Surgical treatment of peri-implantitis - Consensus report of working group 4

The following consensus report is based on four background reviews (Keeve et al., Implant Dent 2019 28(2): 177-186; Ramanauskaite et al., Implant Dent 2019 28(2): 187-209; Koo et al., Implant Dent 2019 28(2): 173-176; Sculean et al., Implant Dent 2019 210-216). The surgical treatment of peri-implantitis is indicated in the cases where the first choice of treatment, the non-surgical one, failed with recurrence of bleeding and suppuration. The aim of this review was to systematically screen the literature for possible surface decontamination techniques and material during surgical treatment, the surgical regenerative and non-regenerative treatments of peri-implantitis, radiological and clinical outcomes, the importance of the presence of fixed and or keratinised peri-implant gingiva, and to determine predictable therapeutic options for the clinical surgical management of peri-implantitis lesions. Existent clinical, radiographic and microbiological data do not favour any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Using implantoplasty in surgical non-regenerative treatment leads to a significant decrease in bleeding on probing and probing depth, and may result in improvement of clinical and radiographic parameters, up to 3 years after surgery compared with mechanical debridement alone. Surgical augmentative peri-implantitis therapy resulted in improved clinical and radiographic treatment outcomes compared with the baseline in the majority of studies with 6 months to 7-10 years of follow-up. There is no evidence to support the superiority of a specific material, product or membrane in terms of long-term clinical benefits. The best treatment modality to improve the width of keratinised attached mucosa and bleeding and plaque scores, and to sustain the peri-implant marginal bone level, is the use of an apically positioned flap combined with a free gingival graft.