therapeutic approach for regenerative therapy of peri-implantitis. The results of the [PERSON] et al. study [32] demonstrated that when chemical decontamination was used with implantoplasty in group 3, PPD, BoP, and suppuration significantly decreased. Also, using SCTG in group 2 was found to be effective in thickening the peri-implant keratinized tissue [32]. It has been demonstrated that the grafting of connective tissue (keratinized tissues) to cap implants influenced by peri-implantitis improves peri-implant health [32]. Moreover, the band of keratinized tissue in peri-implant can improve oral hygiene and preclude larger tissue damage owing to the difficulty in the control of plaque in the areas, which have the least keratinized mucosa. Nonetheless, the keratinized mucosa dimension can be a risk factor that increases the likelihood of peri-implantitis occurring [32]. The  
Figure 6: Values of implant survival rate after follow-up (i.e., after surgical treatment) compared to that of baseline (before surgical treatment), reported by [PERSON] et al. [32], [PERSON] et al. [25], [PERSON] et al. [33], [PERSON] et al. [31], and [PERSON] et al. [34]. As these studies showed, only in the [PERSON] et al. study the survival rate was below 100%, while in other studies this value was 100%. ideal treatment of peri-implantitis is the full resolution of the disease and reorganization and preservation of healthy peri-implant tissues. It can be clinically achieved when peri-implant PPD is less than 5 mm, with no BoP, no suppuration, and no ongoing loss. As this condition is rarely reported in the literature, the proposed criteria for successful treatment of the disease is implant survival, mean PPD less than 5 mm, and no ongoing loss. In the [PERSON] et al. study [33], no implants were lost, and 92.5% of implants had the aforementioned criteria. However, when BoP was added to the criteria, the treatment success rate decreased to 75%. Also, the results of this study [33] demonstrated that plaque control was a critical factor in the peri-implantitis treatment, in which all implants which had low plaque scores remained stable, while two patients who had implants with high plaque scores demonstrated progressive bone loss. Overall, the results of this study demonstrated that surgical therapy to eliminate pockets along with apically positioned flap, osteoplasty, and implant surface smoothing could be considered a promising therapeutic approach for stopping the progression of peri-implantitis; however, controlling the plaque is of great importance. Also, the aesthetic outcome can limit the applicability of this therapeutic approach in the anterior maxilla [33]. The results of the [PERSON] et al.