IMPLANT MAINTENANCE Surgical Management of Peri-Implantitis Dr Jeremy Vo explains how he has embraced AIR-FLOW technology in the management of Peri-Implantitis S urgical intervention is often required in the treatment of advanced peri-implantitis lesions. Peri-implantitis is defined as an inflammatory process around an implant, with soft tissue inflammation and loss of supporting marginal bone.1 The aim of surgical therapy is to allow access for the decontamination of implant surfaces which have been exposed to oral biofilms. Fig 1 Radiographic assessment at baseline Several approaches for implant decontamination have been described and can be broadly categorised to include mechanical (eg. carbon fiber curettes), chemical (eg. chlorhexidine) and laser instruments (eg. Er:TYaG).2 Unfortunately there is limited evidence to show which method is superior. Fig 2 Pre-operative clinical photographs There are 3 main approaches for surgical intervention3. Regenerative These include: (i) (ii) (iii) Access surgery Resective surgery Regenerative surgery Access Surgery The primary aim of access surgery is to decontaminate the implant surface.3 Commonly, intrasulcular incisions will allow the conservation of the soft tissues following flap elevation and is important in aesthetic areas. A clinical study with 5 years follow up reported complete resolution of advanced periimplantitis lesions in 42% of implants.4 Resective Surgery This surgical technique is aimed at pocket depth reduction via a reverse beveled incision combined with osteoplasty around the implant.3 As a result, the neck of the implant is usually left exposed to the oral cavity. The 2-year outcome of resective periimplantitis surgery found complete resolution of clinical signs of disease in almost 60% of implants.5 38 Surgery Regenerative surgery is aimed at improving hard tissue integration around the implant (reosseointegration) as well as minimising recession of the peri-implant mucosa.3 Various approaches to bone grafting have been described. Bone substitute materials can be used to fill the intrabony defect which is then covered with a resorbable membrane. A 4-year clinical study found significant reductions in probing pocket depth and radiographic defect fill with a regenerative technique.6 The clinical approach Recently, a powered air-abrasive system utilising a Erythritol (a sugar substitute) has been proposed as an effective method of biofilm removal from the implant surface that is safe on hard and soft tissues (Air-Flow EL-308/A; EMS Electro Medical Systems Nyon, Sweden).7 Erythritol is low-abrasive and it does not cause extensive damage to the surface topography of the implant compared with the use of conventional steel curettes or ultrasonics. Furthermore, in-vitro data also suggests that it M A R CH/ M AY 2 0 1 7 possesses antimicrobial activity.8 Another advantage is that implant surface decontamination is improved compared with using the tips of the curettes which may be too large to reach the deeper parts of the implant thread. The case study below illustrates a protocol that was used to treat advanced peri-implantits. The case was treated with a regenerative approach and had a successful clinical outcome after a follow up period of 6 months. Case Study - Regenerative approach for treatment of Peri-Implantitis A 70 year old female was referred for advanced peri-implantitis in the mandible. She presented complaining of pain and she also noticed discharge from one of the anterior implants. Her medical history was non-contributory and she was a non-smoker. Clinical examination revealed 5 implants in the mandible supporting a w w w.he nry sc he i n.c om. a uhttp://henryschein.com.au