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ePaper created 2017-03-17, 11:08:54 | version 1.38.0
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. 8 Fig. 8 Distribution per indication class at the time of implanta- tion for implants treated for periimplantitis compared with all inserted implants. (All implants: n = 22,724; periimplantitis-afected implants: n = 158). graphic bone fill for diferent surgical approach- es.19 Greater PPD reduction and radiographic bone fill were found when grafting materials and membranes were applied compared with procedures that used access flaps, debridement and resection. In another meta-analysis, great- er PPD reduction and gain of clinical attachment were found when bone grafts and membranes were applied compared with a nonsurgical ther- apy.21 However, regenerative therapy has been shown to be more efective in contained, cir- cumferential intrabony defects than in defects with buccal dehiscences or a predominantly suprabony component.11 Therefore, in our eval- uation, a treatment concept considering defect morphology according to the classification of Schwarz et al. was applied.17, 18 Interestingly, 36.1% of the implants with periimplantitis pre- sented with a defect morphology allowing bone augmentation procedures. For financial reasons, in only 28.5% of the implants did periimplantitis therapy include bone augmentation. This includ- ed defect Classes Ib, c, d and e. The defect mor- phology of the remaining implants treated for periimplantitis corresponded to 55.0% Class II and 8.9% Class Ia defects. These defect types were therefore treated by anti-infective, resec- tive therapy only. For the regenerative treatment of intraosse- ous defects, we applied a DBBM and an NBCM. Our findings are in accordance with other reports that found encouraging results of periimplanti- tis treatment using a DBBM with or without an NBCM. In a case series of 51 consecutively treat- ed patients who presented with periimplantitis, Froum et al. used enamel matrix protein, a com- bination of a platelet- derived growth factor with anorganic bovine bone or mineralized freeze- dried bone and an NBCM.14 Bone level measured by periapical radiographs or bone sounding in- creased and remained stable up to 7.5 years after periimplantitis therapy. Positive results in terms of PPD reduction and radiographic bone fill after one year were also found using a DBBM and an NBCM in intrabony defects with a PPD > 5 mm.15 Using a DBBM, Aghazadeh et al. reported reduced PPD after 12 months and a higher likelihood of radiographic defect fill com- pared with autogenous bone.13 In two other studies, a significant defect reduction was achieved using a DBBM in implants with crater- like defects at the one-year follow-up.12, 16 These results, together with the data of our retrospec- tive evaluation, demonstrate that periimplanti- tis treatment using a DBBM and an NBCM in defects with suitable defect morphologies may be clinically efective. In our retrospective evaluation, only a quar- ter of the implants afected by periimplantitis underwent therapy while all other implants were regarded as hopeless and explanted. We support recommendations of other authors to include patients with implants in a strict maintenance program7, 8 as poor oral hygiene is a well-known risk factor for periimplantitis.6 However, this was probably not ensured in many of the cases 40 Volume 3 | Issue 1/2017 Journal of Oral Science & Rehabilitation