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HERRERA ET AL .
FIGURE 2
Management of peri-implant diseases, according to the diagnosis of the peri-implant condition: healthy peri-implant tissues and
peri-implant mucositis .
FIGURE 3
Management of peri-implant diseases, according to the diagnosis of the peri-implant condition: peri-implantitis .
Based on these care pathways, the management of peri- implantitis should encompass the following steps:
is central to the prevention of the onset of peri-implantitis (Jepsen et al., 2015), this treatment is in fact the most important preventive intervention for peri-implantitis and, as such, represents the main component of professional interventions during SPIC.
• Upon diagnosis, a decision must be made whether the affected implant is treatable. • If so, an initial non-surgical therapy step, which includes sub- marginal instrumentation, is performed. • Following the non-surgical step, re-evaluation of clinical outcomes, based on a set of pre-established criteria for success, will guide the decision whether to enrol the patient in a secondary prevention SPIC programme, or to proceed with the surgical step, provided the affected implant continues to be deemed treatable. • The surgical step of peri-implantitis treatment must always include sub-marginal instrumentation after elevating a surgical flap. • Following evaluation of clinical outcomes after the surgical step, and provided that a set of pre-established criteria for success are met, the patient is enrolled into a secondary prevention SPIC pro- gramme. If these criteria are not fulfilled, and the affected implant is still deemed to be maintainable, the implant should be re- treated.
4.4.3 | Specific care pathways in peri-implantitis
Once a diagnosis of peri-implantitis has been established, two points must be recognized:
• Peri-implantitis is an irreversible condition; therefore, even after successful peri-implantitis therapy, a diagnosis of ‘ stable ’ peri- implantitis is assigned at the particular implant. • Peri-implantitis treatment outcomes depend upon a multitude of factors (implant and prosthetic characteristics, patient factors, local factors, disease severity, bone defect configuration). Consequently, customized interventions specifically targeting one or several of the above factors are used in its management (as reported in the SRs). The treatment outcomes of these interventions are variable.
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