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Are reconstructive procedures successful in treating peri-implantitis? A systematic review

This summary is based on the article published in the Journal of Dental Research: Reconstructive Procedures for Treating Peri-implantitis: A Systematic Review (December 2013)

V. Khoshkam, HL. Chan, GH. Lin, M.P. MacEachern, A. Monje, F. Suarez, W.V. Giannobile, and HL. Wang

Context

Peri-implantitis is defined as inflammation of peri-implant tissues accompanied with changes in the level of crestal bone and with the presence of bleeding on probing and/or suppuration, with or without concomitant deepening of peri-implant pockets. (1) If not properly managed, it is a debilitating condition that results in loss of function and esthetics. (2) 

The number of implants affected by peri-implantitis is likely to increase as more implants are placed. Therefore, identifying an effective strategy for treating this disease is imperative. 

  • Surgical methodologies are commonly applied to manage moderate and advanced peri-implantitis. (3)
  • Resective techniques are used to treat shallow intrabony defects, while regenerative procedures are indicated for deep, crater-type defects. (4) 
  • Regenerative procedures, applying the concept of guided bone regeneration, use of bone grafts, and membranes, are implemented to rebuild peri-implant supporting bone.

Until now, reports comparing the clinical efficacy of various materials and techniques are limited, making selection of therapies empirical and surgeon preference oriented. (5) 

Purpose of the Review

This systematic review aimed to:

  • Assess the potential of reconstructive surgeries for providing better results in comparison to other surgical therapies,
  • Investigate the overall radiologic and clinical outcomes of reconstructive surgeries, and
  • Identifyany procedure and material that could potentially yield superior results for reconstructive procedures.

Key Findings

No evidence in the literature is currently available to compare the clinical effectiveness of reconstructive and non-reconstructive procedures.

Factors that might influence the reconstructive outcomes include systemic conditions of the patients, defect features, methods to detoxify the implant surfaces, types of bone grafts, and uses of membranes.

Controlled studies are needed to investigate the effect of biological agents, various bone grafts and detoxification methods, and flap management strategies to enhance the reconstructive outcomes.

From a clinical management point of view, the reconstructive procedure is one of several treatment options that may be considered, provided with prudent evaluation of systemic and local factors of the patients affected by peri-implantitis; nonetheless, it should be stressed that there is no available evidence in the literature to show that reconstructive procedures with the use of bone grafts and/or membranes provide better treatment outcomes than non-reconstructive procedures.

References

  1. Lang NP, Berglundh T; Working Group 4 of Seventh European Workshop on Periodontology (2011). Peri-implant diseases: where are we now? Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol 38(suppl 11):178-181.
  2. Fransson C, Tomasi C, Pikner SS, Grondahl K, Wennstrom JL, Leyland AH, et al. (2010). Severity and pattern of peri-implantitisassociated bone loss. J Clin Periodontol 37:442-448.
  3. Aljateeli M, Fu JH, Wang HL (2012). Managing peri-implant bone loss: current understanding. Clin Implant Dent Relat Res 14(suppl 1):e109-e118.
  4. Schwarz F, Sahm N, Schwarz K, Becker J (2010). Impact of defect configuration on the clinical outcome following surgical regenerative therapy of peri-implantitis. J Clin Periodontol 37:449-455.
  5. Esposito M, Grusovin MG, Worthington HV (2012). Interventions for replacing missing teeth: treatment of peri-implantitis. Cochrane Database Syst Rev 1:CD004970.

 

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