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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 Fig. 2 Fig. 2 Time after implantation in years at start of periimplantitis therapy. (NA = unknown; n = 158). with a total of 637 implants were referred back to our practice owing to periimplantitis. Of these, 471 implants were deemed hopeless and extracted immediately (73.9%). Eight implants for which periimplantitis therapy was planned had to be extracted at the start of the treatment phase. Thus, periimplantitis therapy was initiat- ed for 158 implants in 107 patients (24.8%). Analysis of the original patient files established that cemented reconstructions were used in 128 implants (77.6%) and screw-retained recon- structions in 37 implants (22.4%). The 158 im- plants had been in place for nine months to 15 years (Fig. 2). Most of the periimplantitis infections had occurred within the first five years after implant insertion (108 implants; 68.4%). In one implant, this period was retro- spectively not clearly determinable. Seventy- two implants treated with periimplantitis therapy were located in the maxilla (45.6%) and 86 in the mandible (54.4%). The distribution of the implantation sites is shown in Figures 3a and b. Before the observation period of our eval- uation, 17 implants had been explanted owing to periimplantitis and replaced (10.8%). The newly inserted implants developed periimplan- titis again. Of the patients referred back to our practice and treated for periimplantitis, 41 were male (38.3%) and 66 were female (61.7%). The mean age of the 107 patients at the start of the periim- plantitis therapy was 58 ± 11 (23–85) years. At the time of implantation, 18 of the 107 patients were smokers (16.8%), three had received bis- phosphonate treatment (3.80%), five had dia- betes mellitus (4.67%) and 81 did present any conspicuous medical findings (75.7%), based on the original patient files. The following prosthet- ic deficiencies of the implants were identified in 25 of the 107 patients (36%): formation of mar- ginal gaps, overcontouring, overload, insuficient biological width, unnecessary splinting and cement residue. In 52 of the 107 patients (48.6%), generalized periodontitis was diagnosed for 79 implants (50.0%) and treated accordingly. The distribu- tion of the periimplantitis defect classes is shown in Figure 4. In 45 implants (28.5%), the therapy included GBR using a DBBM and an NBCM. The remaining 113 implants underwent professional tooth cleaning and were treated according to the implantoplasty protocol. At the start of the periimplantitis therapy, the BOP of the 158 implants was 100.0% and the plaque index was on average 48.5 ± 26.6% (n = 88). After initiation of the periimplantitis therapy, the mean vestibular PPD of the 158 implants was reduced from 4.93 ± 1.94 mm to 2.67 ± 0.88 mm after 12 months (n = 123) and 2.71 ± 0.30 mm after 49–56 months (n = 32; Figs. 5a & b), therefore on average below the level stated for the definition of periimplantitis.9 Stable PPD reduction was also found for im- plants with long-term follow-up data 49–56 months post-therapy (Fig. 6). BOP was absent in 50.0% of 58 analyzed implants at 12 months Journal of Oral Science & Rehabilitation Volume 3 | Issue 1/2017 35