Comparative Efficacy of Air-abrasive Polishing Versus Other Nonsurgical Therapies in Peri-implantitis Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The aim of this review was to compare air polishing devices with conventional periodontal therapy (hand instrumentation and/or ultrasonic debridement), in terms of their clinical, microbiological and patient-related outcomes in patients undergoing periodontal maintenance therapy. An online database search was performed to identify randomized controlled trials (RCTs) published between January 1987 and March 2021. Selection, data extraction and assessment risk of individual bias were conducted by two independent reviewers. The PICO method was employed to formulate the question: "In patients undergoing periodontal maintenance therapy/supportive periodontal therapy, do air polishing systems result in better clinical, microbiological and patient related outcomes than ultrasonic instrumentation or hand instrumentation?" Primary outcomes were bleeding on probing, gingival index and/or bleeding index. Secondary outcomes were probing depth, clinical attachment level, plaque index, microbiological counts and/or patient tolerance. The risk of bias was evaluated and the systematic review protocol was registered in PROSPERO. The electronic search yielded 501 references of which 14 were included in this review. A meta-analysis was not performed due to great heterogeneity within the studies. Air polishing devices and conventional periodontal therapy presented identical results in the 14 studies analysed; however, air polishing devices presented better antimicrobial behaviour and better patient-related outcomes. Both air polishing devices and conventional techniques demonstrated no difference in terms of clinical efficacy; however, air polishing devices seem to present improved antimicrobial results. In addition, they are also a safer, faster and more comfortable option for patients undergoing supportive periodontal therapy.

In this update of a previous systematic review, we compared the effects of surgical and non-surgical treatments for peri-implantitis through the component network meta-analysis (CNMA) with probing depth (PD) reduction as the outcome. Literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials, and Embase databases from August 2010 to June 2023. Randomized controlled trials (RCTs), comparing non-surgical or surgical treatments for peri-implantitis with 6-12 months of follow-up and reported changes in PD, were included. Treatment effects were assessed using a CNMA model based on additivity assumption. We calculated the intraclass correlation coefficient (ICC) to adjust the standard errors for multiple implants within the same patient. Our systematic review identified 44 RCTs, which included 46 treatment regimens consisting of 15 components. These RCTs formed a disconnected network consisting of 11 subnetworks. Surgical treatments with bone grafts and membranes generally attained greater PD reduction than non-surgical treatments, although bone grafts and membranes as components provided moderate benefits. The effect size of antibiotics is greater in non-surgical than surgical treatments, while there is considerable uncertainty regarding the effect size of implantoplasty. Additionally, the effectiveness of components varied between surgical and non-surgical treatments. Current evidence does not yield sufficiently robust estimates for identifying optimal surgical and non-surgical treatment regimens for peri-implantitis, so the findings of our study should be interpreted cautiously. A coordinated strategy is required for designing future trials to fill the gaps in our current knowledge and develop more reliable recommendations.

BackgroundCrimean Congo haemorrhagic fever (CCHF) is a tick‐borne disease that occurs in parts of Asia, Europe and Africa. Since 2000 the infection has caused epidemics in Turkey, Iran, Russia, Uganda and Pakistan. Good‐quality general supportive medical care helps reduce mortality. There is uncertainty and controversy about treating CCHF with the antiviral drug ribavirin.ObjectivesTo assess the effects of ribavirin for treating people with Crimean Congo haemorrhagic fever.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (OVID); Science Citation Index‐Expanded, Social Sciences Citation index, conference proceedings (Web of Science); and CINAHL (EBSCOHost). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for trials in progress. We conducted all searches up to 16 October 2017. We also contacted experts in the field and obtained further studies from these sources.Selection criteriaWe evaluated studies assessing the use of ribavirin in people with suspected or confirmed Crimean Congo haemorrhagic fever. We included randomised control trials (RCTs); non‐randomised studies (NRSs) that included more than 10 participants designed as cohort studies with comparators; and case‐control studies.Data collection and analysisTwo review authors assessed eligibility, risk of bias, and extracted data. For non‐randomized studies we used the ROBINS‐I tool to assess risk of bias. The main effects analysis included all studies where we judged the risk of bias to be low, moderate or high. We summarized dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and used meta‐analyses where appropriate. We carried out a subsidiary appraisal and analysis of studies with critical risk of bias for the primary outcome, as these are often cited to support using ribavirin.Main resultsFor the main effects analysis, five studies met our inclusion criteria: one RCT with 136 participants and four non‐randomized studies with 612 participants. We excluded 18 non‐randomized studies with critical risk of bias, where none had attempted to control for confounding.We do not know if ribavirin reduces mortality (1 RCT; RR 1.13, 95% confidence interval (CI) 0.29 to 4.32; 136 participants; very low‐certainty evidence; 3 non‐randomized studies; RR 0.72, 95% CI 0.41 to 1.28; 549 participants; very low‐certainty evidence). We do not know if ribavirin reduces the length of stay in hospital (1 RCT: mean difference (MD) 0.70 days, 95% CI ‐0.39 to 1.79; 136 participants; and 1 non‐randomized study: MD ‐0.80, 95% CI ‐2.70 to 1.10; 50 participants; very low‐certainty evidence). We do not know if it reduces the risk of patients needing platelet transfusions (1 RCT: RR 1.23, 95% CI 0.77 to 1.96; 136 participants; very low‐certainty evidence). For adverse effects (including haemolytic anaemia and a need to discontinue treatment), we do not know whether there is an increased risk with ribavirin in people with CCHF as data are insufficient.We do not know if adding ribavirin to early supportive care improves outcomes. One non‐randomized study assessed mortality in people receiving ribavirin and supportive care within four days or less from symptom onset compared to after four days since symptom onset: mortality was lower in the group receiving early supportive care and ribavirin, but it is not possible to distinguish between the effects of ribavirin and early supportive medical care alone.In the subsidiary analysis, 18 studies compared people receiving ribavirin with those not receiving ribavirin. All had a critical risk of bias due to confounding, reflected in the mortality point estimates favouring ribavirin.Authors' conclusionsWe do not know if ribavirin is effective for treating Crimean Congo haemorrhagic fever. Non‐randomized studies are often cited as evidence of an effect, but the risk of bias in these studies is high.

The aim of the present study was to evaluate the efficacy of a supportive peri-implant care (SPIC) protocol after surgical therapy of peri-implantitis, combining ultrasonic mechanical debridement and glycine powder air polishing. Thirty subjects diagnosed with peri-implantitis and treated by means of access flap were randomized 6months later into two different SPIC groups: the test group combined a piezoelectric ultrasonic instrumentation with a specific implant PEEK tip and glycine powder air polishing, while control group received the same ultrasonic instrumentation together with a rubber cup and a polishing paste. Patients were followed for 12 months, with intermediate SPIC visits every 3months. Clinical, radiological, microbiological and biochemical outcome variables were registered and calculated. After 12 months of SPIC, probing depths (PD) showed a mean reduction of 0.33 ± 0.11 mm, with significant differences (p < .001) between the test (-0.84 ± 0.43 mm) and the control group (+0.18 ± 0.73 mm). Healthy peri-implant tissues defined by PD <5 mm, absence of BoP (or in only one site around the implant), and no additional bone loss (<0.5 mm), were observed at the final visit in 83% of the implants (87% in the test group and 80% in the control group, p=.255). No adverse events were reported by the subjects participating in the study. The SPIC protocol including mechanical ultrasonic debridement and glycine powder air-polishing demonstrated significantly better efficacy in terms of PD reductions. A strict SPIC protocol can maintain for 1year, or even improve, the results obtained after surgical treatment of peri-implantitis.

This systematic review and meta-analysis aimed to evaluate the efficacy of non-surgical laser therapies compared to other treatment modalities for managing peri-implantitis and to analyze post-treatment outcomes of different interventions. A comprehensive search was conducted across Medline (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), identifying 4675 studies published between January 1953 and November 2023. A total of 15 randomized controlled trials (RCTs) involving 540 patients and 658 implants met the inclusion criteria, with 10 studies eligible for meta-analyses. Meta-analyses revealed that Er:YAG laser therapy significantly reduced bleeding on probing (BOP) by 35.6 % (95 % CI: 17.3 % to 53.9 %; I2 = 83 %) and probing depth (PD) by 0.65 mm (95 % CI: 0.33 to 0.97; I2 = 0 %). The combination of mechanical debridement (MD) and Er,Cr:YSGG laser therapy improved PD by 1.23 mm (95 % CI: 0.76 to 1.70; I2 = 0 %) and reduced BOP by 47.3 % (95 % CI: 38.4 % to 56.1 %; I2 = 0 %). However, none of the therapies showed any significant advantage in preventing crestal bone loss (CBL). Laser therapies did not demonstrate any significant superiority over traditional therapies (p > 0.05). Non-surgical laser therapies, including Er:YAG, Er,Cr:YSGG, Nd:YAG and diode lasers, demonstrated effectiveness in reducing inflammation and probing depths but did not consistently outperform MD alone or in combination with other treatments. The findings emphasize the need for further research and standardized protocols, as no modality significantly prevented CBL. These results provide evidence-based insights into optimizing non-surgical management strategies for peri-implantitis. Non-surgical laser therapies demonstrate significant reductions in inflammation and probing depths in peri-implantitis treatment. However, their comparable outcomes to mechanical debridement highlight the need for further studies to establish their role and develop standardized protocols for optimized clinical use.

To investigate the clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for the treatment of adults with pulmonary arterial hypertension (PAH) within their licensed indications. Major electronic databases (including the Cochrane Library, MEDLINE and EMBASE) were searched up to February 2007. Further data were obtained from dossiers submitted to NICE by the manufacturers of the technologies. The systematic clinical and economic reviews were conducted according to accepted procedures. Model-based economic evaluations of the cost-effectiveness of the technologies from the perspective of the UK NHS and personal social services were carried out. In total, 20 randomised controlled trials (RCTs) were included in this assessment, mostly of 12-18 weeks duration and comparing one of the technologies added to supportive treatment with supportive treatment alone. Four published economic evaluations were identified. None produced results generalisable to the NHS. There was no consensus in the industry submissions on the most appropriate model structure for the technology assessment. Improvement in 6-minute walk distance (6MWD) was seen with intravenous epoprostenol in primary pulmonary hypertension (PPH) patients with mixed functional class (FC) (mainly III and IV, licensed indication) compared with supportive care (58 metres; 95% CI 6-110). For bosentan compared with supportive care, the pooled result for improvement in 6MWD for FCIII patients with mixed PAH (licensed indication) was 59 metres (95% CI 20-99). For inhaled iloprost, sitaxentan and sildenafil no stratified data for improvement in 6MWD were available. The odds ratio (OR) for FC deterioration at 12 weeks was 0.40 (95% CI 0.13-1.20) for intravenous epoprostenol compared with supportive care. The corresponding values for inhaled iloprost (FCIII PPH patients; licensed indication), bosentan, sitaxentan (FCIII patients with mixed PAH; licensed indication) and sildenafil (FCIII patients with mixed PAH; licensed indication) were 0.29 (95% CI 0.07-1.18), 0.21 (95% CI 0.03-1.76), 0.18 (95% CI 0.02-1.64) and [Commercial-in-confidence information has been removed] respectively. The incremental cost-effectiveness ratios (ICERs) for the technologies plus supportive care compared with supportive care alone, determined by independent economic evaluation, were 277,000 pounds/quality-adjusted life-year (QALY) for FCIII and 343,000 pounds/QALY for FCIV patients for epoprostenol, 101,000 pounds/QALY for iloprost, 27,000 pounds/QALY for bosentan and 25,000 pounds/QALY for sitaxentan. For the most part sildenafil plus supportive care was more effective and less costly than supportive care alone and therefore dominated supportive care. In the case of epoprostenol the ICERs were sensitive to the price of epoprostenol and for bosentan and sitaxentan the ICERs were sensitive to running the model over a shorter time horizon and with a lower cost of epoprostenol. Two RCTs directly compared the technologies against each other with no significant differences observed between the technologies. Combinations of technologies were investigated in four RCTs, with some showing conflicting results. All five technologies when added to supportive treatment and used at licensed dose(s) were more effective than supportive treatment alone in RCTs that included patients of mixed FC and types of PAH. Current evidence does not allow adequate comparisons between the technologies nor for the use of combinations of the technologies. Independent economic evaluation suggests that bosentan, sitaxentan and sildenafil may be cost-effective by standard thresholds and that iloprost and epoprostenol may not. If confirmed, the use of the most cost-effective treatment would result in a reduction in costs for the NHS. Long-term, double-blind RCTs of sufficient sample size that directly compare bosentan, sitaxentan and sildenafil, and evaluate outcomes including survival, quality of life, maintenance on treatment and impact on the use of resources for NHS and personal social services are needed.

Individuals with Down's syndrome (DS) differ in their oral condition compared with the healthy population. Periodontal disease in persons with DS under the age of 30 years is very high. Immune deficiencies are also present. For dental practitioners it is difficult to decide on a particular course of treatment. In this study, patients with DS were selected in order to 1) evaluate the effectiveness of surgical and non-surgical periodontal therapies and 2) assess their immunological status. The population consisted of 14 DS patients (14 to 30 years old). Surgical and non-surgical periodontal therapies were compared in a split-mouth design. Clinical measurements of plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment levels (CAL) were taken at baseline, posttreatment, 6 months, and 1 year. Immunomodulatory activity of neutrophils was analyzed in vitro by chemotaxis (Boyden migration chamber), phagocytic activity, and production of super-oxide anion (NBT reduction) tests and compared between DS patients and healthy controls. Both surgical and non-surgical therapies showed a significant improvement in all the clinical parameters compared to baseline. There were no differences between surgical and nonsurgical therapy in PI or GI. There was a significant PD reduction with the non-surgical therapy at 1 to 3 mm PD. However in PD >3 mm the surgical therapy, although not statistically significant, showed better results. Neutrophil chemotaxis, phagocytic activity, and production of super-oxide anion were significantly decreased in the DS patients. After a year, both surgical and non-surgical therapies have similar periodontal clinical improvement in DS patients. There is partial impairment of immunological functions in DS individuals which does not seem to affect the clinical response to therapy.

Peri-implantitis poses a persistent challenge in implant dentistry, driving interest in laser therapy as a potential treatment option. Despite encouraging outcomes, clinical applications of laser therapy differ significantly in terms of wavelength, power setting and session frequency, hindering the development of standardized protocols. This scoping review aimed to map and synthesize current clinical evidence on the efficacy of laser therapy in peri-implantitis management, identify knowledge gaps and provide a foundation for future clinical recommendations. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) guidelines, a comprehensive search was conducted across 5 databases (Scopus, PubMed, Cochrane Library, Embase, and Web of Science) between May and July 2024, covering studies published from 2000 to 2024, with no language restrictions. Two independent reviewers extracted data with high inter-rater agreement (κ = 0.97). A total of 98 clinical studies were included: 56 randomized controlled trials (RCTs), 38 cohort studies and 4 retrospective studies. Diode lasers were the most frequently studied (n = 50), followed by Er:YAG, aPDT, Nd:YAG, and Er,Cr:YSGG lasers. Exposure times ranged from 10 s to 700 s, most commonly around 60 s. Key clinical outcomes included probing depth (PD) reduction, bleeding on probing (BoP) and plaque index (PI), with additional outcomes related to bone loss, clinical attachment level (CAL), gingival recession (REC), cytokine levels, microbial analysis, suppuration, and gingival index (GI). Overall, laser therapy was associated with reduced inflammation, accelerated epithelialization, improved bone parameters, fewer complications, and better patient-reported outcomes. While laser therapy shows considerable promise in the treatment of peri-implantitis, further robust and standardized clinical research is essential to confirm its efficacy, optimize treatment parameters and inform evidence-based clinical guidelines.

Specific interleukin (IL)-1 gene polymorphisms are associated with an increased susceptibility to severe periodontitis, increased inflammation, and increased likelihood of tooth loss during the maintenance phase after conventional periodontal therapy. The aim of the present study was to evaluate the impact of genotype on the maintenance of gained clinical attachment obtained after guided tissue regeneration (GTR) surgical therapy in deep intrabony defects. Forty deep (> or =4 mm) interproximal angular bony defects with presurgical clinical attachment loss of >8 mm were treated by GTR using a non-absorbable expanded polytetrafluoroethylene (ePTFE) membrane. Membranes were surgically removed 4 to 6 weeks after surgery. Afterwards patients were placed on monthly recall for the first year and every 3 months for the following 3 years. At the 4-year re-evaluation, a IL-1 genetic susceptibility test was performed on all patients. Fourteen (35% of the 40 patients) were genotype-positive (+). At baseline no statistically significant differences were found between patients with different genotypes in full mouth plaque score (FMPS), full mouth bleeding score (FMBS), clinical attachment level (CAL), probing depth (PD), or gingival recession. At year 1 follow up visit, no statistically significant differences were noted between genotype + and genotype - patients in FMPS, FMBS, amount of CAL gain, decrease in PD, or increase in gingival recession. Sixteen patients had membrane exposure after the GTR procedures. In these patients, the amount of CAL gain (P <0.001) and PD reduction (P <0.01) 1 year after surgery was significantly lower than those observed in patients without membrane exposure. At the year 4 follow-up visit, no significant differences were found between genotype negative and positive patients in FMPS or FMBS and both groups showed a significant loss in CAL (P<0.001) and increase in PD (P<0.001) when compared to year 1 visit. No change in gingival recession was noted. Genotype + patients showed significantly more CAL loss (P<0.002) and increase in PD (P<0.001) between the years 1 and 4 when compared to genotype - patients. A significant association between genotype and stability of the regenerated attachment was also demonstrated. The results of this study demonstrate that genotype expression did not effect GTR treatment response at 1 year, but had a great impact on long-term stability (year 4). In a 3-year period, patients with positive IL-1 genotype lost about 50% of the first year gained CAL and were about 10 times more likely of experiencing > or = 2 mm CAL loss when compared to oral hygiene matched genotype-negative patients.

Type of Therapy May Influence Outcomes in Patients over Age 70 with Acute Myeloid Leukemia: A Systematic Review of More Than 11,000 Patients

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To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.

Air polishing therapy, utilizing advanced technologies such as erythritol- or glycine-based powders and air-jet devices, is an innovative method for managing oral biofilms without damaging dental surfaces. This systematic review compares Guided Biofilm Therapy (GBT), which combines air polishing followed by ultrasonic calculus removal, with conventional oral hygiene methods, such as ultrasonic debridement followed by rubber cup polishing. The analysis focused on reducing biofilm, improving gingival health, enhancing patient comfort, and reducing treatment duration. This study followed the PICO method to formulate a research question. A bibliographic search was conducted using the PubMed and Cochrane databases, focusing on randomized controlled trials (RCTs) published over the past 10 years. The 2020 PRISMA guidelines were applied, resulting in the selection of six studies published between 2015 and 2025. Only studies that directly compared GBT with conventional methods were included and assessed for methodological quality. The findings indicated that GBT is as effective as traditional methods for reducing oral biofilms. Additionally, GBT improves patient comfort, reduces treatment duration, and is associated with fewer side effects than conventional techniques. Guided Biofilm Therapy represents a promising alternative to conventional oral hygiene methods, offering comparable clinical efficacy with added benefits in terms of patient comfort and treatment efficiency.

Since our individual patient data (IPD) meta-analysis of supportive care and chemotherapy for non-small cell lung cancer (NSCLC), published in 1995, many trials have been completed. We have carried out an updated IPD meta-analysis to assess newer regimens and determine conclusively the effect of chemotherapy. To assess the effect on survival of supportive care and chemotherapy versus supportive care alone in advanced NSCLC. All randomised controlled trials (RCTs), published or unpublished. We searched bibliographic databases, trials registers, conference proceedings and reference lists of relevant trials. Searches were completed to November 2009. Trials had to have commenced accrual on or after 1 January 1965 and should have included patients with NSCLC who had received either chemotherapy and supportive care or supportive care alone. Patients should have not received any previous chemotherapy or had any prior malignancy. For trials included in 1995 we sought updated follow up. For new trials we sought survival and baseline characteristics for all patients. We combined results from RCTs to calculate individual and pooled hazard ratios (HRs). We obtained data on 2714 patients from 16 RCTs. There were 1293 deaths among 1399 patients assigned supportive care and chemotherapy and 1240 among 1315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR = 0.77; 95% CI 0.71 to 0.83, P < 0.0001), equivalent to a relative increase in survival of 23%, an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29% or an absolute increase in median survival of 1.5 months (from 4.5 months to six months). There was no clear evidence that this effect was influenced by the drugs used (P = 0.63) or whether they were used as single agents or in combination (P = 0.40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = 0.77). There was no clear evidence of a difference in the relative effect of chemotherapy across patient subgroups. Quality of life could not be formally assessed. All trials were of good methodological quality with no risk of bias. This meta-analysis of chemotherapy in the supportive care setting demonstrates that chemotherapy improves overall survival in all patients with advanced NSCLC. Patients who are fit enough and wish to receive it should be offered chemotherapy.

This retrospective analysis aims to assess the efficacy of microscope-aided implant decontamination combined with surgical intervention for peri-implantitis and identify factors influencing its success. Patients diagnosed with peri-implantitis in at least one implant and treated with microscope-assisted implant surface decontamination combined with surgery were evaluated. Clinical and radiographic parameters were assessed at baseline, 1-year, and 3-year intervals. Disease resolution, defined as ≤1 bleeding site, probing depth (PD) ≤5mm, and no bone loss >0.5mm, was the primary outcome. Multilevel regression analysis identified predictors affecting disease resolution. Thirty-three patients with 50 implants were included. The 1-year success rate was 92% (N = 46), declining to 80% (N = 40) at 3 years and 76% (N = 38) at final evaluation (37-98 months). At the final visit, 89.4% of implants had PD ≤5mm, with no suppuration (SUP) in 95.7% of cases. Deepest PD at baseline negatively impacted outcomes. Microscope-assisted implant decontamination combined with surgical treatment is effective for peri-implantitis management long-term, serving as a potential reference for implant decontamination procedures. Further randomized controlled trials should investigate this approach's effectiveness compared to non-microscope-assisted decontamination. This is the first clinical study to our knowledge to demonstrate the long-term efficacy (up to 8 years) of a microscope-assisted, multi-step decontamination protocol combined with surgery for treating peri-implantitis. The presented protocol achieved high disease resolution rates of 76%-92%, with significant improvements in probing depth, bleeding, and bone level. Microscopic visualization ensures thorough implant surface cleaning, addressing a critical limitation of conventional blind debridement techniques. This study establishes a potential new standard of care for achieving predictable and sustainable outcomes in the management of advanced peri-implantitis. Dental implants occasionally develop severe infections (peri-implantitis) that damage supporting bone and gums, often leading to implant failure. To improve treatment, we combined surgery with high-magnification dental microscopes for precise cleaning of contaminated implant surfaces-enabling clinicians to visually confirm thorough decontamination-followed by bone grafting to regenerate lost tissue. Evaluating 33 patients (50 infected implants) over 3+ years (average 4.5 years), we found 92% of implants successfully controlled infection at 1 year (minimal bleeding, shallow pockets ≤5mm, no pus, stable bone), declining to 80% at 3 years and 76% at final follow-up. Bleeding, pus, and deep pockets decreased significantly, while bone levels improved. Implants with deeper initial infections had lower success rates. This microscope-assisted approach provides effective, lasting management of peri-implantitis by enhancing cleaning accuracy during surgery, offering a promising clinical strategy. Future studies should compare it directly with non-microscopic methods.