A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities

Abstract

ObjectivesThe current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented.Material and MethodsA narrative review was conducted to fulfill the aim.ResultsThe four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial.ConclusionsA more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.

Evaluation of peri-implant perfusion in patients who underwent avascular augmentation or microvascular reconstruction using laser Doppler flowmetry and tissue spectrophotometry: a prospective comparative clinical study

“…Healthy peri-implant tissue and its physiological perfusion are fundamental requirements for a well-working defense against bacteria and a stable marginal bone level, which is crucial for the long-term survival of an implant [ 1 – 3 ]. Vascularization occurs to a lesser extent in peri-implant mucosa than in natural teeth because the implant tends to have a greater amount of collagen fibers attached to it than Sharpey’s fibers, and it resembles scar tissue [ 1 ]. The lack of natural periodontium around an implant causes peri-implant inflammation to progress faster than gingivitis, affecting natural teeth [ 4 ].…”

A longitudinal analysis of the impact of nonsurgical and surgical treatment of peri‐implantitis upon clinical parameters and implant stability quotient values. A 2–3‐year follow‐up

“…Peri-implant disease is a relatively common entity following the placement of dental implants and a variety of clinical treatment approaches have been used in its management (Chan et al, 2023;Monje et al, 2023). Given the previous variations in disease criteria used to define peri-implantitis (PI) in the existing literature, it is perhaps unsurprising that there is no consensus among dental professionals regarding a preferred treatment protocol to treat periimplantitis and significant empiricism exists in the approaches selected (Renvert & Polyzois, 2018).…”