Treatment of peri-implantits: non-surgical and resective surgical approaches

The aim of the research presented in this thesis was to perform randomized clinical trials to clinically, radiographically, microbiologically and immunologically evaluate the effect of a single implant surface decontaminating/peri-implant debridement intervention in the treatment of peri-implantitis. In addition, the aim was to add knowledge on the peri-implant diagnosis and on the influence of the implant supported crown contour with regard to the peri-implant condition. Cytokine levels of IL-1B and MMP-8 in crevicular fluid around implants showed the potential to discriminate between peri-implant health and disease. In addition, non-surgical therapy did not seem to influence the inflammatory immune response. Regarding non-surgical peri-implantitis treatment, limited treatment success should be expected using either erythritol air-polishing or piezoelectric ultrasonic scaling. Hence, the majority of patients seem to require further surgical treatment after a non-surgical treatment. Regarding surgical peri-implantitis treatment, erythritol air-polishing as implant surface cleansing method result the same treatment effect as saline soaked gauzes in the surgical resective treatment of peri-implantitis. And both therapies seem to result in low treatment success up to 1-year after treatment. Phosphoric acid 35% was found to be superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant did not seem to enhance clinical outcomes. At last, the cervical crown contour at platform-switched, posteriorly placed, two-piece implants did not seem to show a correlation with peri-implant marginal bone loss and soft-tissue health up to 5 year after implant placement.