Surgical Treatment of Periimplantitis With Augmentative Techniques.

OBJECTIVES To address the focused question: "In patients with osseointegrated implants diagnosed with periimplantitis, what are the clinical and radiographic outcomes of augmentative surgical interventions compared with nonaugmentative surgical measures"? MATERIAL AND METHODS Literature screening was performed in MEDLINE through the PubMed database, for articles published until January 1, 2018. Human studies reporting on the clinical (ie, bleeding on probing [BOP] and probing depth [PD] changes) and/or radiographic (ie, periimplant defect reduction and/or fill) treatment outcomes after surgical augmentative periimplantitis therapy, and/or comparing augmentative and nonaugmentative surgical approaches were searched. RESULTS Thirteen comparative and 11 observational clinical studies were included. Surgical augmentative periimplantitis therapy resulted in mean BOP and PD reduction ranging from 26% to 91%, and 0.74 to 5.4 mm, respectively. The reported mean radiographic fill of intrabony defects ranged between 57% and 93.3%, and defect vertical reduction varied from 0.2 to 3.77 mm. Three randomized controlled clinical studies failed to demonstrate the superiority of augmentative therapy compared with nonaugmentative approach in terms of PD and BOP reduction. CONCLUSIONS The available evidence to support superiority of augmentative surgical techniques for periimplantitis management on the treatment outcomes over nonaugmentative methods is limited

Implant Surface Decontamination by Surgical Treatment of Periimplantitis: A Literature Review.

INTRODUCTION The purpose of this review was to evaluate the available published clinical studies to understand the current data on the decontamination efficacy of various agents used in the treatment of periimplantitis and reosseointegration. MATERIALS AND METHODS An electronic PubMed literature search was conducted for studies published from 1998 until 2018. Literature on clinical studies was included in the review. Of the 189 studies retrieved from the literature search, 33 articles were selected for the review. DISCUSSION The available studies reviewed had great heterogeneity to conclude a single treatment of choice for implant surface decontamination for the surgical treatment of periimplantitis. CONCLUSIONS Existent data do not favor any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Further clinical investigations are needed to determine the superiority of a decontamination method if existing

Soft-Tissue Management as Part of the Surgical Treatment of Periimplantitis: A Narrative Review.

BACKGROUND The data on the importance of soft-tissue management during surgical treatment of periimplantitis are still limited, and no clinical recommendations are yet available. AIM To give an overview on the rationale for periimplant soft-tissue augmentation procedures in the light of potential benefits/risks of the presence/absence of keratinized/attached mucosa (KAM) providing recommendations for the clinician. RESULTS The available evidence indicates that the presence of KAM favors periimplant tissue health evidenced by improved bleeding scores and facilitation of self-performed plaque removal, less mucosal recessions, and more stable marginal bone levels over time. Therefore, the rationales to augment KAM are (a) to optimize the possibility for performing an adequate level of oral hygiene, (b) to help maintaining periimplant soft-tissue health and stability, and (c) to improve esthetics. Various techniques with autogenous or xenogeneic membranes have been described so far for KAM augmentation. Additional soft-tissue grafting in conjunction with a combined regenerative and resective surgical procedure seems to be effective in treating and controlling advanced periimplantitis lesions and improving or maintaining the esthetic outcomes. CONCLUSIONS The limited available data seem to indicate that the best outcome to improve the width of KAM, and the bleeding and plaque scores, as well as to maintain the periimplant marginal bone level is the use of an apically positioned flap combined with a free gingival graft in nondiseased periimplant sites. However, at present, it is unknown: (a) to what extent soft-tissue grafting may additionally improve the outcomes after surgical (resective or regenerative) treatment of periimplantitis compared with the same approaches without soft-tissue grafting, and (b) if considered, when should soft-tissue grafting be performed (eg, before or during surgical treatment of periimplantitis). CLINICAL RECOMMENDATIONS Both soft-tissue resective and regenerative approaches may lead to successful outcomes depending on the clinical indication and defect location. However, the selection of one or another surgical approach should be based on defect type (eg, intrabony and suprabony) and location (esthetic or nonesthetic areas). The presence of an adequate width and thickness of KAM may facilitate soft-tissue (flap) management. In patients with a thin phenotype or lack of an adequate width of KAM, soft-tissue grafting may improve the clinical outcomes