Non-submerged reconstructive approach for peri-implantitis osseous defect with removal of implant crowns: One-year outcomes of a prospective case series study.

Abstract

The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap readaptation around the replaced healing abutments, without obtaining a primary wound closure. Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months. At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 and 1.63mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51mm) and BOP (65%) reduction were also noted. Considering its limitations, the use of a non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes.