Regenerative Therapy of Peri-Implantitis: Clinical and Radiologic Documentation of 16 Consecutive Patients With a Mean Follow-Up of 3 Years

Surgical reconstruction of peri-implantitis with adjunctive antimicrobial photodynamic therapy: A case report with 5-year follow-up

BACKGROUND

Peri-implantitis poses a significant challenge in dental implantology due to its potential to result in the loss of supporting tissue around dental implants. Surgical reconstruction is often recommended for intrabony defects, accompanied by various adjunctive therapies, such as antimicrobial photodynamic therapy (aPDT), for bacterial decontamination. However, the long-term efficacy of such treatments remains unclear.

METHODS

This clinical report presents a case of peri-implantitis management in a healthy 55-year-old male using guided bone regeneration principles and surface decontamination via aPDT. The patient exhibited peri-implantitis with probing pocket depths (PPD) of 7 mm at buccal sites, 5 mm at palatal sites, and significant bone loss around implant #12. The reconstructive approach involved preservation of the existing implant and following a non-submerged healing protocol. The surgical phase included meticulous debridement, chemical detoxification with hydrogen peroxide, and aPDT using a 670 nm diode laser with methylene blue as the photosensitizer. Xenogenic bone graft and a resorbable collagen membrane were applied and the patient was followed up to through a 5-year period.

RESULTS

Postsurgery the patient exhibited normal healing, and long-term follow-up at 5 years showed reduced PPD (2 mm buccally, 3 mm mid-palatally), complete intrabony defect fill, and stable bone levels, indicating successful treatment.

CONCLUSIONS

This case report demonstrates the potential long-term success of a reconstructive approach with adjunctive aPDT in peri-implantitis management. However, it highlights the need for standardized protocols and further clinical trials to establish the clinical benefits of aPDT in surgical reconstruction of peri-implantitis defects, serving as valuable pilot data for future research.

HIGHLIGHTS

Why is this case new information? Provides a rare 5-year insight into peri-implantitis intrabony defect reconstruction, offering extended success and outcomes not frequently documented. Demonstrates the efficacy of aPDT with a 670-nm diode laser in achieving successful long-term outcomes, contributing valuable evidence to existing literature.Keys to successful management of this case: Success involves initial non-surgical debridement followed by a reconstructive strategy, incorporating guided bone regeneration and surface decontamination via aPDT. Long-term success hinges on patient compliance with routine oral hygiene, emphasizing the importance of adherence to preventive measures post-reconstruction to minimize recurrence risk.What are the primary limitations to success in this case? Variability in photosensitizer uptake, and potential risks such as tissue damage and bacterial resistance pose challenges to the effectiveness of aPDT. The existing literature on aPDT in peri-implantitis treatment lacks standardization in methodology, laser parameters, and follow-up durations, making it challenging to establish a universally accepted protocol.

Minimal invasiveness in the reconstructive treatment of peri-implantitis defects

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.

Antimicrobial photodynamic therapy associated with bone regeneration for peri-implantitis treatment: A case report

Antimicrobial photodynamic therapy (aPDT) has emerged as a promising alternative to promote bacterial elimination and crestal bone remodeling in patients affected by peri-implantitis, once it is able to access the implant microstructure at the most restricted sites with no damage to implant surface. This paper reports a 6-month follow-up of a patient with peri-implantitis treated by surgical approach with adjunct photodynamic therapy associated to guided bone regeneration. A full thickness open-flap was performed to allow directly mechanical debridement, followed by aPDT using methylene blue 200 μg/mL under red laser irradiation (660 nm, 100 mW, 9 J), providing decontamination of implant surface and surrounding tissue. Photosensitizer was washed twice with saline solution previously to guided bone regeneration, which was carried out using xenogeneic bone and resorbable collagen membrane. After 6-month follow-up, the use of aPDT as an adjunct therapy to the surgical treatment of peri-implantitis promoted sufficient decontamination, clear evidence of bone regeneration, and peri-implant health restoration.