Clinical and radiographic outcomes of a combined resective and regenerative approach in the treatment of peri-implantitis: a prospective case series

Aim: To assess the clinical and radiographic outcomes applying a combined resective and regenerative approach in the treatment of peri-implantitis. Materials and methods: Subjects with implants diagnosed with peri-implantitis (i.e., pocket probing depth (PPD) >= 5 mm with concomitant bleeding on probing (BoP) and >= 2 mm of marginal bone loss or exposure of >= 1 implant thread) were treated by means of a combined approach including the application of a deproteinized bovine bone mineral and a collagen membrane in the intrabony and implantoplasty in the suprabony component of the peri-implant lesion, respectively. The soft tissues were apically repositioned allowing for a non-submerged healing. Clinical and radiographic parameters were evaluated at baseline and 12 months after treatment. Results: Eleven subjects with 11 implants were treated and completed the 12-month follow-up. No implant was lost yielding a 100% survival rate. At baseline, the mean PPD and mean clinical attachment level (CAL) were 8.1 +/- 1.8 mm and 9.7 +/- 2.5 mm, respectively. After 1 year, a mean PPD of 4.0 +/- 1.3 mm and a mean CAL of 6.7 +/- 2.5 mm were assessed. The differences between the baseline and the follow-up examinations were statistically significant (P = 0.001). The mucosal recession increased from 1.7 +/- 1.5 at baseline to 3.0 +/- 1.8 mm at the 12-month follow-up (P = 0.003). The mean% of sites with BoP+ around the selected implants decreased from 19.7 +/- 40.1 at baseline to 6.1 +/- 24.0 after 12 months (P = 0.032). The radiographic marginal bone level decreased from 8.0 +/- 3.7 mm at baseline to 5.2 +/- 2.2 mm at the 12-month follow-up (P = 0.000001). The radiographic fill of the intrabony component of the defect amounted to 93.3 +/- 13.0%. Conclusion: Within the limits of this study, a combined regenerative and resective approach for the treatment of peri-implant defects yielded positive outcomes in terms of PPD reduction and radiographic defect fill after 12 months.