Reconstructive therapy for the management of peri‐implantitis via submerged guided bone regeneration: A prospective case series

Abstract

Background: The present case series assesses the response to reconstructive therapy for the management of 2/3-wall peri-implantitis bone defects following submergedhealing guided bone regeneration. Material and Methods: Fifteen consecutive patients with 27 implants presenting periimplantitis were included. Guided bone regeneration was applied by means of autogenous bone/deproteinized bovine bone mineral grafting mixture and collagen membrane. Patients were assessed at baseline (T0) and at 6 (T1) and 12 months (T2). Clinical and radiographic variables defined the composite success criteria (probing pocket depth [PPD] ≤ 5 mm, no bleeding on probing/suppuration (SUP), no further radiographic bone loss). Patient site-specific comfort was scored using a visual analog scale (VAS). Descriptive statistics was carried out to assess the changes along the study period. Outcomes are reported in terms of mean values (5%-95% percentile values). Results: All the clinical variables substantially changed from T0 through T2. In particular, PPD decreased 3.7 mm (0.7-5.9) from T0 to T2. Likewise, the scores for the modified plaque index (mPI) and modified sulcular bleeding index (mBI) were reduced by 0.5 (−0.5-1.1) and 1.6 (0.4-2.4), respectively. SUP did not display at any implant site at T2 (59.2% implants in 29.2% patients suppurated at T0). Keratinized mucosa decreased 0.6 mm (−0.2-4.4) and while mucosal recession increased 2.5 mm (1.0-4.3). Alike, the radiographic parameters varied significantly from T0 through T2. Infrabony defects were filled by 2.2 mm (0.0-8.6) at T2 and marginal bone loss was reduced by 2.3 mm (−1.1-8.1). The mean VAS score significantly increased from T0 (56.7) through T1 to T2, reaching a score of 96 at T2. At this timepoint, 85.2% of the peri-implantitis lesions were resolved. Conclusions: The proposed surgical approach followed by submerged healing to reconstruct peri-implant bone defects may offer one therapeutic option for failing dental implants. Given the nature of the present study, its effectiveness in comparison to less invasive treatments needs investigation in randomized controlled trials.

Surgical treatment of peri‐implantitis with or without a deproteinized bovine bone mineral and a native bilayer collagen membrane: A randomized clinical trial

“…Data on patient‐related outcomes following reconstructive surgery of peri‐implantitis are limited (Tomasi et al, 2019). However, in a recent publication, patient's site‐specific comfort during oral hygiene was evaluated, and the authors reported that this improved following surgical therapy (Monje et al, 2020). In the present study, high scores were reported for OHIP‐14, and almost all patients were satisfied with the results of therapy.…”

Surgical reconstructive treatment for infraosseous peri‐implantitis defects with a submerged healing approach: A prospective controlled study

“…[41][42][43] Thus far, most of the human research on the reconstructive treatment of peri-implantitis has involved the use of a non-submerged approach, [18][19][20][21]44 and the few studies that have used a submerged approach, have assessed slightly different outcomes or at alternative time points . 14,45,46 At this moment, no other human study has strictly assessed the outcomes of a submerged healing for peri-implantitis through direct clinical examinations of bone fill, a virtue of the necessity to remove the non-resorbable membrane and fixation screws, that we defined as our primary outcome. Therefore, a direct comparison of our results, in particular our primary endpoint to the literature may not be feasible.…”

“…In a more recent study, Monje et al treated 27 implants in 15 patients with peri-implantitis using a submerged healing approach . 45 Relative to the augmentation, the authors used a mixture of an autogenous and xenogenic bovine bone with the application of an absorbable collagen membrane, and assessed the outcomes with periapical radiographs at 1 year, reporting a significant gain of 2.2 mm (ranging 0 to 8.6 mm) in marginal bone levels, and 3.7 mm reduction in PD (0.7 to 5.9). 45 The many design-driven differences, and baseline characteristics of the referenced report relative to ours (the chosen biomaterials, outcome assessment, initial defect characteristics, refabrication of all crowns, etc.)…”

“…45 Relative to the augmentation, the authors used a mixture of an autogenous and xenogenic bovine bone with the application of an absorbable collagen membrane, and assessed the outcomes with periapical radiographs at 1 year, reporting a significant gain of 2.2 mm (ranging 0 to 8.6 mm) in marginal bone levels, and 3.7 mm reduction in PD (0.7 to 5.9). 45 The many design-driven differences, and baseline characteristics of the referenced report relative to ours (the chosen biomaterials, outcome assessment, initial defect characteristics, refabrication of all crowns, etc.) could have led to a greater gain in the mean mesial/distal radiographic scores in our study (3.72 ± 1.41 mm), and the lower PD reductions (2.93 ± 0.25 mm).…”

Reconstructive treatment of peri‐implantitis infrabony defects of various configurations: 5‐year survival and success

“…One still open question is whether after surgical reconstructive interventions, a submerged healing should be preferable. This topic has been recently investigated in a 12 months prospective case TA B L E 4 Differences pre-and 5 years treatment between-groups and intra-groups (means ± SD) PUS elimination (%) series on 15 patients rehabilitated with 27 dental implants by Monje and workers (Monje et al, 2020). The advantage of this approach would be to achieve primary wound closure and to promote an aseptic healing.…”