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Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 61 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 documented by Paolantonio et al., chlorhexidine was demonstrated to maintain the implant connection decontaminationfora period shorter than six months.20 Limitations of the present study clearly rela- te to the study design itself: The short follow-up period and small sample size suggested to care- fully handle the even promising reported outco- mes.Afurtherlimitation isthat onlyless challen- ging bone defects were included in this preliminary study; hence, the regenerative out- comes should be considered in light of this. For this study, only contained circumferenti- al or semicircumferential defects were included that represented the most predictive defect shape, as documented by Schwarz et al., com- pared with two- or one-wall bone defects.6 Ac- cording to the literature, despite profuse efforts, massive soft-tissue shrinkage has been re- ported.6 Forthis reason, newsurgicaltechniques should be applied to counteract this phenome- non. For this purpose, as suggested by Schwarz et al., the use of a connective tissue graft might beeffectiveincontrollingsoft-tissuearchitecture ifadaptedoverthe regeneratedsite.21 Inaddition, a new flap design, as reported by Zucchelli and Mounssif, might represent an alternative strat- egy.22 Furthermore, a studywith a longerfollow- up, larger sample size and different defect types should be designed to corroborate the findings of the present study. However, it can be conclu- ded that, within the limitations of the present preliminary study, the proposed technique, in combination with a self-stabilizing graft materi- al, offers promising results in the treatment of circumferential and semicircumferential bone defects around implants affected byperiimplan- titis, without the use of a barrier membrane. Competing interests The authorsdeclarethattheyhave nocompeting interests. 1. Muthukuru M, Zainvi A, Esplugues EO, Flemmig TF. Non-surgical therapy 0for the management of peri-implantitis: a systematic review. → Clin Oral Implants Res. 2012 Oct;23 Suppl 6:77–83. 2. Serino G, Turri A. Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans. → Clin Oral Implants Res. 2011 Nov;22(11):1214–20. 3. Renvert S, Polyzois I, Claffey N. Surgical therapy for the control of peri-implantitis. → Clin Oral Implants Res. 2012 Oct;23 Suppl 6:84–94. 4. Serino G, Turri A, Lang NP. Maintenance therapy in patients following the surgical treatment of peri-implantitis: a 5-year follow-up study. → Clin Oral Implants Res. 2015 Aug;26(8):950–6. 5. Heitz-Mayfield LJ, Mombelli A. The therapy of peri-implantitis: a systematic review. → Int J Oral Maxillofac Implants. 2014;29 Suppl:325–45. 6. Schwarz F, Sahm N, Schwarz K, Becker J. Impact of defect configuration on the clinical outcome following surgical regenerative therapy of peri-implantitis. → J Clin Periodontol. 2010 May;37(5):449–55. 7. Graziani F, Figuero E, Herrera D. Systematic review of quality of reporting, outcome measurements and methods to study efficacy of preventive and therapeutic approaches to peri-implant diseases. → J Clin Periodontol. 2012 Feb;39 Suppl 12:224–44. 8. Pesce P, Menini M, Tealdo T, Bevilacqua M, Pera F, Pera P. Peri-implantitis: a systematic review of recently published papers. → Int J Prosthodont. 2014 Jan-Feb;27(1):15–25. 9. 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Quantitative analysis of multi-species oral biofilms by TaqMan Real-Time PCR. → Clin Med Res. 2005 Aug;3(3):176–85. 17. Buser D, von Arx T, ten Bruggenkate C, Weingart D. Basic surgical principles with ITI implants. → Clin Oral Implants Res. 2000;11 Suppl 1:59–68. 18. Jensen OT, Bell W, Cotta, J. Osteoperiosteal flaps and local osteotomies for alveolar reconstruction. → Oral Maxillofac Surg Clin North Am. 2010 Aug;22(3):331–46, vi. 19. Renvert S, Polyzois IN. Clinical approaches to treat peri-implant mucositis and peri-implantitis. → Periodontol 2000. 2015 Jun;68(1):369–404. 20. Paolantonio M, Perinetti G, D’Ercole S, Graziani F, Catamo G, Sammartino G, Piccolomini R. Internal decontamination of dental implants: an in vivo randomized microbiologic 6-month trial on the effects of a chlorhexidine gel. → J Periodontol. 2008 Aug;79(8):1419–25. 21. Schwarz F, Sahm N, Becker J. Combined surgical therapy of advanced peri- implantitis lesions with concomitant soft tissue volume augmentation. A case series. → Clin Oral Implants Res. 2014 Jan;25(1):132–6. 22. Zucchelli G, Mounssif I. Periodontal plastic surgery. → Periodontol 2000. 2015 Jun;68(1):333–68. References Volume 2 | Issue 4/201661