Surgical Therapy for Peri-Implantitis Using Deproteinised Bovine Bone Mineral With 10% Collagen, Enamel Matrix Derivative and Doxycycline: A Prospective Cohort 10-Year Implant Study.
Jul 2026· Journal of Clinical Periodontology· 0 citations· 45 references
Medicine
TL;DR
Surgical management of peri-implantitis combined with DBBMC/EMD/doxycycline and personalised SPIT achieved high long-term implant survival and stable clinical outcomes over 10 years.
Abstract
Aim
To assess 10-year implant survival following surgical management of peri-implantitis using deproteinised bovine bone mineral with 10% collagen (DBBMC), enamel matrix derivative (EMD) and doxycycline powder.
Materials And Methods
The original population comprised 30 non-smoking, periodontally stable patients (mean age = 44.9 ± 11 years; 64% female; full-mouth plaque and bleeding score < 20%, no bleeding residual periodontal pockets ≥ 4 mm), each with a single peri-implantitis-affected implant (bleeding on probing, probing depth > 6 mm, ≥ 20% radiographic bone loss, implants in function ≥ 2 years). The surgical procedure involved implant surface decontamination with 24% EDTA followed by defect fill with DBBMC/EMD/doxycycline mixture. Patients underwent individualised supportive peri-implant therapy (SPIT) comprising regular clinical monitoring, professional cleaning and antimicrobial protocols for 10 years.
Results
Twenty-nine of the 30 implants survived (96.6% survival rate). Mean probing depth decreased from 8.90 ± 1.9 mm to 3.06 ± 0.98 mm; radiographic bone loss improved from 57% ± 16.5% to 13% ± 2.5%. During 10-year SPIT, 12 implants required adjunctive azithromycin. Fifty-eight percent achieved the successful treatment outcome criterion (SOTC: probing depth < 5 mm, no bone loss 10% from baseline, absence of bleeding on probing/suppuration and recession < 0.5 mm anterior/1.5 mm posterior implants).
Conclusion
Surgical management of peri-implantitis combined with DBBMC/EMD/doxycycline and personalised SPIT achieved high long-term implant survival and stable clinical outcomes over 10 years.
Peri-implantitis therapy aims at overcoming peri-implant inflammation and preventing further marginal bone loss; however, the achievement of stable reconstructive outcomes remains challenging in non-contained defects. This retrospective study evaluated the 5-year effectiveness of reconstructive surgical protocol using a mixed graft composed of deproteinized bovine bone mineral and biphasic calcium sulfate in non-contained peri-implant defects around standard-length implants. Patients treated for peri-implantitis at a university clinic between January 2018 and June 2019 were retrospectively screened: 28 (32 implants) met the inclusion criteria (probing depth ≥5 mm with bleeding and/or suppuration on probing and radiographic bone loss ≥3 mm). Surgical treatment consisted in full-thickness flap elevation, implant surface decontamination using a standardized protocol, defect grafting, and non-submerged tension-free closure. Clinical and radiographic parameters were assessed at surgery, 3- and 5-year follow-up. Mean follow-up was 61.4 ± 8.5 months. Implant survival at 5 years was 100%. Implant-based treatment success was 75%, disease recurrence occurred in 25% of implants. Probing depth and clinical attachment level showed significant improvements from baseline to both follow-up time points (p < 0.001); radiographic analyses demonstrated significant defect fill and improvement in bone-related parameters (p ≤ 0.002). The proposed reconstructive approach provided stable results in the long-term for non-contained peri-implant defects.
G. Lombardo, Miriana Gualtieri, Guido Lobbia et al.· Journal of cranio-maxillo-fa...· 0 citations
Background and Clinical Significance: Peri-implantitis is an inflammatory condition associated, among other factors, with biofilm accumulation, affecting peri-implant soft and hard tissues and potentially leading to implant loss. Its treatment remains challenging because no single decontamination or regenerative protocol has demonstrated clear superiority. This case report describes a comprehensive surgical and regenerative approach aimed at preserving an affected implant and restoring peri-implant tissue stability; Case Presentation: A systemically healthy 30-year-old patient presented with peri-implant bone loss around an implant in position 25, restored with a lithium disilicate crown and functioning for three years. Treatment included flap elevation, mechanical debridement and air-polishing of the implant surface, followed by thorough irrigation with sterile saline to remove residual abrasive particles and debris, photodynamic antimicrobial therapy, and laser therapy. Bone regeneration was performed using a bone substitute combined with injectable platelet-rich fibrin to produce sticky bone, which was covered with an advanced platelet-rich fibrin membrane. A provisional crown was placed without occlusal contact. After four months, a definitive crown with a modified emergence profile was delivered to improve hygienic access and reduce biofilm retention. Clinical and radiographic follow-up over five years demonstrated stable peri-implant tissues and maintained bone levels; Conclusions: The combined use of surgical decontamination, PRF-assisted regeneration, sticky bone, and prosthetic modification resulted in stable clinical and radiographic outcomes over five years. Identification and elimination of contributing factors were essential for long-term treatment success.
Jakub Kwiatek, O. Barczak, Marcin Lenkowski et al.· Reports· 0 citations
BACKGROUND
Peri-implantitis poses a significant challenge to implant longevity, leading to progressive bone loss and potential implant failure. While reconstructive surgery has been proven effective in regenerating peri-implant tissues, the long-term stability of the regenerated tissues and the impact of supportive peri-implant care (SPIC) on bone levels remains underexplored. This case study presents a 10-year follow-up of a patient treated with reconstructive surgery for peri-implantitis and enrolled in a structured maintenance program.
METHODS
A 68-year-old male with a failing implant in the mandibular right first molar was treated using a reconstructive approach involving surface decontamination, particulate bone grafts, and an acellular dermal matrix as a barrier. Three re-entry procedures were performed over a 10-year period: at 9 months for the second stage of the two-step GBR procedure and at 8 and 10 years for implant placement to replace fractured teeth. These interventions allowed for direct clinical and radiographic assessment of bone-level changes.
RESULTS
At 9 months, bone regeneration was observed with minor residual dehiscences. After 8 years, bone remodeling and crestal bone gain on the lingual aspect were noted in the absence of further surgical interventions. At 10 years, radiographic evaluations confirmed minimal changes in marginal bone levels.
CONCLUSIONS
The presented two-stage regenerative approach successfully restored peri-implant health and function over time while minimizing the patient's financial burden. The three re-entry procedures provided direct clinical evidence of bone regeneration and demonstrated the positive impact of effective maintenance therapy on marginal bone levels and their long-term stability.
KEY POINTS
The described regenerative treatment for peri-implantitis may ensure long-term satisfactory outcomes. Supportive peri-implant care (SPIC) is effective in preventing disease recurrence and may improve crestal bone levels over time.
PLAIN LANGUAGE SUMMARY
This study presents the case of a 68-year-old patient with a failing dental implant due to peri-implantitis. The implant was treated by thoroughly cleaning its surface, placing bone grafts, and using a protective membrane to regenerate bone around the fixture and obtain disease resolution. The patient returned for three follow-up surgeries over 10 years, providing a unique opportunity to directly examine bone stability around the implant. Direct observations revealed that the bone graft healed well within the first 9 months, and the regenerated peri-implant bone remained stable with minimal changes for a decade. Regular check-ups and cleanings also helped prevent disease recurrence and further bone loss. By saving the existing implant, the patient avoided the extra expenses of removing and replacing it. Overall, these results suggest that a regenerative surgical approach, combined with structured maintenance care, can help obtain disease resolution and maintain stable long-term outcomes. This can improve comfort and function while reducing costs for patients.
S. Parma-Benfenati, M. Roncati, Lucrezia Parma-Benfenati et al.· Clinical Advances in Periodo...· 0 citations
BACKGROUND
Correction of peri-implant bone dehiscence (PIBD) and optimization of the peri-implant soft-tissue phenotype are critical for long-term peri-implant tissues stability. A simplified, one-stage, transmucosal variant of the subperiosteal peri-implant augmented layer (sSPAL) technique was appraised and evaluated.
METHODS
Eight systemically healthy patients with posterior mandibular edentulous sites showing an overt dehiscence received tissue-level implants combined with sSPAL using particulate deproteinized bovine bone mineral within a periosteal pouch. Clinical (keratinized mucosa, marginal soft-tissue level, probing depth (PD), and bleeding/suppuration) and radiographic (peri-implant bone dehiscence, buccal bone thickness (BBT), and interproximal bone levels) parameters were assessed at 12 months.
RESULTS
At the 12-month follow-up, all treated patients exhibited complete resolution of PIBDs and a BBT of ≥1.5 mm. Moreover, all implants presented a keratinized mucosa height ≥2 mm associated with stable soft-tissue margins, shallow PDs, minimal bleeding, and no suppuration.
CONCLUSION
Within the limitations of this preliminary case series, sSPAL appears to be a feasible approach to modify the peri-implant phenotype by both reconstructing the hard-tissue component and providing adequate dimensions of the soft-tissue component.
KEY POINTS
The study was performed in order to assess whether and to what extent sSPAL may allow to manage both hard- and soft-peri-implant phenotype components; The isolation of the coronal full-thickness portion of the flap as well as a careful dissection of the periosteal layer taking care of maintaining its integrity are of paramount importance in order to successfully perform the surgical procedure. Finally, the adaptation of the flap should allow for the displacement of the full-thickness portion of the flap around the healing abutment in order to create adequate dimension of the soft-tissue peri-implant phenotype; The absence of at least 6 mm of keratinized tissue above the edentulous ridge as well as a limited thickness of the mucosa lining the bone crest, thus not ensuring adequate dimensions of the soft-tissue phenotype on both buccal and lingual aspects of the implant, may represent a contraindication for the execution of sSPAL.
PLAIN LANGUAGE SUMMARY
The present study pointed out the use of a novel surgical technique, namely the simplified subperiosteal peri-implant augmented layer technique (sSPAL), aimed at managing both hard and softperi-implant tissues in a single surgical intervention. The procedure derives from a published and validated two-stage technique (SPAL technique) aimed at correcting a peri-implant bone dehiscence (PIBD) simultaneously with implant placement. The present pilot study involved eight patients presenting one implant each that was treated with the sSPAL. No implant presented a PIBD at the 12-month CBCT examination, whereas seven of eight patients presented adequate (≥2 mm) dimensions of the peri-implant soft tissues. Therefore, despite taking into account the limitations of the present study due to its exploratory nature, it can be concluded that sSPAL may represent a valuable, simplified alternative to the conventional two-stage SPAL technique.
L. Trombelli, Chiara Franzini, M. Severi· Clinical Advances in Periodo...· 0 citations
In edentulous maxilla with insufficient bone width, both the association of i-PRF+DBBM and DBBM alone were effective in providing bone width gain for implant placement, and the association of DBBM with i-PRF showed similar outcomes compared with DBBM alone for the studied parameters.
Gabriel Rodrigues Oliveira, Vínicius Fabris, Alfonso Sánchez-Ayala et al.· Clinical Oral Investigations· 0 citations
Background and Objectives: Immediate dental implants placed at the time of extraction help preserve alveolar bone, maintain soft tissue architecture, and reduce treatment time. However, compromised bone and soft tissue deficiencies may affect implant outcomes, requiring regenerative approaches. Silk fibroin derived from Bombyx mori has gained attention as a biomaterial because of its favourable mechanical properties and biocompatibility. This study aimed to compare cross-linked bovine collagen membranes with and without silk fibroin around immediate dental implants for soft tissue regeneration.
Materials and methods: Twenty healthy individuals were randomised into two groups following non-surgical periodontal therapy. Group I (Control) received a Cross-linked collagen membrane following immediate implant placement (n = 10), while Group II (Test) received a cross-linked collagen membrane with silk fibroin (n = 10). Immediate implant healing was assessed at the end of the 10th day, 1 month, and 3 Months postoperatively. Gingival tissue thickness (GTT) and keratinised tissue width (KTW) were evaluated at 1 month and 3Months. Bone assessment was performed at baseline and at 3 months post-intervention using Radiovisiography.
Results: Silk fibroin membrane demonstrated significant gingival tissue thickness and enhanced keratinised tissue width with improved wound healing, and greater peri-implant bone stability compared to collagen membrane alone.
Conclusion: Collagen membranes incorporated with silk fibroin may enhance soft tissue regeneration and peri-implant bone stability around immediate implant sites.
Clinical Relevance: Functional composite membrane (Silk fibroin +Collagen) for Soft and Hard tissue augmentation around immediate implants provides greater peri-implant stability.
Jyoti T Naik, Rudrakshi C, M. Prabhuji· Journal of Biology and Medic...· 0 citations