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G u i d e d b o n e r e g e n e r a t i o n i n p e r i i m p l a n t i t i s t h e r a p y Introduction Implant therapy is a well-established method to restore missing teeth. However, periimplant tis- sue infections due to biofilm formation may compromise implant survival. The term “periim- plantitis” describes an inflammatory process in the periimplant mucosa with additional signs of bone loss.1 Periimplantitis occurs in around 10% of implants and 20% of patients.1–3 A very recent meta-analysis reported a mean prevalence of 22% (CI: 14–30%) for periimplantitis.4 Risk factors for periimplantitis are poor plaque control, history of periodontitis, smoking, uncon- trolled diabetes, periimplant cement residue, genetic factors, occlusal overload and history of periimplantitis.5, 6 Current strategies for periim- plantitis therapy include a pretreatment phase with professional tooth cleaning, optimization of plaque control with prosthesis adjustment if nec- essary and nonsurgical debridement.7–9 After- ward, in the surgical phase, a full-thickness flap is prepared and the contaminated implant surface is thoroughly cleaned. Intraosseous defects can be filled using a bone substitute or tissue graft material with or without a resorbable membrane. The postsurgical protocol includes systemic an- tibiotic therapy and chlorhexidine rinsing during the healing phase, followed by the maintenance phase with regular recall visits, ranging from three to six months. Regenerative surgical therapy has been shown to predictably obtain partial to full defect fill,10 although the outcome may be influenced by the defect morphology11 and implant sur- face.12 According to the concept of guided bone regeneration (GBR), the use of a deproteinized bovine bone mineral (DBBM) either with or with- out a native bilayer collagen membrane (NBCM) has been evaluated in various clinical studies and demonstrated marked short-term clinical im- provements and promising long-term results.12–16 The aim of our retrospective evaluation was to analyze the eficacy of the periimplantitis treat- ment with or without bone augmentation in patients over a long-term observation period up to five years post-therapy. Materials and methods S t u d y p o p u l a t i o n The retrospective evaluation included 107 pa- tients with 158 implants that were treated for periimplantitis between 2009 and 2015. Im- plants had been inserted between 1993 and 2014 by the same surgeon (JUW) according to the manufacturers’ instructions. Implant sys- tems included Steri-Oss (Nobel Biocare, Zurich, Switzerland), CAMLOG implant system (Cylin- der Line, Screw Cylinder Line, Root-Line, SCREW-LINE, SCREW-LINE Promote plus, iSy, CAMLOG Biotechnologies, Basel, Switzerland), ITI and Straumann implants (Straumann, Basel, Switzerland), FRIALIT 2 (Dentsply Sirona, Mann- heim, Germany), XiVE (Dentsply Sirona), ASTRA TECH OsseoSpeed (Dentsply Sirona), IMZ Twin- Plus (Dentsply Sirona) and ANKYLOS (Dentsply Sirona). If necessary, bone augmentation proce- dures were performed before or during the im- plantation. After completion of the healing phase, the patients were referred back to their dentists or prosthodontists for further prosthet- ic treatment and follow-up. Later on, some of those patients were referred to our practice again because of periimplantitis. T h e r a p y Before periimplantitis treatment, clinical and radiographic evaluation took place. In the case of acute inflammation, anti-inflammatories were locally applied. Patients underwent pro- fessional tooth cleaning and periodontal therapy in the case of generalized periodontitis. Periimplantitis was classified and treated in accordance with Schwarz et al. (Fig. 1).17, 18 After exposing the defects and removing granulation tissue, implantoplasty was performed using dia- monds rotary instruments and Arkansas stones finishing burs. Defects were cleaned with ster- ile saline. Intraosseous defects (defect Classes Ib, c, d and e; Fig. 1) were augmented according to the treatment protocol using a DBBM (Geistlich Bio-Oss spongiosa granules, Geistlich Pharma, Wolhusen, Switzerland) and an NBCM (Geistlich Bio-Gide Perio, Geistlich Pharma). The surgical area was carefully closed, a periodontal wound dressing applied (Coe-Pak, GC Europe, Leuven, Belgium) and a radiographic evaluation per- formed. Patients were advised to rinse cautiously with chlorhexamed 0.2% (GSK, London, U.K.) from the first day postsurgery for one week. Antibiotics were given at the discretion of the surgeon starting 24 h before surgery until suture removal eight days postsurgery. Patients were followed up according to a strict recall schedule in our practice. If necessary, supplementary therapy, such as gingivectomy or implantoplas- ty, was performed during the follow-up phase. Journal of Oral Science & Rehabilitation Volume 3 | Issue 1/2017 33