Table 11 Included studies—surgical treatment of peri-implantitis: adjunctive augmentative therapy

Schwarz et al. [48, 51, 54]

RCT, parallel

20 patients

PD >6 mm, BOP + and/or pus

4 years nonsubmerged healing

OHI + initial nonsurgical therapy

OHI + initial nonsurgical therapy

Test

21 implants machined and medium-rough surfaces

Intrabony defect >3 mm

Open flap surgery + mechanical debridement (plastic curettes) + nanocrystalline hydroxyapatite paste

Open flap surgery + mechanical debridement (plastic curettes) + bovine-derived xenograft + native collagen barrier membrane

BOP reduction: 32 % (4 years, subject level)

PD reduction: 2.5 (0.9) mm (4 years, subject level)

Control

BOP reduction: 51 % (4 years, subject level)

PD reduction: 1.1 (0.3) mm (4 years, subject level)

BOP and PD reductions sign. higher at control sites

Deppe et al. [40]

CCT, parallel

32 patients

PD ≥5 mm, BOP + progressive vertical bone loss

5 years

Group 2 OHI + open flap^a surgery + air polishing + carbon dioxide laser (cw mode, 2.5 W, 12 × 5 s) decontamination + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane

Group 4 OHI + open flap^b surgery + air polishing + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane

Test

73 implants machined, rough- and medium-rough surfaces

SBI: 0.5 (0.8) (BL) to 2.1 (1.4) (48 months, implant level)

PD: 4.8 (1.4) (BL) to 2.5 (1.1) mm (48 months, implant level)

Control

SBI: 1.2 (0.6) (BL) to 1.9 (1.0) (48 months, implant level)

PD: 5.7 (1.4) (BL) to 2.5 (1.4) mm (48 months, implant level)

Comparable outcomes in both groups

Roos-Jansaker et al. [45–47]

CCT, parallel

25 patients

BOP + and/or pus

5 years transmucosal healing systemic antibiotic medication (amoxicillin + metronidazole for 10 days)

Removal of the suprastructure

Removal of the suprastructure

Test

45 implants machined and medium-rough surfaces

Bone loss ≥3 threads one- to four-wall defects

Open flap surgery + debridement + decontamination using hydrogen peroxide 3 % algae derived xenograft + resorbable synthetic barrier membrane

Open flap surgery + debridement + decontamination using hydrogen peroxide 3 % algae derived xenograft +

PD reduction: 3.0 (2.4) mm (5 years, implant level)

Radiographic defect fill: 0.1 (0.5) mm (5 years, implant level)

Control

PD reduction: 3.3 (2.0) mm (5 years, implant level)

Radiographic defect fill: 0.1 (0.5) mm (5 years, implant level)

Comparable defect fill and BOP reductions in both groups

Schwarz et al. [53]

CCT, parallel

27 patients

PD >6 mm, BOP + and/or pus

12 months nonsubmerged healing

Circumferential-type (Ie) defects OHI + initial nonsurgical therapy

Buccal dehiscence-type defects with a semicircular (Ib) or circular component (Ic)

Test Ib

27 implants machined and medium-rough surfaces

Intrabony defect >3 mm

Open flap surgery + mechanical debridement (carbon curettes) + decontamination (cotton pellets soaked in saline)

OHI + initial nonsurgical therapy Open flap surgery + Mechanical debridement (carbon curettes) + decontamination (cotton pellets soaked in saline)

BOP reduction: 38.9 (16.6) % (12 months, subject level)

Supracrestal component ≤1 mm

Bovine-derived xenograft + native collagen barrier membrane

Bovine-derived xenograft + native collagen barrier membrane

PD reduction: 1.6 (0.9) mm (12 months, subject level)

Test Ic

BOP reduction: 25.9 (14.7) % (12 months, subject level)

PD reduction: 1.6 (0.7) mm (12 months, subject level)

Control Ie

BOP reduction: 61.1 (16.7) % (12 months, subject level)

PD reduction: 2.7 (0.7) mm (12 months, subject level)

Sign. difference in BOP reductions between Ic and Ie

Rocuzzo et al. [44]

CCT, parallel

26 patients

PD ≥6 mm

12 months nonsubmerged healing simultaneous connective tissue graft at sites lacking keratinized mucosa systemic antibiotic medication (amoxicillin + clavulanic acid for 6 days)

SLA surfaced implants

TPS surfaced implants

Test

26 implants rough and medium-rough surfaces

Crater-like (intrabony) defects

OHI

OHI

BOP reduction: 60.4 % (12 months, subject level)

Open flap surgery + mechanical debridement (plastic curettes) + decontamination (24 % EDTA and 1 % CHX gel) + bovine-derived xenograft

Open flap surgery + mechanical debridement (plastic curettes) + decontamination (24 % EDTA and 1 % CHX gel) + bovine-derived xenograft

PD reduction: 3.4 (1.7) mm (12 months, subject level)

Radiographic defect fill: 1.9 (1.3) mm (12 months, subject level)

Control

BOP reduction: 33.9 % (12 months, subject level)

PD reduction: 2.1 (1.2) mm (12 months, subject level)

Radiographic defect fill: 1.6 (0.7) mm (12 months, subject level)

BOP and PD reductions sign. higher in the test group

Schwarz et al. [49, 50, 52]

RCT, parallel

17 patients

PD >6 mm, BOP + and/or pus

4 years nonsubmerged healing

OHI + initial nonsurgical therapy

OHI + initial nonsurgical therapy

Test

17 implants machined and medium-rough surfaces

Intrabony defect >3 mm

Open flap surgery + debridement + decontamination using an Er:YAG laser device (cone-shaped glass fibre tip) at 11.4 J/cm² implantoplasty at bucally and supracrestally exposed implant parts

Open flap surgery + Mechanical debridement (plastic curettes) + decontamination (cotton pellets soaked in saline) implantoplasty at bucally and supracrestally exposed implant parts

BOP reduction: 71.6 (24.9) % (4 years, subject level)

Supracrestal component >1 mm

Bovine-derived xenograft + native collagen barrier membrane at intrabony components

Bovine-derived xenograft + native collagen barrier membrane at intrabony components

PD reduction: 1.3 (1.8) mm (4 years, subject level)

Control

BOP reduction: 85.2 (16.4) % (4 years, subject level)

PD reduction: 1.2 (1.9) mm (4 years, subject level)

BOP and PD reductions comparable in both groups

Aghanzadeh et al. [43]

RCT, parallel

45 patients

PD ≥2 mm, BOP + and pus

12 months nonsubmerged healing systemic antibiotic medication (Azithromycin for 4 days)

Open flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3 % cortical bone chips harvested from the mandibular ramus + resorbable synthetic barrier membrane

Open flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3 % bovine-derived xenograft + resorbable synthetic barrier membrane

Test

75 implants medium-rough surfaces

Bone loss ≥2 mm

BOP reduction: 44.8 (6.3) % (12 months, implant level)

Angular defects ≥3 mm in depth

PD reduction: 2.0 (0.3) mm (12 months, implant level)

Radiographic bone level gain: 0.2 (0.3) mm (12 months, implant level)

Control

BOP reduction: 50.4 (5.3 %) (12 months, implant level)

PD reduction: 3.1 (0.2)mm (12 months, implant level)

Radiographic bone level gain: 0.8 (0.4) mm (12 months, implant level)

PD reductions and bone level gains were significantly higher at control sites

Wohlfahrt et al. [55, 58]

RCT, parallel

33 patients

PD ≥5 mm, BOP + intrabony defects ≥4 mm

12 months submerged healing for 6 months

Open flap surgery + mechanical debridement (titanium curettes) + conditioning using 24 % ethylenediaminetetraacetic acid gel (2 min) + augmentation of intrabony defect components using porous titanium granules

Open flap surgery + mechanical debridement (titanium currettes) + conditioning using 24 % ethylenediaminetetraacetic acid gel (2 min)

Test

33 implants medium-rough surfaces

BOP reduction: 0.38 (2.1) % (12 months, implant level)

PD reduction: 1.7 (1.7) mm (12 months, implant level)

Radiographic defect fill: 57.0 (45.1) % (12 months, implant level)

Control

BOP reduction: 0.56 (2.9) % (12 months, implant level)

PD reduction: 2.0 (2.3) mm (12 months, implant level)

Radiographic defect fill: −14.8 (83.4) % (12 months, implant level) no sign. reductions in BOP scores in both groups comparable reductions in MMP-8 and bone level markers