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: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.

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...

Objectives:The aim of the present study was to evaluate the efficacy of a supportive peri-implant care (SPIC) protocol after surgical therapy of peri-implantitis, combining ultrasonic mechanical debridement and glycine powder air polishing. Materials and Methods:Thirty subjects diagnosed with peri-implantitis and treated by means of access flap were randomized 6 months later into two different SPIC groups: the test group combined a piezoelectric ultrasonic instrumentation with a specific implant PEEK tip and glycine powder air polishing, while control group received the same ultrasonic instrumentation together with a rubber cup and a polishing paste. Patients were followed for 12 months, with intermediate SPIC visits every 3 months. Clinical, radiological, microbiological and biochemical outcome variables were registered and calculated.Results: After 12 months of SPIC, probing depths (PD) showed a mean reduction of 0.33 ± 0.11 mm, with significant differences (p < .001) between the test (−0.84 ± 0.43 mm) and the control group (+0.18 ± 0.73 mm). Healthy peri-implant tissues defined by PD <5 mm, absence of BoP (or in only one site around the implant), and no additional bone loss (<0.5 mm), were observed at the final visit in 83% of the implants (87% in the test group and 80% in the control group, p = .255). No adverse events were reported by the subjects participating in the study. Conclusions:The SPIC protocol including mechanical ultrasonic debridement and glycine powder air-polishing demonstrated significantly better efficacy in terms of PD reductions. A strict SPIC protocol can maintain for 1 year, or even improve, the results obtained after surgical treatment of peri-implantitis.