In this Let’s Talk episode, Garrett Hiob convenes three experts—Asra Ramanauskaite‑Couture, Lisa Heitz‑Mayfield and Alberto Monje—to dissect the practical, clinical pathways for tackling peri‑implantitis surgically. Their shared conviction: before any scalpel or graft material is considered, a rigorous, step‑wise protocol must be followed.
1. Identify and Control Risk Factors All three panelists underscore that successful outcomes hinge first on a comprehensive assessment of both patient‑related and site‑specific risks. This means:
Prosthetic design assessment: Can the patient maintain good hygiene around existing restorations?
Medical and behavioral review: Smoking status and history of periodontitis must be documented, since both double the risk of disease recurrence.
Patient motivation: Only those willing to commit to lifelong, supportive peri‑implant care should proceed to surgery.
If non‑surgical decontamination (mechanical cleaning, local antimicrobials) brings resolution, no further intervention is needed. But when pockets persist, the conversation turns to surgery.
2. Choose Your Surgical Approach by Defect Configuration Ramanauskaite‑Couture and Monje agree that defect morphology dictates technique:
Reconstructive (Regenerative) Surgery
Ideal case: Contained, three‑ or four‑wall bony defects deeper than half the implant’s length.
Goal: Rebuild lost bone, minimize soft‑tissue recession, and restore architecture for long‑term stability.
Limitations: Poor candidates include heavy smokers, patients with thin biotypes, or defects lacking adequate bony walls.
Resective (Pocket‑Elimination) Surgery
Ideal case: Horizontal bone loss or shallow defects, where regeneration carries low predictability.
Goal: Eliminate deep peri‑implant pockets by recontouring bone and soft tissues, shifting the defect to a shallow, maintainable profile.
Advantages: Fewer biomaterials needed, less dependence on patient healing capacity.
Neither method is intrinsically superior—case selection and patient factors steer the decision.
3. Implantoplasty: A Adjunct, Not a Panacea Surgical debridement sometimes includes implantoplasty—mechanical smoothing of exposed implant threads to reduce plaque‑retentive surfaces. Implantoplasty:
Pros: Lowers risk of reinfection by creating a less retentive surface.
Cons: Must be performed conservatively to avoid weakening narrow implants; long‑term data on fracture risk remain limited.
Monje cautions that implantoplasty should only address the exposed portion of threads in non‑contained defects, and never as a standalone cure.
4. Supportive Peri‑Implant Care Is Mandatory All agree that the fourth—and arguably most crucial—step is lifetime maintenance. Studies show that without regular supportive visits (at least twice yearly):
Recurrence rates of peri‑implantitis soar, regardless of how flawless the surgical repair.
Even highly motivated patients slip in their home care, so reinforcement and professional cleaning are non‑negotiable.
Practitioners must clearly communicate the “maintenance commitment” before embarking on any treatment.
Bottom Line Treating peri‑implantitis is not a matter of “one size fits all.” Success demands:
Rigorous risk‐factor control (smoking, prosthetic design, systemic health).
Step‑wise escalation, from non‑surgical therapy to surgery only when needed.
Surgical choice driven by defect morphology, not habit or preference.
Lifetime supportive care to sustain results.
By adhering to these principles—and by selecting cases judiciously—implant specialists can navigate the “battle of concepts” and deliver more predictable, durable outcomes.