Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Surgical Methods

Purpose. Peri-implantitis is one of the major causes of implant failure. The detoxification of the implant surface is necessary to obtain reosseointegration. The aim of this review was to summarize in vitro and in vivo studies as well as clinical trials that have evaluated surgical approaches for detoxification of the implant body surfaces. Materials and Methods. A literature search was conducted using MEDLINE (PubMed) from 1966 to 2013. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters, radiographic bone fill, and histological reosseointegration. Results. From 574 articles found, 76 were analyzed. The findings, advantages, and disadvantages of using mechanical, chemical methods and lasers are discussed. Conclusions. Complete elimination of the biofilms is difficult to achieve. All therapies induce changes of the chemical and physical properties of the implant surface. Partial reosseointegration after detoxification has been reported in animals. Combination protocols for surgical treatment of peri-implantitis in humans have shown some positive clinical and radiographic results, but long-term evaluation to evaluate the validity and reliability of the techniques is needed. 1. Introduction The vast majority of implants are successful over the long term. However, failure does occur. These failures occur for a variety of reasons. Currently available literature indicates that peri-implant infections are one of the major causes of implant failure. These infections have been related to biofilms colonization of the implant surface that induces an inflammatory response [1]. These conditions are divided into those affecting only the soft tissues (peri-implant mucositis) or those resulting in loss of supporting bone (peri-implantitis) [2]. Infections affecting only the soft tissues can normally be resolved by debriding the area along with increased attention to personal oral hygiene. The clinician’s current dilemma is how to optimally deal with infected implant surfaces where partial loss of bone has occurred. To date there have been no human studies demonstrating on histologic level the reattachment of bone to infected implant surfaces. The current belief is that this is a result of the bacteria and their byproducts left on the implant surfaces. As a result, many approaches have been suggested to detoxify these surfaces. This paper will present an overview of the surgical approaches suggested to date. Lack of a specific clinical and radiographic