The Use of Implantoplasty and Guided Bone Regeneration in the Treatment of Peri-implantitis: Two Case Reports

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The Use of Implantoplasty and Guided Bone Regeneration in the Treatment of Peri-implantitis: Two Case Reports
December 2003
Suh, Jong-Jin MSD, PhD; Simon, Ziv DMD, MS; Jeon, Young-Sik MSD, PhD; Choi, Byeong-Gap MSD, PhD; Kim, Chong-Kwan MSD, PhD
Implant Dentistry: Volume 12(4) December 2003 pp 277-282
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Abstract
A variety of treatment modalities have been proposed for the management of peri-implantitis. These are mostly based on empiric experience and use the systemic administration of an antibiotic in conjunction with surgical intervention. To ensure decontamination of the affected implant surface(s), chemical and/or mechanical debridement is used. For textured implant surfaces, detoxification using implantoplasty could also give favorable results when used as part of the procedure. Two cases are reported in which implants developed localized peri-implantitis lesions. Implantoplasty followed by topical tetracycline decontamination was used in conjunction with guided bone regeneration. In both cases, the procedures were effective in arresting disease and regenerating lost bone. These results suggest that the technique holds promise and should be investigated further.
Peri-implant disease (peri-implantitis) manifests as a microbial plaque-induced inflammatory process, 1-5 which could be preceded by occlusal overload 6 affecting the soft tissues and bone around osseointegrated dental implants. Left untreated, this condition will in most instances lead to progressive bone loss, implant loss, and the need for revisional treatment. However, reports of effective and predictable interventional methods of treatment for peri-implantitis are few. The rationale in current treatment approaches to peri-implantitis largely has been derived from established periodontal treatment modalities. It is generally thought that similarities in pathogenesis do exist between peri-implant disease and periodontitis because there are similar microbiota involved. 7-9 There is a correlation between the presence of plaque and peri-implant disease, 10 and with long-term implant success 11 and, on occasion, favorable responses to antimicrobials. 12 Although both surgical and nonsurgical approaches have been proposed, convincing data is lacking and the treatment of peri-implantitis remains empiric. 13
To be effective, early intervention is advisable to prevent significant bone loss, whether horizontal, vertical, or both. Guided bone regeneration with the use of membranes and various graft materials has been reported to be effective, 14-20 although no randomized and properly control-led studies have been published to date. The application of guided bone regeneration to the management of peri-implantitis usually involves implant surface debridement and detoxification, placement of a bone graft covered with a membrane, and resubmergence of the implant during the healing interval. Clinicians have suggested different detoxification agents such as tetracycline, 15,16,21 citric acid, 15,22-24 chlorhexidine gluconate, 25 and hydrogen peroxide. However, direct comparison to establish whether any of these agents is superior to the others in removing plaque organisms and their biofilms has not been done, and, again, their use is strictly empiric. A key consideration in this detoxification step is that roughened or textured implant surfaces, now commonly used for more challenging treatment scenarios (such as bone of low density), are more retentive to bacterial plaque if they become exposed to the oral cavity 13 and, therefore, more difficult to detoxify. Alternative nonchemical methods of implant surface decontamination also have been suggested. The use of lasers, 26-29 air abrasion, 30 or removal of the affected implant surface region have been described as being effective in this context. The last approach, ie, removal of the affected surface region, has been termed implantoplasty (or fixture modification31) and is aimed at modifying the implant's surface using rotary instruments. 25 With textured implant surfaces, this approach renders the affected implant surface less plaque-retentive in the hopes of arresting progressive crestal bone loss. Implantoplasty in conjunction with guided bone regeneration was used in the treatment of peri-implantitis in the present series of 2 case reports.
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