Surgical management of peri-implantitis: a systematic review and meta-analysis of treatment outcomes.

BACKGROUND This systematic review was requested by the Task Force of the American Academy of Periodontology as a follow-up study of the 2013 report, with an aim to investigate the efficacy of different surgical approaches to treat peri-implantitis. METHODS A search of four electronic databases from January 1990 to May 2013 was performed. Studies included were human clinical trials published in English that applied surgeries for treating peri-implantitis. Parameters evaluated included probing depth (PD) reduction, clinical attachment level gain, bleeding on probing (BOP) reduction, radiographic bone fill (RBF), and mucosal recession. The weighted mean (WM) and the 95% confidence interval of the studied parameters were estimated with the random-effect model. RESULTS A total of 1,306 studies were initially identified, after reviewing titles, abstracts, and full texts, and 21 articles, 12 of which were case series, were finally included. Four treatment groups were identified: 1) access flap and debridement; 2) surgical resection; 3) application of bone grafting materials; and 4) guided bone regeneration. The mean initial PD ranged from 4.8 to 8.8 mm, with initial BOP ranging from 19.7% to 100%. Short-term follow-ups (3 to 63 months) revealed that the available surgical procedures yielded a WM PD reduction of 2.04 (group 2) to 3.16 mm (group 4), or 33.4% to 48.2% of the initial PD. The WM RBF was 2.1 mm for groups 3 and 4. CONCLUSIONS Within the limitation of this systematic review, the application of grafting materials and barrier membranes resulted in greater PD reduction and RBF, but there is a lack of high-quality comparative studies to support this statement. The results might be used to project treatment outcomes after surgical management of peri-implantitis.