Bone gain through implantoplasty without graft material

Background

The prevalence of peri-implantitis is high. All surgical treatment approaches include a surface decontamination protocol but implantoplasty goes one step beyond. The removal of all macro and microstructures on the exposed implant surface creates a radical change of environment. Several reports indicate that implantoplasty can stop further bone loss but, at this stage, significant bone gain obtained without graft material has never been associated with implantoplasty.

Aim/Hypothesis

The aim of this study was to assess the clinical outcome of peri-implantitis lesions after using a peri-implantitis resective surgical treatment protocol that included systematic removal of all prosthetic components in order to create optimal conditions for implantoplasty.

Material and Methods

Forty eight patients (60 implants) were included in the study and were followed for a mean observation time of 20 months. Surgical technique- after removal of all prosthetic components, flaps were elevated, granulation tissue removed and implantoplasty performed on all the exposed implant surfaces using special helical cylindrical carbide burs (H375 and HK375, Dexter) and a high speed turbine. Titanium particles were carefully removed, the prosthesis was placed and flaps sutured. No additional decontamination protocol was used, nor grafting material. The implants were evaluated through a clinical and radiographic analysis the day of treatment and, at least, 6 months later. The measurement system used known implant sizes and inter thread distances.

Results

Three implants were lost (5%) due to further bone loss and recurrence of the disease. 6 implants (10%) presented bone loss up to 2 mm, 27 implants (45%) showed no change in marginal bone levels and 24 implants (40%) presented bone gain up to 3 mm. This outcome was observed without the use any graft material. The mean marginal bone level change was a bone gain of 0.52 mm. No inflammation and or suppuration were observed for all remaining implants.

Conclusion and Clinical Implications

Implantoplasty is a reliable surgical treatment option for peri-implantitis bone lesions. A bone regeneration process can be observed without graft material.