The Impact of Implant Design, Defect Size, and Type of Superstructure on the Accessibility of Nonsurgical and Surgical Approaches for the Treatment of Peri-implantitis.

PURPOSE The success of nonsurgical or surgical treatments of peri-implantitis is unpredictable, often without a clear reason. The aim of this study was to investigate the efficacy of nonsurgical and surgical cleaning, focusing on the impact of implant design, defect size, type of superstructure, and experience of the operator. MATERIALS AND METHODS Conical and straight implants were coated with a biofilm-like material and placed in shallow/deep defects in an artificial jaw model. Treatment was done by three operators and included either healing abutments or crowns as superstructures. Analysis was done using stereomicroscopy and ImageJ software. RESULTS Nonsurgical treatment of peri-implantitis defects was inefficient in removing all biofilm areas, regardless of the depth of the defect. The type of implant, experience of the operator, or type of superstructure did not have a significant impact. Surgical treatment was more efficient than a nonsurgical approach with regard to biofilm residues. However, the surgical approach failed to clean the apical portion of the exposed part of the implants. CONCLUSION Nonsurgical and surgical treatment were found to be ineffective in cleaning the exposed portion of implants with peri-implantitis. Treatment of peri-implantitis should therefore also include other approaches, such as chemical or biological modalities.