Treatment of advanced peri-implantitis with regenerative therapy: a review of the rationale, technique, and outcomes

Abstract

This article reviews a regenerative technique for treatment of implants with Advanced Peri-implantitis (where bone loss is greater than 50% of the implant length). Also reviewed are the prevalence, classification, and rationale for treatment. Literature is presented that shows regeneration (re-osseointegration) of new bone to an implant with peri-implantitis is possible in humans. An 8-step regenerative approach which has been used to successfully treat advanced peri-implantitis is presented in detail covering case selection flap access, implant surface decontamination (SDC), biologics placed on the debrided implant surface which is then covered with a bone graft and membrane barrier. The type of barrier used depends on whether there is sufficient keratinized tissue. If the latter is not present a subepithelial soft tissue connective graft is harvested from the palate to serve as the barrier. Most articles and decision trees recommend that an implant with advanced peri-implantitis be treated by implant removal, rebuilding of the site, and attempting to place another implant. The regenerative technique described in this article was used to treat 170 consecutively treated implants (48 with advanced peri-implantitis) and resulted in a 98.8% success rate with 168/170 implants retained and healthy at a 2–10 years follow up, thus avoiding implant removal.