Private Practice for Oral Surgery, Lindau/Lake Constance, Lindau, Germany.
Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
Clin Implant Dent Relat Res. 2023 Aug;25(4):696-709. doi: 10.1111/cid.13209. Epub 2023 May 17.
Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss.
A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review.
Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique.
The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.
分析三维种植体位置、骨缺损形态和软组织情况，指导保留或去除严重种植体周围炎病变种植体的决策。本叙述性综述的目的是分析和全面阐述在严重种植体周围骨丧失的情况下，专注于种植体周围骨再生的治疗选择。
两位审稿人独立进行数据库检索，以确定至少随访 6 个月的关于种植体周围骨再生的病例报告、病例系列、队列、回顾性和前瞻性研究。在数据库分析过程中，共检索到 344 篇研究，作者选择了 96 篇出版物进行综述。
脱蛋白牛骨矿物质仍然是组合使用或不使用屏障膜时治疗种植体周围炎骨缺损再生的最佳记录材料。虽然在种植体周围炎治疗中使用自体骨的研究很少，但它们确实报告了垂直骨再生的良好潜力。此外，虽然膜是引导骨再生的固有部分，但一项为期 5 年的随访研究表明，有膜和无膜都可以改善临床和影像学效果。在观察再生性手术治疗种植体周围炎的临床研究中，经常使用全身抗生素，但文献分析不支持这种药物的积极作用。大多数关于再生性种植体周围炎手术的研究建议去除修复体，并使用边缘切口和全层瓣提升。这允许在一定程度上进行再生程序，但存在伤口裂开和不完全再生的风险。提到雨披技术的替代方法可能会降低裂开的风险。种植体表面去污的有效性可能会影响种植体周围骨再生，但没有特定技术的临床优势。
现有文献表明，种植体周围炎治疗的成功仅限于减少探诊出血、改善种植体周围探诊深度和少量垂直缺损填充。在此基础上，无法对手术治疗种植体周围炎的骨再生提出具体建议。应密切关注瓣设计、表面去污、骨缺损移植材料和软组织增强的创新方法，以寻找有利于种植体周围骨增强的先进技术。
