Surgical therapy of peri-implant disease: a 3-year follow-up study of cases treated with 3 different techniques of bone regeneration.
BACKGROUND
Advanced peri-implant intrabony defects require comprehensive surgical treatment regimens different from periodontal therapy strategies. The purpose of this longitudinal trial was to evaluate the peri-implant outcomes following guided bone regeneration with 3 treatment protocols.


METHODS
In 25 patients, 41 peri-implant defects with supporting bone loss >50% of the implant length were treated with flap surgery plus autogenous bone grafts alone (FG) (controls, n = 12) plus non-resorbable (FGM) (test 1, n = 20) or bioabsorbable barriers (FGRM) (test 2, n = 9) and supportive antimicrobial therapy. Following submerged healing, the membranes were removed (FGM), and the peri-implant probing depths (PD), probing bone levels (BL), mobility scores (PT), and intrabony defect height (DH) were radiographically evaluated at baseline, 6 months, and 1 and 3 years post-therapy.


RESULTS
Non-surgical/anti-infective therapy resulted in a limited improvement of PD scores after 6 months. At the 3-year visit, surgical treatment revealed significant changes from baseline for the controls and both of the test groups for PD: 5.1 +/- 2.7 mm (FG), 5.4 +/- 3.0 mm (FGM), and 2.6 +/- 1.6 mm (FGRM), and for BL: 3.2 +/- 2.4 mm (FG), 3.4 +/- 2.4 mm (FGM), and 2.3 +/- 1.6 mm (FGRM), Mann-Whitney test, P < or = 0.05. The changes for DH and PT were significant only for FG- and FGM-treated subjects. The overall improvement for FGRM-treated patients during the 3-year observation was less marked. However, the differences between the 3 surgical treatment protocols did not affect the treatment outcomes after 3 years.


CONCLUSIONS
Autogenous bone grafting is an appropriate treatment regimen to augment open crater-formed peri-implant defects. Although certain clinical situations require an additional fixation of barrier membranes, their routine application should be approached with caution.
Khoury
F
F
Department of Oral and Maxillofacial Surgery, Westfalian Wilhelm-University, Münster, Germany. prof.khoury@t-online.de
Buchmann
R
R
D020341:Absorbable Implants; D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001861:Bone Regeneration; D016025:Bone Transplantation / Q000379:methods; D016009:Chi-Square Distribution; D015921:Dental Implants / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D016557:Guided Tissue Regeneration, Periodontal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010514:Periodontal Pocket / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D011138:Polytetrafluoroethylene; D011859:Radiography; D015203:Reproducibility of Results; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D015921:Dental Implants; D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene