The therapy of peri-implantitis: a systematic review.

This review showed that successful treatment outcomes 12 months following therapy of peri-implantitis could be achieved in a majority of patients in seven studies. While favorable short-term outcomes were reported in many studies, lack of disease resolution as well as progression or recurrence of disease and implant loss despite treatment were also reported. All studies included in this review had either an unclear or high risk of bias, which should be considered when interpreting the results. Furthermore, the reported outcomes must be viewed in the context of the varied peri-implantitis case definitions and severity of disease included, as well as the heterogeneity in study design, length of follow-up, and exclusion/inclusion criteria. While the currently available evidence does not allow any firm specific recommendations for nonsurgical or surgical therapy of peri-implantitis, the following elements of therapy seem to be beneficial: A pretreatment phase including • Oral hygiene instruction and counseling for smoking cessation • Assessment of the prosthesis for access for plaque control • Prosthesis removal and adjustment if required • Nonsurgical debridement with or without antimicrobials Surgical access (when resolution of peri-implantitis is not achieved with nonsurgical treatment) • Full-thickness mucoperiosteal flap to allow thorough cleaning of the contaminated implant surfaces (numerous techniques, may involve modification of the implant surface topography). • The stabilization of the intraosseous peri-implant defect with a bone substitute/bone graft/bioactive substance with or without a resorbable barrier membrane Postoperative anti-infective protocol • Peri-or postoperative systemic antibiotics • Chlorhexidine rinses during the healing period (several weeks) Maintenance care • Three- to 6-month maintenance, including oral hygiene instruction and supramucosal biofilm removal