There is a need to establish effective treatment protocols for the management of peri-implantitis to achieve stable long-term outcomes. The 5th ITI Consensus found successful 12-month outcomes following peri-implantitis treatment could be achieved in a limited number of studies (Heitz-Mayfield, Needleman, Salvi & Pjetursson, 2014). In these studies, although favorable short-term peri-implantitis treatment outcomes were reported in the majority of patients and implants, nonresolution of peri-implantitis, disease recurrence, progression of bone loss and implant loss were also reported. The majority of studies reported treatment outcomes inconsistently. Few studies reported medium to long-term outcomes. Furthermore, the effect of supportive care (supportive peri-implant/ periodontal therapy, SPT) on treatment outcomes was not addressed.
Therefore, the aim of this systematic review was to evaluate the clinical outcomes for patients with implants treated for peri-implantitis who subsequently received supportive care for at least 3 years.
The primary outcome was survival (both at implant and patient level), defined as the presence of the implant, regardless of the health of the surrounding tissues. Secondary outcomes were implant success and peri-implantitis recurrence, if defined by the authors.
The results of this systematic review are based on 18 studies, of which 13 could be used for quantitative assessments. On average, 26 patients (median, IQR 21–32) with 36 implants (median, IQR 26–45) were included in those 13 studies. Sufficient data were available to perform meta-analyses of the primary outcome.
- In patients successfully treated for peri-implantitis, an individualized supportive care program, including professional and self-performed biofilm removal at implants and teeth, is associated with positive medium- to long-term outcomes.
This statement is based on the results of 18 studies.
- Under current peri-implantitis treatment protocols, which include supportive care, about three-quarters of implants treated for peri-implantitis may still be present after 5 years. These outcomes might be affected by patient, implant-, prosthesis-, and treatment-related factors.
This statement is based on 13 studies, presenting an estimated cumulative implant survival of 76%–100% across 4 studies at 5 years and of 70%–99% across 2 studies at 7 years.
- Although limited, there is evidence that implant surface can affect the medium- to long-term stability of peri-implantitis treatment outcomes.
This statement is based on the findings of two studies. One study found reduced success outcomes of implants with TPS (titanium plasma sprayed) compared with SLA (sandblasted large-grit acid-etched) surfaces over 7 years. One study found reduced outcomes of moderately rough compared with turned/minimally rough implant surfaces over 3 years.
- Despite receiving regular supportive care, certain patients may require retreatment, adjunctive therapies, and/or implant removal due to disease progression or recurrence.
This statement is based on 2 studies that reported peri-implantitis recurrence and 5 studies that reported on treatment success.
- What definition of peri-implantitis treatment success is practical in clinical practice?
Peri-implantitis treatment success is defined as stable peri-implant bone levels, absence of probing depths >5 mm, and no bleeding or suppuration on probing.
Success in clinical practice, however, may be defined as the absence of progression of the disease, regardless of whether clinical parameters adhere to the above strict success criteria.
In addition, patients may also require that their implant reconstructions are aesthetic, comfortable, and easy to clean in order to consider the treatment a success.
- What clinical signs indicate that there is recurrence of peri-implantitis?
After having achieved resolution of peri-implantitis, the presence of bleeding and/or suppuration on probing together with an increase in probing depth may indicate recurrence of disease. A radiograph may be indicated if a diagnosis remains unclear.
- What peri-implantitis treatment protocols could be considered appropriate to use in daily clinical practice?
Certain steps should be followed during the active treatment of periimplantitis as outlined in the 5th ITI Consensus Statements (Heitz-Mayfield et al., 2014). These steps include:
1. Thorough assessment and diagnosis.
2. Control of modifiable local and systemic risk factors for peri-implantitis.
3. Nonsurgical debridement.
4. Early reassessment of peri-implant health, generally within 1-2 months.
5. Surgical access if resolution has not been achieved, including:
- Open flap debridement
- Thorough surface decontamination of the implant and associated prosthetic components.
- Option of regenerative/reconstructive or resective approaches
- Appropriate postoperative anti-infective therapy
6. Supportive care tailored to the patient risk profile, most likely 3–6 monthly.
- What supportive care protocols can be considered appropriate to use in daily clinical practice?
Various supportive care protocols have been proposed. It is recommended to provide individualized supportive care according to the patient’s needs and risk profile.
Supportive care should include oral hygiene measures, biofilm removal, monitoring oral health, and reduction in modifiable risks related to peri-implantitis. Every effort should be made to motivate the patient and facilitate their ability to maintain plaque control both at implants and teeth, aiming for a low full mouth plaque score (FMPS <20%).
- Are there any implant variables that could influence long-term outcomes of an implant successfully treated for peri-implantitis?
Clinicians should be aware that implant surface characteristics may have an impact on treatment success. Other implant and prosthetic variables may also impact on treatment success, requiring modification of the supportive care program.