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inflammatory lesion. Target sites for surgical treatment are those pre- senting with persisting signs of pathology after non-surgical therapy, that is, deep pockets together with BOP/SOP. A standard surgical procedure includes, in addition to flap eleva- tion and removal of inflamed tissue, cleaning/ decontamination of the implant surface using, for example, small pieces of gauze soaked in saline and removal of mineralized deposits with curettes. Additional procedures in the surgical treatment of peri-implantitis may include: (i) the management of peri-implant osseous defects using reconstructive approaches, (ii) additional methods for implant surface decontamination and (iii) the adjunctive use of local/systemic antibiotics.
Additional question addressed by the WG
R8.2: Expert consensus-based recommendation treatment of peri-implantitis is complex, we recommend that it is provided by dentists with specific training or by specialists . Supporting literature Expert opinion Quality of evidence Not applicable Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
R8.1. What is the importance of adequate self- performed oral hygiene in the context of surgical treatment of peri-implantitis?
Background
Recognition of peri-implantitis as a disease entity is relatively recent and the armamentarium of surgical approaches is constantly evolving. The dental team must be continuously updated on the most effective treatment modalities. Treatment of peri-implantitis lies within the scope of the speciality of periodontology.
Additional question addressed by the WG
R8.1: Expert consensus-based recommendation We recommend not to perform surgical treatment of peri-implantitis in patients not achieving and maintaining adequate levels of self- performed OH . Supporting literature Expert opinion Quality of evidence Not applicable Grade of recommendation GradeA — ## Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
R8.3. What are the end points of successful surgical therapy of peri-implantitis?
Additional question addressed by the WG
R8.3: Expert consensus-based recommendations 1. We recommend that, at implant level, clinicians use ≤ 1 point of BOP, absence of SOP, PD ≤ 5 mm and absence of progressive bone loss compared to pre-treatment bone levels to verify disease resolution . 2. We recommend that clinical parameters be recorded 6 months post- treatment and that radiographs be obtained at 12 months . 3. We suggest that complication-free survival of the implant and implant-supported prosthesis and patient satisfaction (e.g., aesthetic appreciation) be included in the long-term evaluation of treatment outcomes . Supporting literature Expert opinion Quality of evidence Not applicable Grade of recommendation GradeA — "" (1,2); Grade B — " (3) Strength of consensus (1) Strong consensus (0% of the group abstained due to potential CoI) (2) Strong consensus (0% of the group abstained due to potential CoI) (3) Strong consensus (0% of the group abstained due to potential CoI)
Background
Studies have shown the detrimental effects of surgical treatment of periodontitis in patients with insufficient levels of self-performed OH (Sanz et al., 2020). Since bacterial biofilms are considered the primary etiological factor for both periodontitis and peri-implantitis, the impor- tance of adequate self-performed levels of OH needs to be empha- sized also in the context of surgical treatment of peri-implantitis. Similar to the periodontal scenario, studies on surgical treatment of peri-implantitis have also indicated unfavourable outcomes in patients not achieving and maintaining adequate levels of self-performed OH (De Waal et al., 2015; Koldsland et al., 2018).
R8.2. What is the level of professional expertise required for surgical treatment of peri-implantitis?
Background
Additional question addressed by the WG
Studies (e.g., Carcuac et al., 2017, 2020; Karlsson et al., 2019) demon- strate that progression of peri-implantitis occurs in the presence of clinical signs of inflammation, and is manifested through reduction of peri-implant bone levels. In contrast, shallow peri-implant PDs and absence of BOP/SOP have been associated with stable peri-implant support in longitudinal studies.
R8.2: Expert consensus-based recommendation We recommend that dental teams offering implant therapy also possess the professional expertise to manage peri-implantitis. Since surgical
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