# Peri-Implantitis Therapy Using Surgical Methods:
## 4 Discussion
study [34] demonstrated that 26.9% and 34.6% of patients in group 1 and group 2, respectively, had no additional bone loss, no BoP or suppuration with a maximum PPD of \(\leq\)5 mm, at year three after surgical treatment, indicating the higher therapeutic efficacy of bone substitute + CM, compared to that of bone substitute + CGF, in the treatment of peri-implantitis. Also, the results of this study demonstrated that prognostic indicators, such as history of periodontitis, radiographic vertical defect depth (VDD) at the baseline, and the configurations of peri-implant bone defect, negatively affected the treatment outcome, in which patients with a history of periodontitis and higher VDD values had poorer treatment outcome. Moreover, patients with four-wall defects, compared to those with other defect types, have more favorable treatment outcome. The long-term (five years) effects of regenerative treatment on peri-implantitis were evaluated by [PERSON] et al. [25]. In this study, the highest reduction of BoP was observed by -86.1% using bone substitute material and a resorbable membrane. After surgical intervention, all individuals in the study utilized supportive therapy, including oral hygiene, and the plaque was controlled very efficiently throughout the study. Perfect oral health is a prerequisite for the successful treatment of implants. The authors [25] demonstrated that using the resorbable membrane to cover the bone substitute had no improvement effects on the long-term outcomes. Moreover, in this study patients were not randomly assigned to treatment groups; thus, further research studies are needed and should further assess various surgical therapeutic approaches using a randomized clinical trial [25]. In all five studies [25; 31; 32; 33; 34], BoP values showed considerable improvement compared to that of their baseline. [PERSON] et al. [31] could significantly decrease the BoP value by 80% using regenerative surgical therapy, DBBMC, EMD, and doxycycline, indicating the efficacy of this regenerative treatment approach of peri-implantitis. The results of this study also demonstrated that SPT caused a decrease in the BoP after surgical treatment, in which the use of SPT at the four-month interval, compared to that at six-month interval, caused a 60% decrease in BoP in the treated implants, indicating that if SPT extended longer than four months, the risk of inflammation recurrence increased in dental implants, resulting in a deterioration in the maintenance of implants for a long time. Nonetheless, this study [31] used only a single treatment protocol and had no comparison/control groups; thus, determining the effects of the various \"cocktail\" components on the results of treatment was impossible. Also, the regenerative bone gain was stable in all five studies [25; 31; 32; 33; 34] after the treatment, meaning that therapeutic approaches could largely inhibit bone loss in the patients. The level of bone was found to be stable in 92.5% of the implants after the surgical treatments [33]. This study [33] also demonstrated that BoP decreased by 75% in the two-year follow-up period, and there was no implant loss. The plaque score in the majority of patients (95%) was less than 10% after surgical treatment at every control visit and decreased by 67.5% at the final period of review compared to that of baseline. The results of this study [33] suggestedthat the apically positioned flap and osteoplasty in combination with implantoplasty was an effective and reliable strategy for peri-implantitis treatment but increased gingival recession in aesthetic areas [33]. The results of this study [33] demonstrated that surgical therapy to eliminate pockets combined with an apically positioned flap, osteoplasty, and implant surface smoothing, is a promising approach to inhibiting the progression of peri-implantitis for a period of two years.