Long-term surgical treatment outcomes of peri-implantitis

Background: To assess the long-term results of the surgical treatment of peri-implantitis by means of clinical, radiographic outcomes, and whenever possible, a composite definition of disease resolution. Furthermore, this review aimed at evaluating the prognostic indicators of long-term disease recurrence. Methods: A systematic screening was conducted to identify long-term clinical studies (≥5 years) on the surgical therapy of peri-implantitis. Data pertinent to study methodology, surgical intervention and clinical and radiographic outcomes were retrieved from the original studies. Qualitative assessment was performed. Results: Overall, 17 long-term studies were included in the qualitative synthesis. Due to the heterogeneity, quantitative analysis was not suggested. The mean disease resolution rate was 58.6%. The mean progressive bone loss arrestment (>1 mm) at the latest follow-up following therapy was reached in 69.6%. Resolution of bleeding on probing at the latest follow-up was achieved in 59.9%. The need for retreatment was deemed in 27.2% of the cases. Disease resolution following a second attempt was seldomly evaluated. The implant survival rate resulted in 88.6% (range: 75%–100%). The odds for disease recurrence following surgical treatment of peri-implantitis were ∼8× higher when residual pathogenic pockets were present during follow-up. Moreover, the extent of bone loss, the width (<2 mm) of keratinized mucosa following surgical treatment, and implant surface (modified) influenced disease recurrence. Conclusion: The surgical treatment of peri-implantitis yields to favorable outcomes in the long-term. Data suggest that the long-term disease resolution is ∼60% under supportive peri-implant care, while ∼70% exhibit progressive bone loss arrestment. Hence, the need for retreatment is not infrequent. Residual pockets (≥6 mm) following surgical therapy and the advanced extent of bone loss imply a risk for disease recurrence. Clinical Relevance: These findings suggest that the surgical treatment of peri-implantitis is effective in the long-term in patients enrolled in supportive peri-implant therapy. However, its predictability can be interfered in scenarios exhibiting advanced lesions or in those that display residual deep pockets following therapy.