Regenerative Treatment of Peri-Implantitis Using Bone Substitutes and Membrane: A Systematic Review

Purpose: This systematic review aimed to assess the available literature for regenerative treatment of peri-implantitis using bone graft substitutes and membranes. Methods: A search in electronic databases was conducted to assess all types of clinical studies treating bone defects derived from peri-implantitis using guided bone regeneration (GBR) techniques. Results: During the first screening, 399 titles were identified. Finally, 17 articles reporting on 173 implants were included. The articles mainly focused on radiographic bone fill of the defect. Qualitative measures of "bone fill" were reported: 10.4% of the implants showed complete "bone fill," whereas 85.5% revealed incomplete defect closure. No bone fill was shown in 4.0%. Little information (in 53.2%) was provided regarding the probing depth before or after treatment. Data concerning the inflammatory status of soft tissues were also scarce and only reported in three studies. A large heterogeneity concerning disinfection protocols and regenerative materials used was found. The high percentage of low-quality studies rendered a meta-analysis impossible. Conclusion: Complete fill of the bony defect using GBR seems not to be a predictable outcome. The mucosal health status is left unconsidered in most studies. Well-controlled trials are needed to determine predictable treatment protocols for the successful regenerative treatment of peri-implantitis using GBR technique.