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Table 3 Included studies reporting on surgical peri-implantitis treatment

From: Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Publication Design Population Case definition Period Test Control Mean (SD) outcome Supportive therapy/comments
a) Non-reconstructive surgery
Adjunctive and alternative measures for implant surface decontamination/systemic antibiotics
Papadopoulos et al. (2015) RCT,
parallel
16 patients
12 females and 7
males. Mean age: 55 (8.7; range: 40–73) years
16 implants
BOP/ SUPP on probing + PD ≥ 6 mm and bone loss ≥ 2 mm 6 months Mechanical debridement with plastic curettes + use of cotton swabs soaked in saline solution + use of a diode laser (low-power 980 nm) Control
Mechanical debridement with plastic curettes + use of cotton pellets soaked in saline solution
Subject level
Test baseline: 81.2%; 6 months: 23.8%
Control baseline: 93.8%; 6 months: 31.3%
Significant reduction compared to the baseline (p < 0.05)
No significant difference between groups (p > 0.05)
PD
Test baseline: 5.92 mm, 6 months: 4.44 mm
Control baseline: 5.52 mm, 6 months: 4.31
Significant reduction compared to the baseline (p < 0.05)
No significant difference between groups (p > 0.05)
Additional use of diode laser does not seem to have an extra beneficiary effect
Hallström et al. (2017) RCT,
parallel
31 patients
Test: 15; mean age: 68.8 (25.0) years; female 75%; current smokers: 40%; tooth loss due to periodontitis: 47%
Control: 16; mean age: 71 (7.7) years; female 63%; current smokers: 21%; tooth loss due to periodontitis: 53%
31 implants
Test: 15
Control: 16
BOP/ SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2 mm 12 months OHI + mechanical debridement with curettes and cotton pellets soaked in saline + post-operative systemic antibiotics – Zithromax (Sandoz AS, Copenhagen, Denmark) 250 mg × 2 at the day of surgery, and 250 mg × 1 per day for 4 days OHI + mechanical debridement with curettes and cotton pellets soaked in saline Subject level
BOP
Test baseline: 100%; 12 months: 12.4 (9.2) %
Control baseline: 100%; 12 months: 13.3 (11.1)%
No significant difference between groups (p = 0.1)
PD reduction
Test: 1.7 (1.1) mm, p < 0.001
Control: 1.6 (1.5) mm, p < 0.001)
No significant difference between groups (p = 0.5)
RBL
Test baseline: 4.6 (1.6) mm; 12 months: 4.0 (1.6) mm
Control baseline: 4.9
(1.7), mm; 12 months: 4.5 (1.5) mm
No significant difference between groups (p = 0.4)
During the study, participating individuals received professional prophylaxis every third month
Adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with access flap surgery alone
Albaker et al. (2018) RCT, parallel 24 patients
Tests: 11; mean age: 58.4 (8.0) years; 82% male; current smokers: 45%
Control: 13; mean age: 61.5 (9.9) years; 69% male; current smokers: 54%
Bone loss ≥ 2 mm compared with previous examination or ≥ 3 mm (in the absence of previous radiograph) + PD ≥ 5 mm + BOP/SUPP 12 months Access flap + implant cleaning with curettes and irrigation with sterile saline + aPDT (0.005% methylene blue photosensitizer, diode laser 670 nm 1 min + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks Access flap + implant cleaning with curettes and irrigation with sterile saline + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks Subject level
BOP
Test baseline: 35.9 (10.6)%, 12 months: 17.4 (5.5)%
Control baseline: 26.5 (8.4)%, 12 months: 14.8 (3.1)%
Between-group comparison: p = 0.22
PD
Test baseline: 5.0 (1.2) mm, 12 months: 3.7 (1.1) mm,
Control baseline: 5.4 (1.0) mm, 12 months: 3.9 (1.1) mm. Between group comparison: p = 0.51
Radiographic bone level
Test baseline: 4.1 (1.4) mm, 12 months: 43.4 (1.4) mm;
Control baseline: 4.5 (1.5) mm, 12 moths: 3.8 (1.4) mm
Between-group comparison: p = 0.19
During the study, all patients received professional prophylaxis every third month
Single application of aPDT does not provide additional benefit in improving clinical and radiographic parameters
Toma et al. (2019) RCT, parallel 47 patients, 70 implants
Test 1: 16 patients, 23 implants, mean age: 67.5 (12.9) years; 95% female; history of periodontitis: 73% patients
Test 2: 16 patients, 23 implants; mean age: 61.7 (13.4) years; 81% female; history of periodontitis: 82%
Control: 15 patients, 25 implants; mean age: 68.9 (15.8) years; 77% female; history of periodontitis: 84%
PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm 6 months Test 1:
Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + air abrasive device with glycine powder + CHX mouthrinse 0.2% for 10 days
Test 2:
Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + titanium brush for 30 s with oscillating handpiece + CHX mouthrinse 0.2% for 10 days
Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + CHX mouthrinse 0.2% for 10 days Implant level
BOP
Test 1 baseline: 59 (5.2)%; 6 months: 23 (2.3)%; p < 0.001
Test 2 baseline: 62 (4.7)%; 6 months: 16 (3.7)%; p < 0.001
Control: 54 (4.4)%; 6 months: 29 (3.4)%; p < 0.001
Significantly higher reduction in test 2 groups (p < 0.001)
PD
Test 1 baseline: 6.94 (1.29) mm; 6 months: 4.71 (1.24) mm; p < 0.001
Test 2 baseline: 6.45 (1.87) mm; 6 months: 3.98 (1.43) mm; p < 0.001
Control: 7.11 (1.15) mm; 6 months: 5.44 (0.69) mm; p > 0.001
Significantly great reduction in test 1 and test 2 groups (p < 0.001)
RBL
Test 1 baseline: 7.34 (1.29) mm; 6 months: 6.44 (1.46) mm;
Test 2: 7.09 (1.23) mm, 6 months: 5.88 (1.3) mm
Significantly less bone loss in test 2 group
3- and 6-months after surgery patients received professional supragingival cleaning
Test treatments were more effective, but treatment success remained low
Cha et al. (2019) RCT, parallel 46 patients
Test: 24 patients/24 implants; mean age: 63 (range: 46–84) years; female 60%
Control: 22 patients/ 22 implants; mean age: 60.2 (range: 40–83) years; female: 40%
Peri-implant bone loss > 2 mm + PD > 5 mm + BOP 6 months OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive minocycline ointment
Repeated applications after 1, 3 and 6 months
OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive placebo ointment
Repeated applications after 1, 3 and 6 months
Subject level
BOP/SUPP (%) change
At the deepest site
Test: 0.58 (0.50)
Control: 0.32 (0.57); Intergroup comparison p = 0.102
Mean change: test: 0.49 (0.35), control: 0.31 (0.46); Between-group comparison: p = 0.141
PD changes
At the deepest site
Test: 3.58 (2.32) mm
Control: 2.45 (2.13) mm; Between-group comparison: p = 0.094
Mean change
Test: 2.68 (1.73) mm, control: 1.55 (1.86) mm, Between-group comparison: p = 0.039
RBL
Test baseline: 6.33 (1.91) mm, 6 months: 7.05 (1.85) mm
Control baseline: 5.16 (1.74) mm, 6 months: 5.47 (1.51) mm; p = 0.014
2.3-fold higher increase in test group (9.7 (0.56) mm vs control 0.31 (0.49) mm)
Treatment success (PD < 5 mm + no BOP/SUPP + no further bone loss):
Test: 55.7%,
Control: 36.3%
All participants were recalled at 1, 3, and 6 mo to receive professional supragingival debridement and oral hygiene reinforcement
Repeated local application of minocycline combined with access flap surgery provides significant benefits in terms of clinical parameters and radiographic bone fill, with a higher treatment success
De Waal et al. (2013) RCT,
parallel
30 patients
Test: 15; mean age: 59.4 (14.0) years; female: 10; current smokers: 4; former smokers: 3; history of periodontitis: 6
Control: 15; mean age: 61.5 (10.0) years; female: 10; current smokers: 7; former smokers: 1; history of periodontitis: 5
79 implants machined,
rough- and medium-rough
surfaces
Test: 15 patients, 31 implants
Control: 15 patients, 48 implants
BOP/SUPP + PD ≥ 5 mm and bone loss ≥ 2 mm 12 months OHI/mechanical debridement + 
resective therapy (apical re-positioned flap + bone
re-contouring) + surface
debridement using surgical
gauzes soaked in saline + 
decontamination using 0.12%
CHX + 0.05% cetylpyridinium
chloride (CPC)
OHI/mechanical debridement + 
resective therapy (apical
re-positioned flap + bone
re-contouring) + surface
debridement using surgical gauzes
soaked in saline + decontamination
using placebo solution
Implant level
BOP (% of implants with BOP)
Test baseline: 96.8 (30)%, 12 months: 96.8 (30)%
Control baseline: 95.8 (46)%, 12 months: 94.7 (36)%
No significant difference between groups (p = 0.965)
PD
Test baseline: 6.6 (1.6) mm, 12 months: 4.3 (2.1) mm
Control baseline: 5.5 (1.4) mm, 12 months: 3.7 (0.8) mm. No significant difference between groups (p = 0.563)
% of implants with SUPP
Control baseline: 31.3 (15)%1; 12 months: 5.8 (6)%
Test baseline: 64.5 (20)%; 12 months: 29.0 (9)%
No significant difference between groups
(p = 0.977)
RBL
Test baseline: 4.3 (2.1) mm, 12 months: 5.0 (2.5)
Control baseline: 3.6 (1.9) mm, 12 months: 3.9 (2.0)
No significant difference between groups
(p = 0.949)
During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants and teeth were cleaned as necessary
Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri-implantitis does not lead to superior clinical results
De Waal et al. (2015) RCT, parallel 44 patients
Test: 22; mean age: 58.6 (10.2) years; female: 17; current smokers: 7; former smokers: 1; history of periodontitis: 10
Control: 22; mean age: 60.5 (11.6) years; female: 14; current smokers: 6; former smokers: 5; history of periodontitis: 10
108 implants machined,
rough- and medium-rough
surfaces
Test: 22 patients, 49 implants
Control: 22 patients, 59 implants
BOP and/or SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2 12 months OHI/mechanical debridement + 
resective therapy (apical
re-positioned flap + bone
re-contouring) + surface
debridement using surgical
gauzes soaked in saline + 
decontamination using 0.12%
CHX + 0.05% cetylpyridinium chloride
OHI/mechanical debridement + 
resective therapy (apical
re-positioned flap + bone
re-contouring) + surface
debridement using surgical
gauzes soaked in saline + 
decontamination using 2.0% CHX
Implant level
BOP (% of implants with BOP)
Test baseline: 98.0 (47)%, 12 months: 77.1 (37)%
Control baseline: 94.9 (56)%, 12 months: 68.5 (37)%
No significant difference between groups (p = 0.583)
PD
Test baseline: 4.7 (1.0) mm, 12 months: 3.0 (0.7) mm
Control baseline: 5.0 (1.2) mm, 12 months: 2.9 (0.7) mm. No significant difference between groups
% of implants with SUPP
Baseline test:: 57.1 (28)%; 12 months: 10.4 (5)%
Control baseline: 49.2 (29)%; 12 months: 1.9 (1)%
No significant difference between groups
(p = 0.222)
RBL
Test baseline: 4.0 (1.5) mm, 12 months: 4.3 (1.7) mm
Control baseline: 4.1 (1.6) mm, 12 months: 4.1 (1.7) mm
No significant difference between groups
(p = 0.950)
During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants, and teeth were cleaned as necessary
The use of a 2% CHX solution for implant surface decontamination during resective peri-implantitis therapy does not lead to improved clinical and radiographic results compared with a 0.12% CHX + 0.05% CPC solution
Carcuac et al. (2016, 2017) RCT,
parallel
67 patients
Group 1: systemic antibiotics/implant surface decontamination with CHX: 27; mean age: 65.7 (range: 23–90) years; female: 20; smokers: 33.3%; history of periodontitis: 77.8%
Group 2: systemic antibiotics/implant surface decontamination with saline: 25; mean age: 67.9 (range: 21–88) years; female: 17; smokers: 36%; history of periodontitis: 84%
Group 3: no systemic antibiotics/implant surface decontamination with an CHX: 24; mean age: 64.6 (range: 27–81) years; female: 14; smokers: 33.3%; history of periodontitis: 87.5%
Group 4: no systemic antibiotics/implant surface decontamination with saline: 24; mean age: 66.9 (range: 30–88) years; female: 14; smokers: 29.2%; history of periodontitis: 87.5%
121 implants: 25.6% non-modified, 74.4% modified surface
Group 1 + 2: 68 implants
Group 4 + 3: 53 implants
PD ≥ 6 mm + BOP/SUPP + bone loss > 3 mm 3 years Debridement with titanium-coated curettes + 
Group 1 and group 3 decontamination with 0.2% CHX
 + Group 1 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery
Debridement with titanium-coated curettes + Group 2 and 4
decontamination with saline for 2 min. + Group 2 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery
Implant level
BOP reduction
1 year
Group 1: 39.1%
Group 2: 34.8%
Group 3: 44.4%
Group 4: 51.4%
No significant difference among groups (p < 0.05)
3 years:
Presence of BOP/SUPP (%)
Group 1: 66.2%
Group 2: 52.8%
Group 3: 70%
Group 4: 32.3%
PD reduction 1 year
Group 1: 2.80 (1.87) mm
Group 2: 3.44 (1.66) mm
Group 3: 2.16 (1.79) mm
Group 4: 1.69 (2.22) mm
Significantly greater in group 2 than in groups
3 and 4 (p < 0.05)
PD reduction 3 years
Overall PD reduction compared to baseline: reduction of 2.73 ± 2.39 mm
Group 1: 3.00 (2.44) mm
Group 2: 2.38 (2.55) mm
Group 3: 2.67 (2.48) mm
Group 4: 2.90 (2.12) mm
PD reduction was more pronounced at non-modified surface implants
SUPP
Baseline: mean: 68.7%
Group 1: 72.3%
Group 2: 65.2%
Group 3: 67.3%
Group 4: 70.3%
After 1 year:
Mean 17.4%
Group 1: 13%
Group 2: 6.5%
Group 3: 22.2%
Group 4: 31.4%
RBL 3 years
Group1: gain 0.32 ± 1.64 mm
Group 2: loss − 0.51 ± 1.87 mm
Group 3: loss − 0.28 ± 1.78 mm
Group 4: gain 0.65 ± 0.86 mm
During the 12-mo follow-up period, supragingival polishing was performed and oral hygiene reinforced in 3-mo intervals
The local use of chlorhexidine had no overall effect on treatment outcomes
Potential benefits of systemic antibiotics are not sustained over 3 years
Non-reconstructive therapy with implantoplasty
Romeo et al. (2005, 2007) RCT,
parallel
17 patients
22 implants rough surfaces
Test: 10 patients, 19 implants
Control: 7 patients, 16 implants
BOP/SUPP + 
PD > 4 mm horizontal
peri-implant
translucency
36 months Full mouth disinfection/
mechanical debridement + 
resective therapy (apical
re-positioned flap + bone
re-contouring) + 
decontamination
using metronida zole + tetracycline hydro
chloride (3 min) + implantoplasty using diamond and
Arkansas burs/silicone
polishers + Amoxicillin 50 mg/kg/day for 8 days + CHX mouthrinse for 2 weeks
Full mouth disinfection/
mechanical debridement + 
resective therapy (apical
re-positioned flap + bone
re-contouring) + decontamination using metronidazole
 + tetracycline hydrochloride
(3 min) + Amoxicillin 50 mg/kg/day for 8 days
Implant level
mBI
Test baseline: 2.83 (0.47), 3 years: 0.61 (0.67)
Control baseline: 2.86 (0.35),
2 years: 2.33 (0.74)
Between group comparison: Student’s t-value of + 9.61
PD
Test baseline: 5.70 (1.69) mm, 2 years: 3.58 (1.06) mm, 3 years: 3.21 (0.56) mm
Control baseline: 6.52 (1.62) mm, 2 years: 5.5 (1.47) mm. Significantly higher PD values in control group (Student’s t-value + 5.5)
ML (recession)
Test baseline: 0.5 (0.91) mm,
3 years: 1.96 (1.42) mm
Control baseline: 0.23 (0.84) mm, 2 years: 1.64 (1.29) mm
Between group comparison: Student’s t-value of + 9.61
Recession index in control group significantly lower (Student’s t-value of − 2.14)
RBL mesial and distal
Test baseline: 3.82 mm and 3.94 mm; 3 years: 3.81 mm and 3.94 mm
Control baseline: 3.45 mm and 3.49 mm
3 years: 5.35 mm and 5.42 mm
The mean variation of marginal bone level values mesial and distal
Test: 0 and 0.001 mm (p > 0.05)
Control: 1.44 and 1.54 mm (p < 0.05)
Implantoplasty was an effective treatment of peri-implant infection and peri-implantitis progression
Lasserre et al. (2020) RCT,
parallel
29 patients
Smokers excluded
42 implants with modified surface
Test: 15 patients; mean age: 62.3 (range: 42–74) years; female: 11; history of periodontitis: 13; 22 implants
Control: 14 patients; mean age: 71 (range: 59–92) years; female: 11; history of periodontitis: 13; 20 implants
PD > 5 mm + bone loss ≥ 2 mm + BOP/SUPP 6 months OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + implantoplasty + 0.1% CHX mouthrinse for 10 days OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + air abrasive device with amino acid glycine powder + 0.1% CHX mouthrinse for 10 days
p < 0.008
Implant level
BOP
Test baseline: 94.7 (10.7)%, 6 months: 33.3 (24.2)%, p < 0.008
Control baseline: 87.4 (22.3)%, 6 months: 26.3 (23.2)%
PD
Test baseline: 6.72 (1.78) mm, 6 months: 2.73 (1.59)
Control baseline: 5.61 (1.56) mm, 6 months: 2.33 (1.49) mm
ML (recession)
Test baseline: 0.23 (0.48) mm, 6 months: 0.75 (0.71) mm, p < 0.008
Control baseline: 0.57 (0.85) mm, 6 months: 1.11 (0.89) mm
RBL
Test baseline: 4.73 (2.67) mm, 6 months: 4.47 (3.06), p < 0.008
Control baseline: 5.21 (2.06) mm, 6 months: 4.67 (2.05) mm, p < 0.008
No differences in any parameter between two groups (p > 0.008)
After 3 and 6 months careful professional supragingival cleansing was performed
Implantoplasty is as effective as glycine air polishing
b) Studies comparing reconstructive therapy versus access flap surgery
Wohlfahrt et al. (2012) RCT,
parallel
32 patients (13 female; 19 male)
Test: 16; mean age: 65.0 (10.0) years; smokers:
6 (37.5%)
Control: 16; mean age: 57.2 (12.3) years; smokers 10 (58.8%)
32 implants
medium rough
surfaces
PD ≥ 5 mm,
BOP + 
intrabony
defects
 ≥ 4 mm
12 months submerged
healing for 6 months
Access 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)
Implant level
BOP (bleeding sites pro implant) reduction
Test: 0.38 (2.1) %
Control: 0.56 (2.9) %
Not significant improvement compared to baseline
No significant difference between groups (p = 0.60)
PD reduction
Test: 1.7 (1.7) mm
Control: 2.0 (2.3) mm
Significant improvement compared to baseline (p < 0.001)
No significant difference between groups (p = 0.66)
RDF
Test: 57.0 (45.1) mm
Control: − 14.8 (83.4) mm
Significantly higher in test group (p < 0.001)
Radiographic defect height reduction:
Test: 2.0 (1.7) mm
Control: 0.1 (1.9) mm
Significantly higher in test group (p < 0.001)
Test group showed significantly better radiographic peri-implant defect fill compared with controls. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated
Andersen et al. (2017)
(Wolhlfahrt et al. continuum)
  12 patients
12 implants
Test: 6 patients, 6 implants
Control: 6 patients, 6 implants
  7 years    Implant level
PD changes
Test baseline: 6.5 (1.9) mm, 7-years: 4.3 (2.4) mm
Control baseline: 6.5
(2.3) mm, 7 years: 3.5 (1.2) mm
RDF
Mean radiographic osseous defect fill:
test: 1.9 (2) mm
control: 1.3 (1.4) mm
Comparative statistical analysis was not performed
Follow-ups were handled by the referring dentists
Surgical treatment of peri-implant osseous defects showed unpredictable results
Hamzacebi et al. (2015) RCT, split-mouth design 19 patients, 38 implants
Test: 19 implants
Control: 19 implants
Mean age: 60.98 (11.90) years
BOP/ SUPP + PD ≥ 5 mm + radiographic bone loss ≥ 2 mm 6 months Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + intrabony defect fill with platelet-ruch fibrine (PRF) plugs and membranes + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days Implant level
BOP
Test baseline: 79.31 (31.7)%; 6 months: 25.29 (14.51)%; p < 0.001
Control baseline: 65.47 (36.08)%; 6 months: 21.43 (16.57)%; p > 0.001
Between group comparison not conducted
PD
Test baseline: 6.13 (1.05) mm; 6 months: 3.30 (0.49) mm
Control baseline: 5.78 (0.71) mm; 6 months:3.71 (0.42) mm
Between-group comparison: p < 0.001 (higher reduction in test group)
ML
Test baseline: 0.62 (0.49) mm; 6 months: 0.14 (0.28) mm
Control baseline: 0.83 (0.65) mm; 6 months: 1.04 (0.62) mm
Between-group comparison: p < 0.001 (higher reduction in test grouo)
Supportive therapy NR
PRF application led to better clinical results
Jepsen et al. (2016) Multicenter RCT,
parallel
63 patients (27 female, 36 male)
63 implants
Test: 33 patients; mean age: 57.5 (12.6) years; current smokers:
11 (33.3%); former smokers: 9 (27.3%); history of periodontal treatment: 17 (51.5%); 33 implants
Control: 30 patients; mean age: 59.1 (12.2) years; current smokers:
7 (23.3%); former smokers: 11 (36.7%); history of periodontal treatment: 20 (66.7%);
30 implants
PD ≥ 5 mm + BOP/SUPP
 + intraosseous circumferential three-wall defects ≥ 3 mm
12 months Access flap + mechanical debridement with rotary titanium brush and H2O2 3% (1 min) followed by rinsing with saline (60 s) + Titanium granules + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery Access flap + mechanical debridement with rotary titanium brush and H2O2 3% (1 min) followed by rinsing with saline (60 s) + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery Subject level
BOP reduction
Test: 56.1 (30.5)%
Control: 44.9 (38.2)%
Significant reduction compared to baseline (p < 0.001)
No significant difference between groups (p > 0.05)
PD reduction
Test: 2.8 (1.3) mm
Control: 2.6 (1.4) mm
Significant reduction compared to baseline (p < 0.001)
No significant difference between groups (p > 0.05)
SUPP reduction
Test: 23.2 (32.8) %
Control: 25.6 (32.7) %
Significant reduction compared to baseline (p < 0.001)
No significant difference between groups (p > 0.05)
Radiographic defect height reduction:
mesial/distal:
test: 3.61 (1.96)/3.56 (2.07) mm
control: 1.05 (1.42)/1.04 (1.34) mm
Significantly higher in test group (p < 0.0001)
RDF
mesial/distal:
test: 79.00 (29.85)%/74.22 (36.33)%
control: 23.11 (46.28)%/21.89 (30.16)%
Significantly higher in test group (p < 0.0001)
Patients were recalled at 6 wk and 3, 6, 9, and 12 mo after
surgery for professional oral hygiene procedures with supragingival debridement and hygiene instructions provided as
needed
Test group showed significantly enhanced radiographic defect fill compared with control group. Similar improvements according to clinical measures were obtained after both surgical treatment modalities
Renvert et al. (2018) RCT, parallel 41 patients
41 implant
Test: 21 patients; female: 13; 21 implants
Control: 20 patients; female: 9; 20 implants
PD ≥ 5 mm + BOP/SUPP + marginal bone loss, defined as a crater like defect ≥ 3 mm 12 months Access flap + 
mechanical debridement with titanium curettes + decontamination with 3% H2O2 + application of bovine-derived deproteinized bone particles + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4
Access flap + 
mechanical debridement with titanium curettes + decontamination with 3% H2O2 + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4
Implant level
BOP
Test baseline: 100%,
12 months: 47.6%
Control baseline: 100%, 12 months: 35%
No difference between groups (p = 0.41)
PD
Test baseline: 6.5 (1.9) mm, 12 months: 2.9 (1.4) mm, p > 0.001
Control baseline: 6.7 (1.8) mm, 12 months:
4.2 (2.8) mm, p > 0.001
Significantly greater reduction in the test group (p < 0.01)
ML (mid-buccal recession)
Test: 1.2 m
Control: 1.9 mm
No difference between groups (p = 0.76)
RDF
Test:
0.7 (0.9) mm
Significant compared to the baseline ( p = 0.004)
Control:
0.2 (0.2) mm
Not significant compared to baseline (p = 0.10)
Successful treatment outcome (defect fill ≥ 1.0 mm, PPD values at implant ≤ 5 mm, no BOP, and no SUPP):
Test: 9/21 (42.9%) patients
Control: 1/20 (5.0%) patients; Between-group comparison: p < 0.01
Based on individual needs, professional prophylaxis was performed every 3rd month
Successful treatment outcome using a bone substitute was more predictable when a composite therapeutic endpoint was considered
Isehed et al. (2016, 2018) RCT, parallel 23 patients
23 implants
Smokers inlcuded
Test: 10 patients, 10 implants
Control: 13 patients, 13 implants
PD ≥ 5 mm + BOP/ SUPP + angular bone loss ≥ 3 mm 5 years Access flap + mechanical debridement with
ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + application of Emdogain (EMD) (0.3 ml) + non-submerged healing
Access flap + mechanical debridement with
ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + non-submerged healing
Implant level
BOP-positive sites
5 years
Test: 5/11 (55.6%) implants
Control: 2/9 (40%) implants
Presence of SUPP:
Test baseline:
9/15 (60%); 1 year: 1/15 (7%)
Control baseline: 6/14 (43%); 1 year: 1/14 (7%)
SUPP at 3 years
Test: 2/13 (20%) implants
Control: 3/12 (33%) implants
MBL changes
5 years
Test: 4.1 mm
Control: 3.3 mm
Change: test: + 1.4 mm
Control: + 1.3 mm
p = 0.90
Between 1 and 5 years after the peri‐implant surgical treatment, supportive therapy was performed based on individual needs at the specialist clinic or by the patient's general dental clinic, usually with 3‐ or 6‐month intervals
Test group showed increased bone levels 12 months after treatment
Renvert et al. (2021) RCT 66 patients
66 implants
Test: 34; female 54%; age: 62.2 (10.2) years
Smokers 8 (22%)
Control: 32; female 50%; age: 62.9 (10) years; smokers: 9 (26%)
Heavy smokers (> 10 cig./day) excluded
PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 3 mm + intraosseous defect component of at least 3 mm depth and a circumference at least 270 ◦ detected intraoperatively 1 year Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H2O2 1 min + saline rinsing + defect fill with bovine bone mixed with bloos + bilaminar collagen membrane + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H2O2 1 min + saline rinsing + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks Subject level
BOP (severity of blleding pro implant)
Test baseline: 1.3 (0.9), 12 months: 0.4 (0.6)
Control baseline: 1.4 (1.0); 12 months: 0.5 (0.6);
Between-group comparison: p = 0.992
PD
Test baseline: 6.7 (1.5) mm, 12 months: 4.8 (1.5);
Control baseline: 6.8 (1.3); 12 months: 4.5 (1.5) mm
Between-group comparison: p = 0.578
SUPP (sites per implant)
Test baseline: 1.8 (1.4); 12 months: 0.3 (0.9);
Control baseline: 1.6 (1.5), 12 months: 0.3 (0.9)
Between-group comparison: p = 0.879
ML (recession)
Test baseline: 0.4 (1.8) mm, 12 months: 0.8 (1.2) mm
Control basleine: 0.6 (0.9); 12 months: 1.4 (1.5) mm
Between-group comparison: p = 0.136
RDF at the deepest site
Test: 2.7 (1.3) mm
Control: 1.4 (1.2) mm;
Between-group comparison: p < 0.001
Mean RDF
Test: 2.3 (1.2)mm
Control: 1.1 (1.1)
Between-group comparison: p = 0.001
Oral hygiene insructions were provided after 3, 6, 9 and 12 months following the surgery
Reconstructive therapy resulted in significantly more RDF. No difference in clinical paramenetrs was noted
c) Reconstructive therapy
Adjunctive and alternative measures for implant surface decontamination following reconstructive therapy
Deppe et al. (2007) CCT,
parallel
16 patients
32 implants machined,
rough- and
medium-rough
surfaces
Test: 9 patients, 17 implants
Control: 7 patients, 15 implants
PD ≥ 5 mm, BOP + progressive
vertical
bone loss
5 years 3 weeks prior to surgery: CHX gel applications (0.3%)
Group 2 OHI + access flap surgery + air abrasive device + 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
3 weeks prior to surgery: CHX gel applications (0.3%)
Group 4 OHI + access flapb surgery + air abrasive device + beta tricalcium
phosphate + cortical bone chips
harvested from the retromoar area
(50:50) + nonresorbable synthetic
barrier membrane
Implant level
SBI
Test baseline: 0.5 (0.8), 5 years: 2.1 (1.4)
Control baseline: 1.2 (0.6), 5 years: 1.9 (1.0)
PD
Test baseline: 5.0 (1.3) mm, 5 years: 2.5 (1.4) mm
Control baseline: 4.8 (1.4) mm, 5 years: control: 2.5 (1.1). No significant difference between the groups (p > 0.05)
Radiographic DIB (distance from the implant shoulder to the first bone contact)
Test baseline: 2.3 (0.9) mm
5 years: 4.5 (1.2) mm
Control baseline: 4.1 (0.9) mm, 5 years: 4.7 (1.1) mm
No significant difference between the groups (p > 0.05)
Over the 5-year period, if plaque and bleeding scores indicated poor oral hygiene, remotivatino and reinstruction of OHI were performed
There seems to be no difference between laser and conventional decontamination
Isler et al. (2018a) RCT, parallel 41 patients
60 implants
Test: 20 patients; mean age: 54.4 (8.08) years; female: 9; current smokers: 5 (25%); history of periodontitis: 9 (45%); 30 implants
Control: 21 patients; mean age: 54.18 (10.36) years; female: 10; current smokers: 6 (28.5%); history of periodontitis: 8 (38%); 30 implants
 ≥ 2 mm marginal bone loss + BOP/SUP with or without deepening of PDs 12 months Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + ozone application + bovine bone mineral mixed with pieces of concentrated growth factors (CGF) + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + bovine bone mineral mixed with CGF + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week Implant level
BOP
Test baseline: 96.6 (10.5), 12 months: 15.8 (19.1), p < 0.001
Control baseline: 97.5 (10.06), 12 months:
25 (21.7), p < 0.001
No difference between groups (p = 0.575)
PD
Test baseline: 6.27 (1.42) mm, 12 months: 2.75 (0.7) mm, p < 0.001
Control baseline: 5.73 (1.11) mm, 12 months:
3.34 (0.85) mm, p < 0.001
No difference between the groups (p = 0.158)
ML (recession):
Tests baseline: 0.12 (0.14) mm, 12 months: 0.48 (0.75) mm, p < 0.01
Control baseline: 0.25 (0.42) mm, 12 months: 0.55 (0.64) mm, p < 0.01
No difference between groups (p = 0.753)
RDF
Test: 2.32 (1.28) mm
Control: 1.17 m (0.77) mm
Significantly higher fill in test group (p = 0.02)
The patients were re-evaluated at 1, 3, 6, 9, and 12 months postoperatively and supportive care was given at the same time points
Higher radiographic defect fill in the test group
Reconstruction of the defect with different bone fillers, with and without a membrane
Khoury et al. (2001) CCT,
parallel
25 patients; mean age: 48.2 (6.3) years; 22 female
41 implants
Test 1: 20 implants
Test 2: 9 implants
Control: 12 implants
Bone loss > 50% of implant length + intrabony crater-form defect 3 years Test 1
Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H2O2 + Test 1
autogenous bone + non-resorbable membrane
Test 2
autogenous bone + resorbable membrane
 + submerged healing + Antibiotics administered 4 weeks prior to surgery (for 1 week), and later starting 1 day and finishing 7 days after surgery according to the individual susceptibility test results
Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H2O2 + autogenous bone
 + submerged healing + Antibiotics administered 4 weeks prior to surgery (for 1 week), and later starting 1 day and finishing 7 days after surgery according to the individual susceptibility test results
Implant level
PD changes
Test 1: 5.4 (3.0) mm
Test 2: 2.6 (1.6) mm
Control: 5.1 (2.7) mm
Significant improvement compared to baseline in all groups (p > 0.001)
Significantly less improvement in test 2 group compared to test 1 and the control (p ≤ 0.05)
Radiographic vertical intrabony defect height reduction:
Test 1: 2.8 (3.1) mm
Test 2: 1.9 (3.2) mm
Control: 2.4 (2.7) mm
Significantly less improvement in test 2 group compared to baseline (p = 0.102)
No difference among the groups (p ≤ 0.05)
The patients wereenrolled in a supportive maintenance program and monitored on a 3- to 6-month recall schedule including repeated oral hygiene instructions and a full-mouthtooth cleaning according to their individual needs
17 out of 29 barrier-treated implants (58.6%) were compromised by early post-therapy complication (e.g., dehiscence, exposure, fistula, or sequester formation)
Schwarz et al. (2006, 2008, 2009) RCT,
parallel
20 patients; 14 female; mean age: 54.4 (12.5) years; 1 patient light smoker (< 10 cig./day)
21 implants
Test: 9 patients, 9 implants
Control: 10 patients, 11 implants
PD > 6 mm + BOP/SUPP + intrabony component > 3 mm 4 years OHI + initial non-surgical therapy
Access flap surgery + mechanical
debridement (plastic curettes) + 
nanocrystalline hydroxyapatite paste + non-submerged healing
OHI + initial non-surgical therapy
Access flap surgery + mechanical
debridement (plastic curettes) + 
bovine-derived xenograft + native
collagen barrier membrane + non-submerged healing
Subject level
BOP reduction
Test: 32%
Control: 51%
PD reduction
Test: 1.1 (0.3) mm
Control: 2.5 (0.9) mm
BOP and PD reductions significantly
higher at control sites
A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene were performed at 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48 months after treatment
Long-term outcome obtained in test group without barrier membrane must be considered as poor
Aghazadeh et al. (2012) RCT,
parallel
45 patients
71 implants medium-rough
surfaces
Test: 23 patients; mean age: 67.0 (7.5) years; smokers: 69.6%;
37 implants
Control: 22 patients; mean age: 70.1 (6.2) years; smokers: 40.9%; 34 implants
PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm + angular peri-implant bone defect ≥ 3 mm 12 months Access flap surgery + mechanical
debridement (titanium instruments) + 
decontamination using hydrogen
peroxide 3% cortical bone chips
harvested from the mandibular ramus
 + resorbable synthetic barrier
Membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days
Access flap surgery + mechanical
debridement (titanium
instruments) + decontamination
using hydrogen peroxide 3%
bovine-derived xenograft + resorbable
synthetic barrier membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days
Implant level
BOP reduction
Test: 50.4 (5.3)%
Control: 44.8 (6.3)%
No significant difference between the groups (p > 0.05)
PD reduction
Test: 3.1 (0.2) mm
Control: 2.0 (0.2) mm
Significantly higher in the test group (p < 0.01)
SUPP reduction
Test: 25.2 (4.3)%
Control: 11.5 (5.2)%
Significantly higher in the test group (p < 0.01)
RDF
Test: 1.1 (0.3) mm
Control: 0.2 (0.3) mm
Significantly higher in test group (p < 0.05)
Six weeks after surgery the first supportive therapy was given, and the subjects were enrolled in a maintenance program with visits everythird month. Allexisting teeth and implants werecleaned using a rubber cup and alow-abrasive paste
Bovine xenograft provided more radiographic bone fill than authogenous bone
Roos-Jansaker et al. (2007, 2011, 2014) CCT,
parallel
25 patients
45 implants
Test: 13 patients; mean age: 64.9 (7.5) years; current smokers: 10 (76.9%); former smokers: 2 (15.4%); 23 implants
Control: 12 patients; mean age: 65.7 (7.4) years; current smokers: 8 (66.7%); former smokers: 3 (25%); 22 implants
Bone loss > 3 threads (≥ 1.8 mm) one-to-four intrabony defect + BOP and/or SUPP 5 years Removal of the suprastructure
Access flap surgery + debridement +
decontamination using
3% H2O2 + algae-derived xenograft
 + resorbable synthetic barrier
membrane + non-submerged healing + 
systemic antibiotic medication
(Amoxicillin + Metronidazole for
10 days)
Removal of the suprastructure
Access flap surgery + debridement + 
decontamination using
3% H2O2 + algae-derived xenograft
 + 
non-submerged healing + 
systemic antibiotic medication
(Amoxicillin + Metronidazole for
10 days)
Implant level
PD reduction at the deepest site
Test: 3.0 (2.4) mm
Control: 3.3 (2.0) mm
No significant difference between the groups (p = 0.60)
ML(recession changes at the deepest site)
Test: − 1.6 (1.5) mm
Control: − 1.7 (2.1) mm
No significant difference between the groups (p = 0.89)
RDF
Test: 1.5 (1.2) mm
Control: 1.1 (1.2) mm
No significant difference between the groups (p = 0.24)
The participants were then enrolled in a maintenance program with visits every third month. At these visits, full‐mouth plaque scores were obtained. Re‐instruction in oral hygiene procedures was performed as necessary. Teeth and implants were cleaned using a rubber cup and a low‐abrasive paste
Additional use of a membrane did not improve the outcome
Güler et al. (2017) CCT, parallel 24 patients (9 female, 15 male). mean age: 45.36 (14.1) years
35 implants
Test: 18 patients; 19 implants
Control: 6 patients, 16 implants
Light smokers included (< 10 cig.7 day):
Test: 3 (18.75%)
Control: 3 (50%)
PD > 5 mm + BOP/SUPP
Class Ib° defects (vestibular dehiscence + circumferential bone resorption)
Class Ic°° defects (vestibular dehiscence + circumferential bone resorption)
Class Id defects (circumferential bone resorption)
6 months OHI + access flap + mechanical cleaning with rotating titanium brush + titanium granules + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days OHI + access flap + mechanical cleaning with rotating titanium brush + xenograft + resorbable collagen membrane + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days Implant level
BOP
Test baseline: 50.17 (25.19)%, 6 months: 24.32 (11.22)%
Control baseline: 63.51 (24.38)%, 6 months:
33.00 (15.51)%
Significantly higher reduction in test group (p = 0.02)
PD
Test baseline: 5.28 (1.06) mm, 6 months: 3.34 (0.82) mm
Control baseline: 4.72 (1.02) mm, 6 months:
3.34 (0.82) mm
No significant difference between groups (p = 0.698)
ML (recession)
Test baseline: 0.01 (0.003) mm, 6 months: 0.42 (0.58) mm
Control baseline: 0.208 (0.452) mm, 6 months:
0.51 (0.48) mm
No significant difference between groups (p = 0.476)
RDF
Test: 1.74 (0.65) mm
Control: 1.05 (0.54) mm
Significantly higher reduction in test group (p = 0.006)
Radiographic bone filling was significantly higher in the test group
Isler et al. (2018b) RCT,
parallel
52 patients
105 implants
Test: 26 patients; female: 10; current smokers: 6; history of periodontitis: 11; 52 implants (23% on-modified, 77% modified)
Control: 26 patients; female: 15; current smokers: 9; history of periodontitis: 13; 52 implants (19.2% non-modified, 80.8% modified)
Bone loss ≥ 2 mmbased on baseline radiograph + BOP /SUPP 12 months OHI + supra/subgingival mechanical debridement 4–6 weeks prior to surgery
Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + concentrated growth factor (CGF) membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks
OHI + supra/subgingival mechanical debridement 4–6 weeks priot to surgery
Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + collagen membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks
Implant level
BOP
Test baseline: 97.12 (10.79)%, 12 months: 35.58 (30,.14)%, p < 0.001
Control baseline: 97.12 (8.15)%, 12 months: 29.81 (30.02), p < 0.001
Between-group comparison: p = 0.503
PD
Test baseline: 5.92 (1.26) mm, 12 months: 3.71 (1.09) mm, p < 0.001
Control baseline: 5.41 (1.16) mm, 12 months: 2.70 (0.80) mm, p < 0.001
Between-group comparison: p = 0.001
ML (recession)
Test baseline: 0.04 (0.20) mm, 12 months: 0.25 (0.39) mm, p = 0.007
Control baseline: 0.06 (0.20) mm, 12 months: 0.27 (0.44) mm, p = 0.026
Between-group comparison: p = 0.925
RDF
Test: 1.63 (1.0) mm
Control: 1.98 (0.75) mm, p = 0.154
Treatment success (PD < 5 mm + no BOP/SUPP, no further bone loss):
Test: 26.9% implants
Control: 42.3% implants
All patients were enrolled in postoperative maintenance care programs at three different time points during the study periods (3, 6, and 9 months). Supragingival/mucosal mechanical debridement and reinforcement of oral hygiene were performed during postoperative period. When necessary localized subgingival/mucosal instrumentation was done except for the area of surgery
Control group showed better results
Polymeri et al. (2020) RCT, parallel 24 patients, 24 implants
Test: 13; mean age: 57.3 (15.1) years; female: 5 (38%); smokers: 2 (15%); history of periodontal treatment: 6 (46%)
Control: 11; mean age: 65.5 (11.2) years; female: 6 (55%); smokers: 3 (27%); history of periodontal treatment: 4 (36%)
Bone loss ≥ 3 mm + PD ≥ 5 mm + BOP/SUPP + intra-osseous defect component ≥ 3 mm at the deepest part and presence of at least three walls 12 months Access flap + mechanical debridement with titanium curettes + decontamination with 3% H2O2 1 min + xenogrfat (EndoBone) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX Access flap + mechanical debridement with titanium curettes + decontamination with 3% H2O2 1 min + xenogrfat (BioOss) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX Subjest level
BOP
Test basleine: 100 (0.0)%, 12 months: 50 (10.2)%, p < 0.001
Control baseloine: 100 (0.0)%, 12 months: 45.5 (33.2)%, p < 0.001
Between-group comparison: p = 0.670
PD
Test basleine: 7.1 (1.2)%, 12 months: 3.4 (0.5)%, p < 0.001
Control baseloine: 7.0 (1.8)%, 12 months: 3.4 (0.6)%, p < 0.001
Between-group comparison: p = 0.910
Radiographic defect depth
Test baseline:; 5.9 (1.8) mm, 12 months: 2.9 (1.3), p < 0.001
Control baseline: 4.9 (0.9) mm, 12 months: 2.4 (0.6) mm, p < 0.001
Bestween-group comparison: p = 0.183
RBL
Test baseline: 4.9 (1.1) mm, 12 months: 2.1 (1.3)mm, p < 0.001
Control baseline: 5.3 (1.2) mm, 12 months: 3.1 (1.3) mm, p < 0.001
Between-group comparison: p = 0.073
Treatment success (PD ≤ 5 mm + no BOP/SUP + no further bone loss): test: 13%, control: 18% of patients
Patients
were recalled at 6 weeks and 3, 6, 9, and 12 months after the surgery
for professional oral hygiene procedures that included supragingival debridement and polishing with a rubber cup and a low-abrasive
paste
Test and control groups showed comparable outcomes
d) Combined therapy
Schwarz et al. (2011, 2012, 2013, 2017) RCT,
parallel
15 patients
11 females, 4 males; median age: 63 years
Heavy smokers (≥ 10 cigarettes/day) excluded
15 patients
Test: 6 patients, 6 implants
Control: 9 patients, 9 implants
PD ≥ 6 + BOP/SUPP +
intrabony component > 3 mm + supracrestal component > 1 mm
7 years Initial non-surgical therapy + OHI
Access flap + Er:YAG laser device (cone-shape glass fiber tip) at 11.4 J/cm2 + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft + 
native collagen membrane + non-submerged healing
Initial non-surgical therapy + OHI
Access flap mechanical debridement with plastic curettes and saline-soaked cotton gauses + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft + 
native collagen membrane + non-submerged healing
Subjest level
BOP reduction
Test: 86.66 (18.26)%
Control: 89.99 (11.65)%
Significant improvement compared to baseline (p < 0.001)
PD reduction
Test: 0.74 (1.89) mm
Control: 2.55 (1.67) mm
Significant improvement compared to the baseline (p < 0.001)
ML (reduction of recession)
Test: 1.36 (1.04) mm
Control: 0.49 (0.92) mm
A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene wereperformed at 1, 3, and 6 months after therapy. Afterwards, recall appointments to provide a professionally administered plaque removal and reinforcement of oral hygiene were scheduled on an annual basis
Combined surgical therapy of advanced peri-implantitis was not influenced by the initial method of surface decontamination
De Tapia et al. (2019) RCT,
parallel
30 patients
Heavy smokers (≥ 10 cigarettes/day) excluded
30 patients
Test: 15 patients; mean age: 65.53 (10.29) years; female: 11 (73.3%); light smokers: 6 (40%); 15 implants
Control: 15 patients; mean age: 55.47 (11.75) years; female: 9 (60%); light smokers: 4 (26.7%); 15 implants
PD ≥ 6 mm + BOP/SUPP + bone loss > 30% of the implant surface + intrasurgically osseous defect with at least two bone walls and depth of 3 mm of intrabony component 12 months Initial non-surgical therapy:
OHI
Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H2O2 3%
 + titanium brush with an oscillating low speed + non-submerged healing + combination of 500 mg Amoxicillin and 500 mg Metronidazole 3 times a day, for 7 days
Initial non-surgical therapy:
OHI
Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H2O2 3%
 + non-submerged healing + combination of 500 mg Amoxicillin and500 mg Metronidazole 3 times a day, for 7 days
Subject level
BOP
Test baseline: 100%, 12 months: 79%
Control baseline: 100%, 12 months: 55%,
between-group comparison: p = 0.147
PD
Test baseline: 6.16 (1.27) mm; 12 months: 3.31 (0.72)
Control: 6.17 (0.98) mm; 12 months: 3.87 (0.81) mm Between-group comparison: p = 0.04
SUPP
Test baseline: 43%; 12 months: 0%
Control baseline: 47%; 12 months: 23%; p = 0.053
ML (recession)
Test: 0.4 (0.45) mm
Control: 0.6 (0.62) mm; Between-group comparison: p = 0.374
RBL
Test: 2.51 (1.21) mm,
Control: 0.73 (1.26) mm; Between-group comparison: p = 0.003
RDF:
Test: 81 (22)%
Control: 52 (55)%; Between-group comparison: p = 0.111
Patients were seen at weekly intervals for the first 4 weeks to monitor healing and, then, at 3‐month intervals during the first year
The additional use of a titanium brush during combined treatment of peri-implantitis resulted in statistically significant benefits in terms of PD reduction
  1. RCT randomized clinical trial, OHI oral hygiene instructions, BOP bleeding on probing, PD probing depth, SUPP suppuration, BI bleeding index, mBI modified bleeding index, RBL radiographic bone level, RDF radiographic bone defect fill, ML soft-tissue level, H2O2 hydrogene peroxide