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Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 55 S u r g i c a l t r e a t m e n t o f p e r i i m p l a n t i t i s Introduction Differenttreatment strategiesforperiimplantitis have been suggested.1–3 Despite the unesthetic outcomes, the resective approach was consid- ered the only longitudinally effective strategy.4 However, nonsurgical(which basicallyconsisted of simple subgingival mechanical debridement with or without systemic or local anti-infective agent delivery) and regenerative approaches were considered ineffective.5 In fact, despite some positive short-term outcomes that have been reported in many studies,3, 6 absence of resolution, as well as progression or recurrence after treatment of disease, leading to the loss of implant, were also highlighted.5 According to Graziani et al., current literature on periimplant disease prevention and treatment does not pro- vide applicable clinical information.7 In fact, the lack of efficacy of the current methods for treat- ing periimplantitis may be due to insufficient understanding ofthe entire biologicaletiologyof the disease. Therapy concepts for periodontitis have been directlytransferredto periimplant dis- ease treatments, neglecting the differences be- tween teeth and implants that may be highly relevant to periimplantitis treatment concepts. In fact, since implant surface and topology differ dramatically on the micro- and macrolevel from tooth structure and shape, conventional bacte- rialremovalanddebridementcannotbeeffective on implants.8 At the same time, since implants alwayspresenttheopportunityforbacterialcon- tamination at the implant–abutment junction, often positioned at the bone level,9 guided bone regeneration techniques or regenerative proce- dures cannot be successful (at least in the long run) owing to the recontamination of the site throughtheimplant–abutmentjunction.Anaddi- tionalreasonforlowsurgicaloutcomes might be the misunderstanding of triggering conditions for the implant disintegration process. In fact, according to Sanz and Chapple, the use of un- equivocal case definitionswould help in increas- ing the quality of research on this topic.10 As it is easy to understand, differences in periimplant environment (soft- and hard-tissue conditions, 3-D implant positioning, triggering factor of dis- ease)couldcompletelychangetheprognosisand give rise to different treatment plans. However, one of the most important factors affecting sur- gicaloutcomes, particularlyinthe case ofregen- erative procedures, appears to be the selection ofpatients, especiallyas regardsthe shape ofthe bonedefect.6 Infact,self-containingorthree-wall bone defects demonstrated a higher clinical and radiographic improvement in terms of bone re- generation.6 Circumferential and semicircumferential in- trabony defects displayed promising outcomes when treatedwith the application of a particula- te bone materialstabilizedwith a collagen mem- brane.3, 6 Besides loose particulate bone materi- als, alloplastic biomaterials designed to harden in situ are commonly used in dental indications.11 These resorbable materials (GUIDOR easy-graft CLASSIC, Sunstar Suisse, Étoy, Switzerland) are composedofcalciumphosphateparticlescoated Radiographic analysis demonstrated a complete or semicomplete filling of the defect in all of the cases, with a significant bone gain at six and 12 months. Microbiological analysis, in terms of total bacterial count and singlepathogens,demonstratedasignificantdecreaseofmicrobiological contamination in all ofthe test sites between baseline and the 12 months follow-up: at the sulcus, the neighboring teeth and the connection. C o n c l u s i o n Withinthelimitationsofthepresentpreliminarystudy,theproposedtech- nique, in combination with a self-stabilizing graft material, offers prom- isingresultsforthetreatmentofcircumferentialandsemicircumferential bonedefectsaroundimplantsaffectedbyperiimplantitis,withouttheuse of a membrane. K e y w o r d s Periimplantitis, periimplant disease, surgical treatment, graft material. Volume 2 | Issue 4/201655