Background and Aim
The main problem in periimplantitis is often the combination of
severe perimplant bone loss with a contaminated implant surface
and an insufficient soft tissue situation. Classic surgical concepts
with a crestal access to the bony defect and debridement of the
surface most often lead to partial defect regeneration and a soft
tissue recession. An incision above the pathologic bony lesion is
contrary to basic surgical treatment rules.
To overcome this problem a new surgical concept was developed
which allows to clean the implant surface, reconstruct the bony
defect and improve soft tissue height and thickness without cutting
the papilla complex. This pilot study evaluates the early clinical
outcome of implants with severe periimplantitis treated with this
modified approach for regenerative periimplantitis therapy.
Methods and Materials
A total of 11 implants in 9 patients (6 females, 3 males, 7 nonsmokers,
2 smokers) were included. All implants (2 Straumann Bone
Level, 2 NobelActive, 1 Frialit II, 2 OsseoSpeed, 2 OsseoSpeed
Profile, 2 NobelPerfect; 5 incisor, 1 canine, 1 premolar and 4 molar
implants) were treated according to the same treatment protocol:
horizontal mucosal incision 5 mm apical to marginal mucosa,
supraperiostal preparation in apical direction, cutting through
periostium at level of the implant apex, subperiostial coronal flap
elevation, exploration and cleaning of the periimplant defect,
thorough debridement of the implant surface with the Er:YAG laser (Morita), subperiostal grafting with connective tissue, grafting of the
bony defect with autogenous bone chips from the mandibular
ramus, bilayered suturing of periosteum and mucosa. During this
pilot study, implant survival, marginal bone levels, periimplant
probing depths, recession and tissue thickness (PIROP ultrasonic
measurement) were evaluated.
Results
All implants were still in function at the final examination. Mean
follow-up period was 7.3 months (range, 5 to 12 months). Interproximal,
oral and buccal marginal bone levels increased
significantly in relation to the implant shoulder from pre-operative
examination to final examination. No signs of suppuration or
periimplant infection were present. Probing depths and recession
decreased significantly, while the soft tissue thickness improved
from pre-operative examination to final examination (pre-op 1.54 to
2.31 mm).
Conclusion
Marginal bone levels and soft tissue results suggest feasibility for
the regeneration of severe periimplant hard and soft tissue
deficiencies by this new treatment approach. With the use of this
concept the simultaneous implant surface cleansing and
improvement of hard and soft tissue seems to be possible and
unfavorable postoperative exposure of titanium surface can be
prevented.

A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects-  Laser-assisted periimplant defect regeneration (LAPIDER)