Background : Peri-implantitis is a biofilm-related disease characterized by tissues inflammation and bone resorption. Despite the absence of accepted protocols, different therapeutic approaches were proposed as non-surgical therapy, access flap, resective and regenerative surgery associated to various decontamination methods of the implant surface. A beneficial effect was nevertheless reported as a result of implantoplasty in association with a resective or regenerative surgical approach.

Aim/Hypothesis : The aim of this study was to observe the clinical effects of implantoplasty applied in different surgical approaches as resective surgery and regenerative surgery.

Material and Methods : Fifteen patients with peri-implantitis were enrolled during a period of 30 months; the overall number of implants involved was 34. All patients were initially treated with non-surgical therapy in order to decrease peri-implant tissues inflammation and 6-8 weeks later the surgical treatment was performed. The surgical approach was chosen based on the anatomy of the bone defect. In bone defects with limited infra-bone portion (≤ 4mm) and where the peri-implant ostectomy was an acceptable biologic cost for adjacent teeth or implants a resective surgical approach was chosen and implantoplasty was performed on the resulting exposed implant surface. In deep infra bone defects (> 4mm) and in those defects where the resection of bone wouldn’t be acceptable a regenerative surgical approach was chosen. Six months after surgery all patients were reevaluated and probing depth, bone level and peri-implant soft tissues inflammation parameters (redness, bleeding-on-probing, swelling) were recorded.

Results : Two implants in two different patients treated with a combination of regenerative surgery and implantoplasty failed due to a lack a primary closure after surgery: one was removed 4 months after surgery, the other implant needed a surgical re-entry three weeks and was then dropped out. Six months after surgery all the other implants showed no signs of peri-implant inflammation, probing depths ≤ 5 mm and no further radiographic bone resorptions; mean probing depth (PD) gain was 2,27 mm. No negative side effects linked to the dispersion of metal filing were recorded.

Conclusion and Clinical implications : The association of implantoplasty and a surgical treatment of peri-implantitis resulted in an improvement of all clinical parameters regarding the peri-implant tissues and could therefore be considered a safe and effective treatment option.

Implantoplasty in the surgical treatment of peri-implantitis- a case series