Clinical and Radiographic Outcomes of Combined Surgical Therapy for Peri-implantitis with Complex Bone Defects

Abstract

The purpose of this study was to evaluate the clinical and radiographic outcomes of combined surgical therapy for the management of peri-implantitis associated with complex bone defects. We hypothesized that this combined approach may be associated with improvements in clinical parameters and radiographic defect fill. This study was designed as a single-arm exploratory retrospective study. Twenty-one patients with thirty-eight implants diagnosed with peri-implantitis were enrolled. All patients initially received non-surgical mechanical debridement and local antimicrobial therapy, followed four weeks later by combined surgical therapy. The surgical protocol consisted of full-thickness flap elevation, debridement of granulation tissue, implantoplasty of the supra-bone defect portion, chemical surface decontamination, and regenerative treatment with xenogeneic bone grafts and resorbable collagen membranes using the Poncho technique. Clinical parameters, including probing pocket depth (PPD), probing attachment level (PAL), and bleeding on probing (BOP), as well as standardized radiographic assessments, were recorded at baseline and at one, three, six, and twelve months postoperatively. Mean probing pocket depth decreased from 6.15 ± 1.08mm and 5.68 ± 1.23 mm at buccal and lingual sites at baseline to 3.79 ± 0.67 mm and 3.45 ± 0.49 mm at 1 month, respectively, and remained stable through 12 months. Probing attachment level showed a similar pattern, decreasing from 5.80 ± 0.89 mm and 5.46 ± 1.11mm to 3.78 ± 0.61 mm and 3.54 ± 0.46 mm at buccal and lingual sites, respectively. Bleeding on probing and suppuration decreased from 80.9% at baseline to 0% at 1 month and remained low throughout follow-up. Mean bone defect depth decreased from 3.40 ± 1.73mm at surgery to 055 ± 0.79 mm at 6months and 0.77 ± 0.94 mm at 12 months (p < 0.001). Within the limitations of this study, including the small sample size, short follow-up period, and heterogeneity in implant-related factors such as prosthetic design, peri-implant soft tissue, implant systems, and surface characteristics, combined surgical therapy was associated with improvements in clinical and radiographic parameters in implants affected by peri-implantitis with complex bone defects. Combined surgical therapy may represent a potential treatment option for peri-implantitis when careful case selection, thorough surface decontamination, and supportive periodontal maintenance are provided.