Regenerative Treatment of Peri-Implantitis Using Bone Substitutes and Membrane: A Systematic Review

Abstract

Purpose: This systematic review aimed to assess the available literature for regenerative treatment of peri-implantitis using bone graft substitutes and membranes. Methods: A search in electronic databases was conducted to assess all types of clinical studies treating bone defects derived from peri-implantitis using guided bone regeneration (GBR) techniques. Results: During the first screening, 399 titles were identified. Finally, 17 articles reporting on 173 implants were included. The articles mainly focused on radiographic bone fill of the defect. Qualitative measures of "bone fill" were reported: 10.4% of the implants showed complete "bone fill," whereas 85.5% revealed incomplete defect closure. No bone fill was shown in 4.0%. Little information (in 53.2%) was provided regarding the probing depth before or after treatment. Data concerning the inflammatory status of soft tissues were also scarce and only reported in three studies. A large heterogeneity concerning disinfection protocols and regenerative materials used was found. The high percentage of low-quality studies rendered a meta-analysis impossible. Conclusion: Complete fill of the bony defect using GBR seems not to be a predictable outcome. The mucosal health status is left unconsidered in most studies. Well-controlled trials are needed to determine predictable treatment protocols for the successful regenerative treatment of peri-implantitis using GBR technique.Regenerative treatment of peri-implantitis using bone substitutes METHODS: A search in electronic databases was conducted to assess all types of clinical studies treating bone defects derived from peri-implantitis using GBR techniques.RESULTS: During the first screening, 399 titles were identified. Finally, seventeen articles reporting on 173 implants were included. The articles mainly focussed on radiographic bone fill of the defect. Qualitative measures of "bone fill" were reported: 10.4% of the implants showed complete "bone fill", whereas 85.5% revealed incomplete defect closure. No bone fill was shown in 4.0%. Little information (in 53.2%) was provided regarding the probing depth before or after treatment. Data concerning the inflammatory status of soft tissues was also scarce and only reported in three studies. A large heterogeneity concerning disinfection protocols and regenerative materials used was found. The high percentage of low-quality studies rendered a meta-analysis impossible.Conclusion: Complete fill of the bony defect using GBR seems not to be a predictable outcome.The mucosal health status is left unconsidered in most studies. Well-controlled trials are needed to determine predictable treatment protocols for the successful regenerative treatment of periimplantitis using GBR-technique.

Surgical Regenerative Treatments for Peri-Implantitis: Meta-analysis of Recent Findings in a Systematic Literature Review

“…Barrier membranes are intended to stabilize the graft and to prevent epithelial downgrowth and fibroblast transgrowth into the grafted area, thereby favouring the population of bone cells in a bony defect. In agreement to findings in this review, Sahrmann et al [73] concluded that guided bone regeneration using both bone graft substitute and membrane represents the major part of published surgical regenerative treatment of peri-implantitis cases. Schwarz et al [27] stated that combination of biomaterial (bovine-derived xenograft) together with collagen membrane resulted in improved clinical outcomes compared to biomaterial (nanocrystalline hydroxyapatite) alone.…”

Can Periimplantitis Be Treated?

“…Unfortunately there is paucity of current literature comparing the effectiveness of various surgical techniques and grafting materials to treat periimplantitis. In addition, a recent systematic review found that there was only partial bone regeneration in most studies 104 ; thus, it is uncertain if guided bone regeneration is superior to other nonsurgical or surgical methods for treating periimplantitis. 105 Summary Surgical interventions are more effective in the management of periimplantitis compared with nonsurgical interventions.…”

What’s new on the dental scene?

“…Aim: The aim of the present review by Sahrmann et al (Clin Impl Dent Rel Res 2011;13:46-57) [3] was to systematically evaluate the outcome of GBR using a bone-graft substitute in combination with a membrane on the basis of the parameters to PPD, BOP, and marginal bone loss (BL).…”