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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 included in our evaluation, as almost half of the patients presented with generalized periodon- titis at the start of the periimplantitis treatment. Therefore, periimplantitis may have proceeded in many implants to a stage that required ex- plantation. In fact, a recent analysis demon- strated that implants provided with prostheses delivered by general practitioners were at higher risk of moderate and severe periimplantitis.22 Dentists who follow up on implant patients should be sensitized and should be instructed to establish strict maintenance programs ac- cording to consensus statements, especially regarding diagnosis of mucositis. Regular clin- ical monitoring with professional plaque remov- al and reinforcement of oral hygiene may also have been a main factor of the long-term suc- cess of the 158 implants that received periim- plantitis therapy in our evaluation. Simultaneous bone augmentation proce- dures at the time of implantation may bear high- er risk of periimplantitis.23, 24 The results of our retrospective evaluation, however, established that only 12.7% of the implants that received periimplantitis therapy had initially been insert- ed together with bone augmentation. Bone augmentation in all 22,724 inserted implants was 31%. The results indicate that implants in augmented sites are not more susceptible to periimplant infection than implants inserted without bone augmentation. Nevertheless, clear conclusions must first be drawn in clinical studies including both hopeless implants and implants suitable for periimplantitis therapy. Various clinical studies have found smokers to be at higher risk of developing periimplant infections.6, 25 A meta-analysis by Atieh et al. found a significantly higher frequency of periim- plant disease in smokers (36%).2 This is in ac- cordance with the results of our retrospective evaluation, in which 16.8% of the patients who underwent periimplantitis therapy were smok- ers and 16.7% of the smokers had already under gone explantation and re-implantation previously. Uncontrolled diabetes and the intake of bisphosphonates are two additional risk fac- tors for periimplantitis.6, 25 In our retrospective evaluation, 4.67% of the patients were diabet- ic and 3.80% received bisphosphonates at the time of implantation. Lindhe et al. demonstrat- ed that 5% of the patients that had undergone periimplantitis therapy and 23% of the patients in which explantations were performed despite the therapy had diabetes.6 These results sup- port the conclusion that implant patients with diabetes are at higher risk and should be in- formed accordingly. Similarly, bisphosphonates have been found to increase the risk of implant failure due to impaired implant osseointegra- tion. However, a review has shown that success- ful long-term results of implant therapy can be achieved in patients despite bisphosphonate intake.26 Our retrospective evaluation, however, does not provide a clear conclusion for negative efects of bisphosphonate intake or diabetes mellitus on the long-term survival of implants. In an additional subanalysis, the overall ex- plantation rate of implants placed between 1993 and 2014 was calculated to be 5.45%. Three implant systems presented with a failure rate of more than 10%. However, the number of periimplantitis patients who were not re- ferred back and treated elsewhere is not known. Therefore, the analysis does not allow for defini- tive conclusions of the prevalence of periim- plantitis afecting implants inserted in our prac- tice. Conclusion In our retrospective evaluation, data from pa- tients who were referred for periimplantitis treatment were analyzed. Using a treatment approach that included a hygiene phase and that considered defect morphology, PPD and BOP were improved and remained stable over more than four years post-therapy. Retreatments or explantations may be necessary and should be considered part of periimplantitis therapy. The results of our evaluation demonstrated that periimplantitis can be treated successfully and with good long-term results if a treatment ap- proach is chosen based on defect morphology and on consensus recommendations and if pa- tients are enrolled in a strict maintenance pro- gram. However, owing to the retrospective character of this evaluation, it is recommended that scientifically sound clinical trials be per- formed to further evaluate the eficacy of the periimplantitis treatment described here. Competing interests The expenses for statistical data analysis and description were covered by Geistlich Pharma, Wolhusen, Switzerland. Other than that, the authors declare that they have no competing interests. Journal of Oral Science & Rehabilitation Volume 3 | Issue 1/2017 41