Regenerative Surgical Treatment of Peri-Implantitis: A Systematic Review and Meta-Analysis

TL;DR

This study compares regenerative surgical treatments to standard cleaning for treating peri-implantitis, finding better bone healing but no clear advantage in soft tissue outcomes.

Contribution

The study provides a meta-analysis comparing regenerative surgical treatments with open flap debridement for peri-implantitis.

Findings

Regenerative treatments improved radiographic bone level compared to open flap debridement.

No significant differences were found in probing pocket depth or bleeding on probing.

Advanced regenerative approaches did not show clear superiority over bone grafting alone.

Abstract

Background/Objectives: This systematic review and meta-analysis evaluated the clinical effectiveness of regenerative surgical treatments compared with open flap debridement (OFD) in the management of peri-implantitis and, secondarily, assessed whether more advanced regenerative approaches, including guided bone regeneration (GBR), platelet-rich fibrin (PRF), and hyaluronic acid (HA), provide additional clinical benefit compared with bone grafting alone. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines and the PICO model, covering the period from 1993 to 2024. From 2119 identified articles, 63 full-text papers were reviewed, and 12 studies met all inclusion criteria. These studies compared regenerative treatments with OFD and bone grafting using clinical outcomes of probing pocket depth (PPD), radiographic bone level (RBL), bleeding on probing (BOP), suppuration (SUP), mucosal recession (REC), and clinical attachment level (CAL). Meta-analysis was performed using a random-effects model. Results: Regenerative treatments demonstrated superior outcomes in radiographic bone level gain compared with OFD (p < 0.001), while no statistically significant differences were observed for PPD (p = 0.77), BOP (p = 0.13), SUP (p = 0.42), REC (p = 0.14), or CAL (p = 0.96). Comparisons between bone grafting and other regenerative materials also showed no statistically significant differences. Conclusions: Regenerative procedures improved radiographic bone outcomes but did not consistently outperform OFD in soft tissue parameters, and no advanced regenerative modality demonstrated clear clinical superiority over bone grafting alone. Further high-quality randomized controlled trials with standardized methodologies are needed to establish clinical guidelines for peri-implantitis surgery.

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