Objectives The present systematic review aimed at evaluating the efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. Methods Studies reporting on outcomes of reconstructive surgery at peri‐implantitis‐related bone defects at 12 months were identified through an electronic search. Following data extraction, two different sets of meta‐analyses were performed. Primarily, controlled studies were used to evaluate the potential benefit of reconstructive surgical therapy over controls. Secondly, overall outcome of reconstructive surgical therapy was assessed by comparing baseline values with outcomes at 12 months. Results were expressed as weighted mean differences (WMD) or risk ratios (RR). Heterogeneity was described by I2 and prediction intervals. Results The potential benefit of reconstructive techniques over control procedures was evaluated in three studies, representing a total of 116 implants. Altogether, 16 studies reported on the outcome of reconstructive measures at 12 months after surgery. The meta‐analyses identified a larger improvement in marginal bone levels (MBL, WMD = 1.7 mm) and in defect fill (WMD = 57%) for test procedures, but found no differences for clinical measures (reduction of probing depth (PD) and bleeding on probing (BOP). Changes of clinical attachment and soft tissue levels were not considered. In terms of overall outcome, therapy resulted in improved MBL (WMD = 2.0 mm) and CAL (WMD = 1.8 mm), in recession (WMD = 0.7 mm), in reduced PD (WMD = 2.8 mm) and in reduced BOP (Implants: RR = 0.4/Sites: RR = 0.2). None of the included studies addressed patient‐reported outcome measures. Conclusions The available evidence on reconstructive therapy at peri‐implantitis‐related defects is limited by (a) the low number of controlled studies, (b) the lack of controlled studies for commonly used procedures, (c) the heterogeneity between studies and (d) the choice of outcome measures. A high variability for predicted outcomes at 12 months was noted. The interpretation of the demonstrated larger MBL gain for test procedures is difficult as graft material may not be distinguishable from newly formed bone. Potential aesthetic and patient‐reported advantages remain to be demonstrated.

Objective To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri‐implantitis. Methods In this multicenter randomized clinical trial, 138 patients (147 implants) with peri‐implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra‐oral radiographs, and patient‐reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient‐reported outcomes. Results During follow‐up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. Conclusions Surgical therapy of peri‐implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.

BackgroundTo identify factors associated with the presence of buccal soft tissue dehiscences (BSTD).MethodsThis cross‐sectional observational study assessed 52 cases (CAS) with a minimum of 24 months of loading, with the presence of a BSTD, defined as an exposure of the prosthetic abutment, the implant neck or the implant surface in the anterior maxillae or mandible (premolar‐premolar) and 52 carefully selected controls (CON) matched for age and years in function, being the only difference between groups the BSTD. Clinical parameters and radiographic findings from periapical radiographs and Cone Beam Computed Tomographies (CBCT) were analyzed to assess their association with the occurrence of BSTD using a multivariate regression model.ResultsThe CAS had a mean keratinzed mucosa (KM) of 1.65 ± 1.31 mm, whereas in the CON KM was 3.27 ± 1.28 mm (P = 0.001). Probing depths were similar in both groups, whereas bleeding on probing and plaque scores were higher in the CAS (P = 0.001). Mean bone level scores in the CAS were 1.71 ± 1.04 mm, and 1.27 ± 1.01 mm in CON (P = 0.143). The first bone to implant contact at the buccal aspect was 4.85 ± 3.12 mm in CAS and 2.15 ± 3.44 mm in CON (P = 0.001). CAS were 1.48 ± 0.93 mm outside the alveolar envelope, whereas the CON were 0.46 ± 0.77 mm. Implants buccally positioned in the CBCT's were 34 times more likely to belong to the case group. The presence of >2 mm of KM at the time of evaluation, presence of adjacent natural teeth, cemented restorations and two‐piece implants were protective factors.ConclusionThe bucco‐palatal implant position was the most relevant factor related to the presence of BSTD.

Aim:The aim of this study was to evaluate the efficacy of a xenogeneic collagen matrix to augment the width of keratinized mucosa (KM), concomitantly to the surgical treatment of peri-implantitis, when compared to the use of an autologous soft tissue graft. Material and methods:In this 12-month parallel-arm randomized controlled clinical trial, patients with peri-implantitis were randomly assigned, one month after nonsurgical therapy, to surgical resective treatment of peri-implantitis consisting on an apically positioned flap (APF) in combination with a KM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of KM and probing pocket depth (PPD) reduction at 12 months. As secondary outcomes, peri-implant radiographic and patientreported outcomes were assessed. Results:The intention-to-treat population consisted of 49 subjects, assigned to either the APF + FGG (n = 23) or APF + CM (n = 26) group. PPDs were reduced by 1.6 mm (SD 1.0) and 1.7 mm (SD 1.2), respectively, being these differences non statistically significant (p = .782). However, the increase in KM was significantly higher in the APF + FGG compared with APF + CM (2.5 mm [SD 1.6] vs. 1.6 mm [SD 1.2], respectively (p = .033). Conclusion:The tested surgical modalities resulted in similar improvements of the clinical parameters. Both free gingival graft and collagen matrix significantly increased the peri-implant keratinized mucosa, but this KM gain was significantly higher with the free gingival graft. Use of CM, however, was better appreciated by the patients, in terms of pain perception and analgesic consumption, although the surgical time was similar.

Background : Despite the significant body of evidence that shows importance of keratinized tissue in maintaining peri-implant health, there is not enough data regarding the role of soft tissue quantity and quality in the treatment of periimplantitis.At present, it is unknown to what extent soft-tissue grafting may additionally improve the outcomes after surgical treatment of periimplantitis and, if considered, when should soft-tissue grafting be performed.Aim/Hypothesis : The hypothesis of the study is that the collagen matrix of porcine origin is associated with lower patient morbidity, in comparison with autologous soft tissue graft, when used for the augmentation of the keratinized tissues simultaneously with the surgical treatment of peri-implantitis.Material and Methods : A two-centre randomized controlled clinical trial was designed to test a study hypothesis. A sample of 40 patients was recruited basing upon the diagnosis of peri-implantitis and absent or insufficient peri-implant mucosa.1 month after the non-surgical treatment, surgical procedure was performed, which included 1) apical repositioning of the partial-thickness flap, 2) treatment of infected implant surfaces with ultrasound device, glycine powder and or implantoplasty (in case of exposure of rough surface), and 3) suturing the xenogenic matrix (test group) or autologous connective tissue graft (control group) to the vascular bed.Peri-implant clinical and radiographic parameters, as well as patient perception of the therapy provided, will be evaluated before and at various stages (up to 26 weeks) after the surgical intervention. Also, change of vestibulum depth was analyzed, as well as the time spent for the procedure measured.Results : 40 patients with the mean age of 64 years, were included in the study. 30 (76%) of them were females and 10 (24%) were males. 8 patients (20%) were smokers with less than 10 cig day. After randomization, 21 (52.5%) patients were allocated to the test and 19 (47.5%) to the control group. At 6 months visit, statistically significant increase (1.75 mm) of the width of keratinized mucosa was observed, when compared to the baseline. Probing depth decrease was also statistically significant (3.84 mm vs 5.48 mm at baseline).Inter-group comparison revealed no statistically significant difference between the test and control groups in changes of the probing depth, soft tissue recession and width of the keratinized mucosa. However, the change of the vestibulum depth was more pronounced in the control group, and this difference was statistically significant. In terms of patient-centered outcome measures, lower intrasurgical pain was reported in the test group. Conclusion and clinical implications: Suggested surgical modality resulted in the improvement of clinical parameters of peri-implant tissues at 6 months after the intervention. Both free gingival graft and collagen matrix provided increase of the peri-implant keratinized mucosa and vestibulum depth. Patients treated with the collagen matrix reported lower difficulty...