. 2021 Nov 15;7:112. doi: 10.1186/s40729-021-00388-x

Table 3.

Included studies reporting on surgical peri-implantitis treatment

Publication	Design	Population	Case definition	Period	Test	Control	Mean (SD) outcome	Supportive therapy/comments
a) Non-reconstructive surgery
Adjunctive and alternative measures for implant surface decontamination/systemic antibiotics
Papadopoulos et al. (2015)	RCT, parallel	16 patients 12 females and 7 males. Mean age: 55 (8.7; range: 40–73) years 16 implants	BOP/ SUPP on probing + PD ≥ 6 mm and bone loss ≥ 2 mm	6 months	Mechanical debridement with plastic curettes + use of cotton swabs soaked in saline solution + use of a diode laser (low-power 980 nm)	Control Mechanical debridement with plastic curettes + use of cotton pellets soaked in saline solution	Subject level Test baseline: 81.2%; 6 months: 23.8% Control baseline: 93.8%; 6 months: 31.3% Significant reduction compared to the baseline (p < 0.05) No significant difference between groups (p > 0.05) PD Test baseline: 5.92 mm, 6 months: 4.44 mm Control baseline: 5.52 mm, 6 months: 4.31 Significant reduction compared to the baseline (p < 0.05) No significant difference between groups (p > 0.05)	Additional use of diode laser does not seem to have an extra beneficiary effect
Hallström et al. (2017)	RCT, parallel	31 patients Test: 15; mean age: 68.8 (25.0) years; female 75%; current smokers: 40%; tooth loss due to periodontitis: 47% Control: 16; mean age: 71 (7.7) years; female 63%; current smokers: 21%; tooth loss due to periodontitis: 53% 31 implants Test: 15 Control: 16	BOP/ SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2 mm	12 months	OHI + mechanical debridement with curettes and cotton pellets soaked in saline + post-operative systemic antibiotics – Zithromax (Sandoz AS, Copenhagen, Denmark) 250 mg × 2 at the day of surgery, and 250 mg × 1 per day for 4 days	OHI + mechanical debridement with curettes and cotton pellets soaked in saline	Subject level BOP Test baseline: 100%; 12 months: 12.4 (9.2) % Control baseline: 100%; 12 months: 13.3 (11.1)% No significant difference between groups (p = 0.1) PD reduction Test: 1.7 (1.1) mm, p < 0.001 Control: 1.6 (1.5) mm, p < 0.001) No significant difference between groups (p = 0.5) RBL Test baseline: 4.6 (1.6) mm; 12 months: 4.0 (1.6) mm Control baseline: 4.9 (1.7), mm; 12 months: 4.5 (1.5) mm No significant difference between groups (p = 0.4)	During the study, participating individuals received professional prophylaxis every third month Adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with access flap surgery alone
Albaker et al. (2018)	RCT, parallel	24 patients Tests: 11; mean age: 58.4 (8.0) years; 82% male; current smokers: 45% Control: 13; mean age: 61.5 (9.9) years; 69% male; current smokers: 54%	Bone loss ≥ 2 mm compared with previous examination or ≥ 3 mm (in the absence of previous radiograph) + PD ≥ 5 mm + BOP/SUPP	12 months	Access flap + implant cleaning with curettes and irrigation with sterile saline + aPDT (0.005% methylene blue photosensitizer, diode laser 670 nm 1 min + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks	Access flap + implant cleaning with curettes and irrigation with sterile saline + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks	Subject level BOP Test baseline: 35.9 (10.6)%, 12 months: 17.4 (5.5)% Control baseline: 26.5 (8.4)%, 12 months: 14.8 (3.1)% Between-group comparison: p = 0.22 PD Test baseline: 5.0 (1.2) mm, 12 months: 3.7 (1.1) mm, Control baseline: 5.4 (1.0) mm, 12 months: 3.9 (1.1) mm. Between group comparison: p = 0.51 Radiographic bone level Test baseline: 4.1 (1.4) mm, 12 months: 43.4 (1.4) mm; Control baseline: 4.5 (1.5) mm, 12 moths: 3.8 (1.4) mm Between-group comparison: p = 0.19	During the study, all patients received professional prophylaxis every third month Single application of aPDT does not provide additional benefit in improving clinical and radiographic parameters
Toma et al. (2019)	RCT, parallel	47 patients, 70 implants Test 1: 16 patients, 23 implants, mean age: 67.5 (12.9) years; 95% female; history of periodontitis: 73% patients Test 2: 16 patients, 23 implants; mean age: 61.7 (13.4) years; 81% female; history of periodontitis: 82% Control: 15 patients, 25 implants; mean age: 68.9 (15.8) years; 77% female; history of periodontitis: 84%	PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm	6 months	Test 1: Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + air abrasive device with glycine powder + CHX mouthrinse 0.2% for 10 days Test 2: Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + titanium brush for 30 s with oscillating handpiece + CHX mouthrinse 0.2% for 10 days	Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + CHX mouthrinse 0.2% for 10 days	Implant level BOP Test 1 baseline: 59 (5.2)%; 6 months: 23 (2.3)%; p < 0.001 Test 2 baseline: 62 (4.7)%; 6 months: 16 (3.7)%; p < 0.001 Control: 54 (4.4)%; 6 months: 29 (3.4)%; p < 0.001 Significantly higher reduction in test 2 groups (p < 0.001) PD Test 1 baseline: 6.94 (1.29) mm; 6 months: 4.71 (1.24) mm; p < 0.001 Test 2 baseline: 6.45 (1.87) mm; 6 months: 3.98 (1.43) mm; p < 0.001 Control: 7.11 (1.15) mm; 6 months: 5.44 (0.69) mm; p > 0.001 Significantly great reduction in test 1 and test 2 groups (p < 0.001) RBL Test 1 baseline: 7.34 (1.29) mm; 6 months: 6.44 (1.46) mm; Test 2: 7.09 (1.23) mm, 6 months: 5.88 (1.3) mm Significantly less bone loss in test 2 group	3- and 6-months after surgery patients received professional supragingival cleaning Test treatments were more effective, but treatment success remained low
Cha et al. (2019)	RCT, parallel	46 patients Test: 24 patients/24 implants; mean age: 63 (range: 46–84) years; female 60% Control: 22 patients/ 22 implants; mean age: 60.2 (range: 40–83) years; female: 40%	Peri-implant bone loss > 2 mm + PD > 5 mm + BOP	6 months	OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive minocycline ointment Repeated applications after 1, 3 and 6 months	OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive placebo ointment Repeated applications after 1, 3 and 6 months	Subject level BOP/SUPP (%) change At the deepest site Test: 0.58 (0.50) Control: 0.32 (0.57); Intergroup comparison p = 0.102 Mean change: test: 0.49 (0.35), control: 0.31 (0.46); Between-group comparison: p = 0.141 PD changes At the deepest site Test: 3.58 (2.32) mm Control: 2.45 (2.13) mm; Between-group comparison: p = 0.094 Mean change Test: 2.68 (1.73) mm, control: 1.55 (1.86) mm, Between-group comparison: p = 0.039 RBL Test baseline: 6.33 (1.91) mm, 6 months: 7.05 (1.85) mm Control baseline: 5.16 (1.74) mm, 6 months: 5.47 (1.51) mm; p = 0.014 2.3-fold higher increase in test group (9.7 (0.56) mm vs control 0.31 (0.49) mm) Treatment success (PD < 5 mm + no BOP/SUPP + no further bone loss): Test: 55.7%, Control: 36.3%	All participants were recalled at 1, 3, and 6 mo to receive professional supragingival debridement and oral hygiene reinforcement Repeated local application of minocycline combined with access flap surgery provides significant benefits in terms of clinical parameters and radiographic bone fill, with a higher treatment success
De Waal et al. (2013)	RCT, parallel	30 patients Test: 15; mean age: 59.4 (14.0) years; female: 10; current smokers: 4; former smokers: 3; history of periodontitis: 6 Control: 15; mean age: 61.5 (10.0) years; female: 10; current smokers: 7; former smokers: 1; history of periodontitis: 5 79 implants machined, rough- and medium-rough surfaces Test: 15 patients, 31 implants Control: 15 patients, 48 implants	BOP/SUPP + PD ≥ 5 mm and bone loss ≥ 2 mm	12 months	OHI/mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + surface debridement using surgical gauzes soaked in saline + decontamination using 0.12% CHX + 0.05% cetylpyridinium chloride (CPC)	OHI/mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + surface debridement using surgical gauzes soaked in saline + decontamination using placebo solution	Implant level BOP (% of implants with BOP) Test baseline: 96.8 (30)%, 12 months: 96.8 (30)% Control baseline: 95.8 (46)%, 12 months: 94.7 (36)% No significant difference between groups (p = 0.965) PD Test baseline: 6.6 (1.6) mm, 12 months: 4.3 (2.1) mm Control baseline: 5.5 (1.4) mm, 12 months: 3.7 (0.8) mm. No significant difference between groups (p = 0.563) % of implants with SUPP Control baseline: 31.3 (15)%1; 12 months: 5.8 (6)% Test baseline: 64.5 (20)%; 12 months: 29.0 (9)% No significant difference between groups (p = 0.977) RBL Test baseline: 4.3 (2.1) mm, 12 months: 5.0 (2.5) Control baseline: 3.6 (1.9) mm, 12 months: 3.9 (2.0) No significant difference between groups (p = 0.949)	During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants and teeth were cleaned as necessary Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri-implantitis does not lead to superior clinical results
De Waal et al. (2015)	RCT, parallel	44 patients Test: 22; mean age: 58.6 (10.2) years; female: 17; current smokers: 7; former smokers: 1; history of periodontitis: 10 Control: 22; mean age: 60.5 (11.6) years; female: 14; current smokers: 6; former smokers: 5; history of periodontitis: 10 108 implants machined, rough- and medium-rough surfaces Test: 22 patients, 49 implants Control: 22 patients, 59 implants	BOP and/or SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2	12 months	OHI/mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + surface debridement using surgical gauzes soaked in saline + decontamination using 0.12% CHX + 0.05% cetylpyridinium chloride	OHI/mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + surface debridement using surgical gauzes soaked in saline + decontamination using 2.0% CHX	Implant level BOP (% of implants with BOP) Test baseline: 98.0 (47)%, 12 months: 77.1 (37)% Control baseline: 94.9 (56)%, 12 months: 68.5 (37)% No significant difference between groups (p = 0.583) PD Test baseline: 4.7 (1.0) mm, 12 months: 3.0 (0.7) mm Control baseline: 5.0 (1.2) mm, 12 months: 2.9 (0.7) mm. No significant difference between groups % of implants with SUPP Baseline test:: 57.1 (28)%; 12 months: 10.4 (5)% Control baseline: 49.2 (29)%; 12 months: 1.9 (1)% No significant difference between groups (p = 0.222) RBL Test baseline: 4.0 (1.5) mm, 12 months: 4.3 (1.7) mm Control baseline: 4.1 (1.6) mm, 12 months: 4.1 (1.7) mm No significant difference between groups (p = 0.950)	During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants, and teeth were cleaned as necessary The use of a 2% CHX solution for implant surface decontamination during resective peri-implantitis therapy does not lead to improved clinical and radiographic results compared with a 0.12% CHX + 0.05% CPC solution
Carcuac et al. (2016, 2017)	RCT, parallel	67 patients Group 1: systemic antibiotics/implant surface decontamination with CHX: 27; mean age: 65.7 (range: 23–90) years; female: 20; smokers: 33.3%; history of periodontitis: 77.8% Group 2: systemic antibiotics/implant surface decontamination with saline: 25; mean age: 67.9 (range: 21–88) years; female: 17; smokers: 36%; history of periodontitis: 84% Group 3: no systemic antibiotics/implant surface decontamination with an CHX: 24; mean age: 64.6 (range: 27–81) years; female: 14; smokers: 33.3%; history of periodontitis: 87.5% Group 4: no systemic antibiotics/implant surface decontamination with saline: 24; mean age: 66.9 (range: 30–88) years; female: 14; smokers: 29.2%; history of periodontitis: 87.5% 121 implants: 25.6% non-modified, 74.4% modified surface Group 1 + 2: 68 implants Group 4 + 3: 53 implants	PD ≥ 6 mm + BOP/SUPP + bone loss > 3 mm	3 years	Debridement with titanium-coated curettes + Group 1 and group 3 decontamination with 0.2% CHX + Group 1 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery	Debridement with titanium-coated curettes + Group 2 and 4 decontamination with saline for 2 min. + Group 2 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery	Implant level BOP reduction 1 year Group 1: 39.1% Group 2: 34.8% Group 3: 44.4% Group 4: 51.4% No significant difference among groups (p < 0.05) 3 years: Presence of BOP/SUPP (%) Group 1: 66.2% Group 2: 52.8% Group 3: 70% Group 4: 32.3% PD reduction 1 year Group 1: 2.80 (1.87) mm Group 2: 3.44 (1.66) mm Group 3: 2.16 (1.79) mm Group 4: 1.69 (2.22) mm Significantly greater in group 2 than in groups 3 and 4 (p < 0.05) PD reduction 3 years Overall PD reduction compared to baseline: reduction of 2.73 ± 2.39 mm Group 1: 3.00 (2.44) mm Group 2: 2.38 (2.55) mm Group 3: 2.67 (2.48) mm Group 4: 2.90 (2.12) mm PD reduction was more pronounced at non-modified surface implants SUPP Baseline: mean: 68.7% Group 1: 72.3% Group 2: 65.2% Group 3: 67.3% Group 4: 70.3% After 1 year: Mean 17.4% Group 1: 13% Group 2: 6.5% Group 3: 22.2% Group 4: 31.4% RBL 3 years Group1: gain 0.32 ± 1.64 mm Group 2: loss − 0.51 ± 1.87 mm Group 3: loss − 0.28 ± 1.78 mm Group 4: gain 0.65 ± 0.86 mm	During the 12-mo follow-up period, supragingival polishing was performed and oral hygiene reinforced in 3-mo intervals The local use of chlorhexidine had no overall effect on treatment outcomes Potential benefits of systemic antibiotics are not sustained over 3 years
Non-reconstructive therapy with implantoplasty
Romeo et al. (2005, 2007)	RCT, parallel	17 patients 22 implants rough surfaces Test: 10 patients, 19 implants Control: 7 patients, 16 implants	BOP/SUPP + PD > 4 mm horizontal peri-implant translucency	36 months	Full mouth disinfection/ mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + decontamination using metronida zole + tetracycline hydro chloride (3 min) + implantoplasty using diamond and Arkansas burs/silicone polishers + Amoxicillin 50 mg/kg/day for 8 days + CHX mouthrinse for 2 weeks	Full mouth disinfection/ mechanical debridement + resective therapy (apical re-positioned flap + bone re-contouring) + decontamination using metronidazole + tetracycline hydrochloride (3 min) + Amoxicillin 50 mg/kg/day for 8 days	Implant level mBI Test baseline: 2.83 (0.47), 3 years: 0.61 (0.67) Control baseline: 2.86 (0.35), 2 years: 2.33 (0.74) Between group comparison: Student’s t-value of + 9.61 PD Test baseline: 5.70 (1.69) mm, 2 years: 3.58 (1.06) mm, 3 years: 3.21 (0.56) mm Control baseline: 6.52 (1.62) mm, 2 years: 5.5 (1.47) mm. Significantly higher PD values in control group (Student’s t-value + 5.5) ML (recession) Test baseline: 0.5 (0.91) mm, 3 years: 1.96 (1.42) mm Control baseline: 0.23 (0.84) mm, 2 years: 1.64 (1.29) mm Between group comparison: Student’s t-value of + 9.61 Recession index in control group significantly lower (Student’s t-value of − 2.14) RBL mesial and distal Test baseline: 3.82 mm and 3.94 mm; 3 years: 3.81 mm and 3.94 mm Control baseline: 3.45 mm and 3.49 mm 3 years: 5.35 mm and 5.42 mm The mean variation of marginal bone level values mesial and distal Test: 0 and 0.001 mm (p > 0.05) Control: 1.44 and 1.54 mm (p < 0.05)	Implantoplasty was an effective treatment of peri-implant infection and peri-implantitis progression
Lasserre et al. (2020)	RCT, parallel	29 patients Smokers excluded 42 implants with modified surface Test: 15 patients; mean age: 62.3 (range: 42–74) years; female: 11; history of periodontitis: 13; 22 implants Control: 14 patients; mean age: 71 (range: 59–92) years; female: 11; history of periodontitis: 13; 20 implants	PD > 5 mm + bone loss ≥ 2 mm + BOP/SUPP	6 months	OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + implantoplasty + 0.1% CHX mouthrinse for 10 days	OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + air abrasive device with amino acid glycine powder + 0.1% CHX mouthrinse for 10 days p < 0.008	Implant level BOP Test baseline: 94.7 (10.7)%, 6 months: 33.3 (24.2)%, p < 0.008 Control baseline: 87.4 (22.3)%, 6 months: 26.3 (23.2)% PD Test baseline: 6.72 (1.78) mm, 6 months: 2.73 (1.59) Control baseline: 5.61 (1.56) mm, 6 months: 2.33 (1.49) mm ML (recession) Test baseline: 0.23 (0.48) mm, 6 months: 0.75 (0.71) mm, p < 0.008 Control baseline: 0.57 (0.85) mm, 6 months: 1.11 (0.89) mm RBL Test baseline: 4.73 (2.67) mm, 6 months: 4.47 (3.06), p < 0.008 Control baseline: 5.21 (2.06) mm, 6 months: 4.67 (2.05) mm, p < 0.008 No differences in any parameter between two groups (p > 0.008)	After 3 and 6 months careful professional supragingival cleansing was performed Implantoplasty is as effective as glycine air polishing
b) Studies comparing reconstructive therapy versus access flap surgery
Wohlfahrt et al. (2012)	RCT, parallel	32 patients (13 female; 19 male) Test: 16; mean age: 65.0 (10.0) years; smokers: 6 (37.5%) Control: 16; mean age: 57.2 (12.3) years; smokers 10 (58.8%) 32 implants medium rough surfaces	PD ≥ 5 mm, BOP + intrabony defects ≥ 4 mm	12 months submerged healing for 6 months	Access flap surgery + mechanical debridement (titanium curettes) + conditioning using 24% ethylenediaminetetraacetic acid gel (2 min) + augmentation of intrabony defect components using porous titanium granules	Open flap surgery + mechanical debridement (titanium currettes) + conditioning using 24% ethylenediaminetetraacetic acid gel (2 min)	Implant level BOP (bleeding sites pro implant) reduction Test: 0.38 (2.1) % Control: 0.56 (2.9) % Not significant improvement compared to baseline No significant difference between groups (p = 0.60) PD reduction Test: 1.7 (1.7) mm Control: 2.0 (2.3) mm Significant improvement compared to baseline (p < 0.001) No significant difference between groups (p = 0.66) RDF Test: 57.0 (45.1) mm Control: − 14.8 (83.4) mm Significantly higher in test group (p < 0.001) Radiographic defect height reduction: Test: 2.0 (1.7) mm Control: 0.1 (1.9) mm Significantly higher in test group (p < 0.001)	Test group showed significantly better radiographic peri-implant defect fill compared with controls. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated
Andersen et al. (2017) (Wolhlfahrt et al. continuum)		12 patients 12 implants Test: 6 patients, 6 implants Control: 6 patients, 6 implants		7 years			Implant level PD changes Test baseline: 6.5 (1.9) mm, 7-years: 4.3 (2.4) mm Control baseline: 6.5 (2.3) mm, 7 years: 3.5 (1.2) mm RDF Mean radiographic osseous defect fill: test: 1.9 (2) mm control: 1.3 (1.4) mm Comparative statistical analysis was not performed	Follow-ups were handled by the referring dentists Surgical treatment of peri-implant osseous defects showed unpredictable results
Hamzacebi et al. (2015)	RCT, split-mouth design	19 patients, 38 implants Test: 19 implants Control: 19 implants Mean age: 60.98 (11.90) years	BOP/ SUPP + PD ≥ 5 mm + radiographic bone loss ≥ 2 mm	6 months	Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days	Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + intrabony defect fill with platelet-ruch fibrine (PRF) plugs and membranes + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days	Implant level BOP Test baseline: 79.31 (31.7)%; 6 months: 25.29 (14.51)%; p < 0.001 Control baseline: 65.47 (36.08)%; 6 months: 21.43 (16.57)%; p > 0.001 Between group comparison not conducted PD Test baseline: 6.13 (1.05) mm; 6 months: 3.30 (0.49) mm Control baseline: 5.78 (0.71) mm; 6 months:3.71 (0.42) mm Between-group comparison: p < 0.001 (higher reduction in test group) ML Test baseline: 0.62 (0.49) mm; 6 months: 0.14 (0.28) mm Control baseline: 0.83 (0.65) mm; 6 months: 1.04 (0.62) mm Between-group comparison: p < 0.001 (higher reduction in test grouo)	Supportive therapy NR PRF application led to better clinical results
Jepsen et al. (2016)	Multicenter RCT, parallel	63 patients (27 female, 36 male) 63 implants Test: 33 patients; mean age: 57.5 (12.6) years; current smokers: 11 (33.3%); former smokers: 9 (27.3%); history of periodontal treatment: 17 (51.5%); 33 implants Control: 30 patients; mean age: 59.1 (12.2) years; current smokers: 7 (23.3%); former smokers: 11 (36.7%); history of periodontal treatment: 20 (66.7%); 30 implants	PD ≥ 5 mm + BOP/SUPP + intraosseous circumferential three-wall defects ≥ 3 mm	12 months	Access flap + mechanical debridement with rotary titanium brush and H₂O₂ 3% (1 min) followed by rinsing with saline (60 s) + Titanium granules + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery	Access flap + mechanical debridement with rotary titanium brush and H₂O₂ 3% (1 min) followed by rinsing with saline (60 s) + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery	Subject level BOP reduction Test: 56.1 (30.5)% Control: 44.9 (38.2)% Significant reduction compared to baseline (p < 0.001) No significant difference between groups (p > 0.05) PD reduction Test: 2.8 (1.3) mm Control: 2.6 (1.4) mm Significant reduction compared to baseline (p < 0.001) No significant difference between groups (p > 0.05) SUPP reduction Test: 23.2 (32.8) % Control: 25.6 (32.7) % Significant reduction compared to baseline (p < 0.001) No significant difference between groups (p > 0.05) Radiographic defect height reduction: mesial/distal: test: 3.61 (1.96)/3.56 (2.07) mm control: 1.05 (1.42)/1.04 (1.34) mm Significantly higher in test group (p < 0.0001) RDF mesial/distal: test: 79.00 (29.85)%/74.22 (36.33)% control: 23.11 (46.28)%/21.89 (30.16)% Significantly higher in test group (p < 0.0001)	Patients were recalled at 6 wk and 3, 6, 9, and 12 mo after surgery for professional oral hygiene procedures with supragingival debridement and hygiene instructions provided as needed Test group showed significantly enhanced radiographic defect fill compared with control group. Similar improvements according to clinical measures were obtained after both surgical treatment modalities
Renvert et al. (2018)	RCT, parallel	41 patients 41 implant Test: 21 patients; female: 13; 21 implants Control: 20 patients; female: 9; 20 implants	PD ≥ 5 mm + BOP/SUPP + marginal bone loss, defined as a crater like defect ≥ 3 mm	12 months	Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ + application of bovine-derived deproteinized bone particles + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4	Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4	Implant level BOP Test baseline: 100%, 12 months: 47.6% Control baseline: 100%, 12 months: 35% No difference between groups (p = 0.41) PD Test baseline: 6.5 (1.9) mm, 12 months: 2.9 (1.4) mm, p > 0.001 Control baseline: 6.7 (1.8) mm, 12 months: 4.2 (2.8) mm, p > 0.001 Significantly greater reduction in the test group (p < 0.01) ML (mid-buccal recession) Test: 1.2 m Control: 1.9 mm No difference between groups (p = 0.76) RDF Test: 0.7 (0.9) mm Significant compared to the baseline ( p = 0.004) Control: 0.2 (0.2) mm Not significant compared to baseline (p = 0.10) Successful treatment outcome (defect fill ≥ 1.0 mm, PPD values at implant ≤ 5 mm, no BOP, and no SUPP): Test: 9/21 (42.9%) patients Control: 1/20 (5.0%) patients; Between-group comparison: p < 0.01	Based on individual needs, professional prophylaxis was performed every 3rd month Successful treatment outcome using a bone substitute was more predictable when a composite therapeutic endpoint was considered
Isehed et al. (2016, 2018)	RCT, parallel	23 patients 23 implants Smokers inlcuded Test: 10 patients, 10 implants Control: 13 patients, 13 implants	PD ≥ 5 mm + BOP/ SUPP + angular bone loss ≥ 3 mm	5 years	Access flap + mechanical debridement with ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + application of Emdogain (EMD) (0.3 ml) + non-submerged healing	Access flap + mechanical debridement with ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + non-submerged healing	Implant level BOP-positive sites 5 years Test: 5/11 (55.6%) implants Control: 2/9 (40%) implants Presence of SUPP: Test baseline: 9/15 (60%); 1 year: 1/15 (7%) Control baseline: 6/14 (43%); 1 year: 1/14 (7%) SUPP at 3 years Test: 2/13 (20%) implants Control: 3/12 (33%) implants MBL changes 5 years Test: 4.1 mm Control: 3.3 mm Change: test: + 1.4 mm Control: + 1.3 mm p = 0.90	Between 1 and 5 years after the peri‐implant surgical treatment, supportive therapy was performed based on individual needs at the specialist clinic or by the patient's general dental clinic, usually with 3‐ or 6‐month intervals Test group showed increased bone levels 12 months after treatment
Renvert et al. (2021)	RCT	66 patients 66 implants Test: 34; female 54%; age: 62.2 (10.2) years Smokers 8 (22%) Control: 32; female 50%; age: 62.9 (10) years; smokers: 9 (26%) Heavy smokers (> 10 cig./day) excluded	PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 3 mm + intraosseous defect component of at least 3 mm depth and a circumference at least 270 ◦ detected intraoperatively	1 year	Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H₂O₂ 1 min + saline rinsing + defect fill with bovine bone mixed with bloos + bilaminar collagen membrane + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks	Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H₂O₂ 1 min + saline rinsing + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks	Subject level BOP (severity of blleding pro implant) Test baseline: 1.3 (0.9), 12 months: 0.4 (0.6) Control baseline: 1.4 (1.0); 12 months: 0.5 (0.6); Between-group comparison: p = 0.992 PD Test baseline: 6.7 (1.5) mm, 12 months: 4.8 (1.5); Control baseline: 6.8 (1.3); 12 months: 4.5 (1.5) mm Between-group comparison: p = 0.578 SUPP (sites per implant) Test baseline: 1.8 (1.4); 12 months: 0.3 (0.9); Control baseline: 1.6 (1.5), 12 months: 0.3 (0.9) Between-group comparison: p = 0.879 ML (recession) Test baseline: 0.4 (1.8) mm, 12 months: 0.8 (1.2) mm Control basleine: 0.6 (0.9); 12 months: 1.4 (1.5) mm Between-group comparison: p = 0.136 RDF at the deepest site Test: 2.7 (1.3) mm Control: 1.4 (1.2) mm; Between-group comparison: p < 0.001 Mean RDF Test: 2.3 (1.2)mm Control: 1.1 (1.1) Between-group comparison: p = 0.001	Oral hygiene insructions were provided after 3, 6, 9 and 12 months following the surgery Reconstructive therapy resulted in significantly more RDF. No difference in clinical paramenetrs was noted
c) Reconstructive therapy
Adjunctive and alternative measures for implant surface decontamination following reconstructive therapy
Deppe et al. (2007)	CCT, parallel	16 patients 32 implants machined, rough- and medium-rough surfaces Test: 9 patients, 17 implants Control: 7 patients, 15 implants	PD ≥ 5 mm, BOP + progressive vertical bone loss	5 years	3 weeks prior to surgery: CHX gel applications (0.3%) Group 2 OHI + access flap surgery + air abrasive device + carbon dioxide laser (cw mode, 2.5 W, 12 × 5 s) decontamination + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane	3 weeks prior to surgery: CHX gel applications (0.3%) Group 4 OHI + access flapb surgery + air abrasive device + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane	Implant level SBI Test baseline: 0.5 (0.8), 5 years: 2.1 (1.4) Control baseline: 1.2 (0.6), 5 years: 1.9 (1.0) PD Test baseline: 5.0 (1.3) mm, 5 years: 2.5 (1.4) mm Control baseline: 4.8 (1.4) mm, 5 years: control: 2.5 (1.1). No significant difference between the groups (p > 0.05) Radiographic DIB (distance from the implant shoulder to the first bone contact) Test baseline: 2.3 (0.9) mm 5 years: 4.5 (1.2) mm Control baseline: 4.1 (0.9) mm, 5 years: 4.7 (1.1) mm No significant difference between the groups (p > 0.05)	Over the 5-year period, if plaque and bleeding scores indicated poor oral hygiene, remotivatino and reinstruction of OHI were performed There seems to be no difference between laser and conventional decontamination
Isler et al. (2018a)	RCT, parallel	41 patients 60 implants Test: 20 patients; mean age: 54.4 (8.08) years; female: 9; current smokers: 5 (25%); history of periodontitis: 9 (45%); 30 implants Control: 21 patients; mean age: 54.18 (10.36) years; female: 10; current smokers: 6 (28.5%); history of periodontitis: 8 (38%); 30 implants	≥ 2 mm marginal bone loss + BOP/SUP with or without deepening of PDs	12 months	Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + ozone application + bovine bone mineral mixed with pieces of concentrated growth factors (CGF) + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week	Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + bovine bone mineral mixed with CGF + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week	Implant level BOP Test baseline: 96.6 (10.5), 12 months: 15.8 (19.1), p < 0.001 Control baseline: 97.5 (10.06), 12 months: 25 (21.7), p < 0.001 No difference between groups (p = 0.575) PD Test baseline: 6.27 (1.42) mm, 12 months: 2.75 (0.7) mm, p < 0.001 Control baseline: 5.73 (1.11) mm, 12 months: 3.34 (0.85) mm, p < 0.001 No difference between the groups (p = 0.158) ML (recession): Tests baseline: 0.12 (0.14) mm, 12 months: 0.48 (0.75) mm, p < 0.01 Control baseline: 0.25 (0.42) mm, 12 months: 0.55 (0.64) mm, p < 0.01 No difference between groups (p = 0.753) RDF Test: 2.32 (1.28) mm Control: 1.17 m (0.77) mm Significantly higher fill in test group (p = 0.02)	The patients were re-evaluated at 1, 3, 6, 9, and 12 months postoperatively and supportive care was given at the same time points Higher radiographic defect fill in the test group
Reconstruction of the defect with different bone fillers, with and without a membrane
Khoury et al. (2001)	CCT, parallel	25 patients; mean age: 48.2 (6.3) years; 22 female 41 implants Test 1: 20 implants Test 2: 9 implants Control: 12 implants	Bone loss > 50% of implant length + intrabony crater-form defect	3 years	Test 1 Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H₂O₂ + Test 1 autogenous bone + non-resorbable membrane Test 2 autogenous bone + resorbable membrane + submerged healing + Antibiotics administered 4 weeks prior to surgery (for 1 week), and later starting 1 day and finishing 7 days after surgery according to the individual susceptibility test results	Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H₂O₂ + autogenous bone + submerged healing + Antibiotics administered 4 weeks prior to surgery (for 1 week), and later starting 1 day and finishing 7 days after surgery according to the individual susceptibility test results	Implant level PD changes Test 1: 5.4 (3.0) mm Test 2: 2.6 (1.6) mm Control: 5.1 (2.7) mm Significant improvement compared to baseline in all groups (p > 0.001) Significantly less improvement in test 2 group compared to test 1 and the control (p ≤ 0.05) Radiographic vertical intrabony defect height reduction: Test 1: 2.8 (3.1) mm Test 2: 1.9 (3.2) mm Control: 2.4 (2.7) mm Significantly less improvement in test 2 group compared to baseline (p = 0.102) No difference among the groups (p ≤ 0.05)	The patients wereenrolled in a supportive maintenance program and monitored on a 3- to 6-month recall schedule including repeated oral hygiene instructions and a full-mouthtooth cleaning according to their individual needs 17 out of 29 barrier-treated implants (58.6%) were compromised by early post-therapy complication (e.g., dehiscence, exposure, fistula, or sequester formation)
Schwarz et al. (2006, 2008, 2009)	RCT, parallel	20 patients; 14 female; mean age: 54.4 (12.5) years; 1 patient light smoker (< 10 cig./day) 21 implants Test: 9 patients, 9 implants Control: 10 patients, 11 implants	PD > 6 mm + BOP/SUPP + intrabony component > 3 mm	4 years	OHI + initial non-surgical therapy Access flap surgery + mechanical debridement (plastic curettes) + nanocrystalline hydroxyapatite paste + non-submerged healing	OHI + initial non-surgical therapy Access flap surgery + mechanical debridement (plastic curettes) + bovine-derived xenograft + native collagen barrier membrane + non-submerged healing	Subject level BOP reduction Test: 32% Control: 51% PD reduction Test: 1.1 (0.3) mm Control: 2.5 (0.9) mm BOP and PD reductions significantly higher at control sites	A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene were performed at 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48 months after treatment Long-term outcome obtained in test group without barrier membrane must be considered as poor
Aghazadeh et al. (2012)	RCT, parallel	45 patients 71 implants medium-rough surfaces Test: 23 patients; mean age: 67.0 (7.5) years; smokers: 69.6%; 37 implants Control: 22 patients; mean age: 70.1 (6.2) years; smokers: 40.9%; 34 implants	PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm + angular peri-implant bone defect ≥ 3 mm	12 months	Access flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3% cortical bone chips harvested from the mandibular ramus + resorbable synthetic barrier Membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days	Access flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3% bovine-derived xenograft + resorbable synthetic barrier membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days	Implant level BOP reduction Test: 50.4 (5.3)% Control: 44.8 (6.3)% No significant difference between the groups (p > 0.05) PD reduction Test: 3.1 (0.2) mm Control: 2.0 (0.2) mm Significantly higher in the test group (p < 0.01) SUPP reduction Test: 25.2 (4.3)% Control: 11.5 (5.2)% Significantly higher in the test group (p < 0.01) RDF Test: 1.1 (0.3) mm Control: 0.2 (0.3) mm Significantly higher in test group (p < 0.05)	Six weeks after surgery the first supportive therapy was given, and the subjects were enrolled in a maintenance program with visits everythird month. Allexisting teeth and implants werecleaned using a rubber cup and alow-abrasive paste Bovine xenograft provided more radiographic bone fill than authogenous bone
Roos-Jansaker et al. (2007, 2011, 2014)	CCT, parallel	25 patients 45 implants Test: 13 patients; mean age: 64.9 (7.5) years; current smokers: 10 (76.9%); former smokers: 2 (15.4%); 23 implants Control: 12 patients; mean age: 65.7 (7.4) years; current smokers: 8 (66.7%); former smokers: 3 (25%); 22 implants	Bone loss > 3 threads (≥ 1.8 mm) one-to-four intrabony defect + BOP and/or SUPP	5 years	Removal of the suprastructure Access flap surgery + debridement + decontamination using 3% H₂O₂ + algae-derived xenograft + resorbable synthetic barrier membrane + non-submerged healing + systemic antibiotic medication (Amoxicillin + Metronidazole for 10 days)	Removal of the suprastructure Access flap surgery + debridement + decontamination using 3% H₂O₂ + algae-derived xenograft + non-submerged healing + systemic antibiotic medication (Amoxicillin + Metronidazole for 10 days)	Implant level PD reduction at the deepest site Test: 3.0 (2.4) mm Control: 3.3 (2.0) mm No significant difference between the groups (p = 0.60) ML(recession changes at the deepest site) Test: − 1.6 (1.5) mm Control: − 1.7 (2.1) mm No significant difference between the groups (p = 0.89) RDF Test: 1.5 (1.2) mm Control: 1.1 (1.2) mm No significant difference between the groups (p = 0.24)	The participants were then enrolled in a maintenance program with visits every third month. At these visits, full‐mouth plaque scores were obtained. Re‐instruction in oral hygiene procedures was performed as necessary. Teeth and implants were cleaned using a rubber cup and a low‐abrasive paste Additional use of a membrane did not improve the outcome
Güler et al. (2017)	CCT, parallel	24 patients (9 female, 15 male). mean age: 45.36 (14.1) years 35 implants Test: 18 patients; 19 implants Control: 6 patients, 16 implants Light smokers included (< 10 cig.7 day): Test: 3 (18.75%) Control: 3 (50%)	PD > 5 mm + BOP/SUPP Class Ib° defects (vestibular dehiscence + circumferential bone resorption) Class Ic°° defects (vestibular dehiscence + circumferential bone resorption) Class Id defects (circumferential bone resorption)	6 months	OHI + access flap + mechanical cleaning with rotating titanium brush + titanium granules + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days	OHI + access flap + mechanical cleaning with rotating titanium brush + xenograft + resorbable collagen membrane + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days	Implant level BOP Test baseline: 50.17 (25.19)%, 6 months: 24.32 (11.22)% Control baseline: 63.51 (24.38)%, 6 months: 33.00 (15.51)% Significantly higher reduction in test group (p = 0.02) PD Test baseline: 5.28 (1.06) mm, 6 months: 3.34 (0.82) mm Control baseline: 4.72 (1.02) mm, 6 months: 3.34 (0.82) mm No significant difference between groups (p = 0.698) ML (recession) Test baseline: 0.01 (0.003) mm, 6 months: 0.42 (0.58) mm Control baseline: 0.208 (0.452) mm, 6 months: 0.51 (0.48) mm No significant difference between groups (p = 0.476) RDF Test: 1.74 (0.65) mm Control: 1.05 (0.54) mm Significantly higher reduction in test group (p = 0.006)	Radiographic bone filling was significantly higher in the test group
Isler et al. (2018b)	RCT, parallel	52 patients 105 implants Test: 26 patients; female: 10; current smokers: 6; history of periodontitis: 11; 52 implants (23% on-modified, 77% modified) Control: 26 patients; female: 15; current smokers: 9; history of periodontitis: 13; 52 implants (19.2% non-modified, 80.8% modified)	Bone loss ≥ 2 mmbased on baseline radiograph + BOP /SUPP	12 months	OHI + supra/subgingival mechanical debridement 4–6 weeks prior to surgery Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + concentrated growth factor (CGF) membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks	OHI + supra/subgingival mechanical debridement 4–6 weeks priot to surgery Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + collagen membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks	Implant level BOP Test baseline: 97.12 (10.79)%, 12 months: 35.58 (30,.14)%, p < 0.001 Control baseline: 97.12 (8.15)%, 12 months: 29.81 (30.02), p < 0.001 Between-group comparison: p = 0.503 PD Test baseline: 5.92 (1.26) mm, 12 months: 3.71 (1.09) mm, p < 0.001 Control baseline: 5.41 (1.16) mm, 12 months: 2.70 (0.80) mm, p < 0.001 Between-group comparison: p = 0.001 ML (recession) Test baseline: 0.04 (0.20) mm, 12 months: 0.25 (0.39) mm, p = 0.007 Control baseline: 0.06 (0.20) mm, 12 months: 0.27 (0.44) mm, p = 0.026 Between-group comparison: p = 0.925 RDF Test: 1.63 (1.0) mm Control: 1.98 (0.75) mm, p = 0.154 Treatment success (PD < 5 mm + no BOP/SUPP, no further bone loss): Test: 26.9% implants Control: 42.3% implants	All patients were enrolled in postoperative maintenance care programs at three different time points during the study periods (3, 6, and 9 months). Supragingival/mucosal mechanical debridement and reinforcement of oral hygiene were performed during postoperative period. When necessary localized subgingival/mucosal instrumentation was done except for the area of surgery Control group showed better results
Polymeri et al. (2020)	RCT, parallel	24 patients, 24 implants Test: 13; mean age: 57.3 (15.1) years; female: 5 (38%); smokers: 2 (15%); history of periodontal treatment: 6 (46%) Control: 11; mean age: 65.5 (11.2) years; female: 6 (55%); smokers: 3 (27%); history of periodontal treatment: 4 (36%)	Bone loss ≥ 3 mm + PD ≥ 5 mm + BOP/SUPP + intra-osseous defect component ≥ 3 mm at the deepest part and presence of at least three walls	12 months	Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ 1 min + xenogrfat (EndoBone) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX	Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ 1 min + xenogrfat (BioOss) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX	Subjest level BOP Test basleine: 100 (0.0)%, 12 months: 50 (10.2)%, p < 0.001 Control baseloine: 100 (0.0)%, 12 months: 45.5 (33.2)%, p < 0.001 Between-group comparison: p = 0.670 PD Test basleine: 7.1 (1.2)%, 12 months: 3.4 (0.5)%, p < 0.001 Control baseloine: 7.0 (1.8)%, 12 months: 3.4 (0.6)%, p < 0.001 Between-group comparison: p = 0.910 Radiographic defect depth Test baseline:; 5.9 (1.8) mm, 12 months: 2.9 (1.3), p < 0.001 Control baseline: 4.9 (0.9) mm, 12 months: 2.4 (0.6) mm, p < 0.001 Bestween-group comparison: p = 0.183 RBL Test baseline: 4.9 (1.1) mm, 12 months: 2.1 (1.3)mm, p < 0.001 Control baseline: 5.3 (1.2) mm, 12 months: 3.1 (1.3) mm, p < 0.001 Between-group comparison: p = 0.073 Treatment success (PD ≤ 5 mm + no BOP/SUP + no further bone loss): test: 13%, control: 18% of patients	Patients were recalled at 6 weeks and 3, 6, 9, and 12 months after the surgery for professional oral hygiene procedures that included supragingival debridement and polishing with a rubber cup and a low-abrasive paste Test and control groups showed comparable outcomes
d) Combined therapy
Schwarz et al. (2011, 2012, 2013, 2017)	RCT, parallel	15 patients 11 females, 4 males; median age: 63 years Heavy smokers (≥ 10 cigarettes/day) excluded 15 patients Test: 6 patients, 6 implants Control: 9 patients, 9 implants	PD ≥ 6 + BOP/SUPP + intrabony component > 3 mm + supracrestal component > 1 mm	7 years	Initial non-surgical therapy + OHI Access flap + Er:YAG laser device (cone-shape glass fiber tip) at 11.4 J/cm2 + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft + native collagen membrane + non-submerged healing	Initial non-surgical therapy + OHI Access flap mechanical debridement with plastic curettes and saline-soaked cotton gauses + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft + native collagen membrane + non-submerged healing	Subjest level BOP reduction Test: 86.66 (18.26)% Control: 89.99 (11.65)% Significant improvement compared to baseline (p < 0.001) PD reduction Test: 0.74 (1.89) mm Control: 2.55 (1.67) mm Significant improvement compared to the baseline (p < 0.001) ML (reduction of recession) Test: 1.36 (1.04) mm Control: 0.49 (0.92) mm	A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene wereperformed at 1, 3, and 6 months after therapy. Afterwards, recall appointments to provide a professionally administered plaque removal and reinforcement of oral hygiene were scheduled on an annual basis Combined surgical therapy of advanced peri-implantitis was not influenced by the initial method of surface decontamination
De Tapia et al. (2019)	RCT, parallel	30 patients Heavy smokers (≥ 10 cigarettes/day) excluded 30 patients Test: 15 patients; mean age: 65.53 (10.29) years; female: 11 (73.3%); light smokers: 6 (40%); 15 implants Control: 15 patients; mean age: 55.47 (11.75) years; female: 9 (60%); light smokers: 4 (26.7%); 15 implants	PD ≥ 6 mm + BOP/SUPP + bone loss > 30% of the implant surface + intrasurgically osseous defect with at least two bone walls and depth of 3 mm of intrabony component	12 months	Initial non-surgical therapy: OHI Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H₂O₂ 3% + titanium brush with an oscillating low speed + non-submerged healing + combination of 500 mg Amoxicillin and 500 mg Metronidazole 3 times a day, for 7 days	Initial non-surgical therapy: OHI Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H₂O₂ 3% + non-submerged healing + combination of 500 mg Amoxicillin and500 mg Metronidazole 3 times a day, for 7 days	Subject level BOP Test baseline: 100%, 12 months: 79% Control baseline: 100%, 12 months: 55%, between-group comparison: p = 0.147 PD Test baseline: 6.16 (1.27) mm; 12 months: 3.31 (0.72) Control: 6.17 (0.98) mm; 12 months: 3.87 (0.81) mm Between-group comparison: p = 0.04 SUPP Test baseline: 43%; 12 months: 0% Control baseline: 47%; 12 months: 23%; p = 0.053 ML (recession) Test: 0.4 (0.45) mm Control: 0.6 (0.62) mm; Between-group comparison: p = 0.374 RBL Test: 2.51 (1.21) mm, Control: 0.73 (1.26) mm; Between-group comparison: p = 0.003 RDF: Test: 81 (22)% Control: 52 (55)%; Between-group comparison: p = 0.111	Patients were seen at weekly intervals for the first 4 weeks to monitor healing and, then, at 3‐month intervals during the first year The additional use of a titanium brush during combined treatment of peri-implantitis resulted in statistically significant benefits in terms of PD reduction

Publication

Design

Population

Case definition

Period

Test

Control

Mean (SD) outcome

Supportive therapy/comments

a) Non-reconstructive surgery

Adjunctive and alternative measures for implant surface decontamination/systemic antibiotics

Papadopoulos et al. (2015)

RCT,

parallel

16 patients

12 females and 7

males. Mean age: 55 (8.7; range: 40–73) years

16 implants

BOP/ SUPP on probing + PD ≥ 6 mm and bone loss ≥ 2 mm

6 months

Mechanical debridement with plastic curettes + use of cotton swabs soaked in saline solution + use of a diode laser (low-power 980 nm)

Control

Mechanical debridement with plastic curettes + use of cotton pellets soaked in saline solution

Subject level

Test baseline: 81.2%; 6 months: 23.8%

Control baseline: 93.8%; 6 months: 31.3%

Significant reduction compared to the baseline (p < 0.05)

No significant difference between groups (p > 0.05)

Test baseline: 5.92 mm, 6 months: 4.44 mm

Control baseline: 5.52 mm, 6 months: 4.31

Significant reduction compared to the baseline (p < 0.05)

No significant difference between groups (p > 0.05)

Additional use of diode laser does not seem to have an extra beneficiary effect

Hallström et al. (2017)

RCT,

parallel

31 patients

Test: 15; mean age: 68.8 (25.0) years; female 75%; current smokers: 40%; tooth loss due to periodontitis: 47%

Control: 16; mean age: 71 (7.7) years; female 63%; current smokers: 21%; tooth loss due to periodontitis: 53%

31 implants

Test: 15

Control: 16

BOP/ SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2 mm

12 months

OHI + mechanical debridement with curettes and cotton pellets soaked in saline + post-operative systemic antibiotics – Zithromax (Sandoz AS, Copenhagen, Denmark) 250 mg × 2 at the day of surgery, and 250 mg × 1 per day for 4 days

OHI + mechanical debridement with curettes and cotton pellets soaked in saline

Subject level

BOP

Test baseline: 100%; 12 months: 12.4 (9.2) %

Control baseline: 100%; 12 months: 13.3 (11.1)%

No significant difference between groups (p = 0.1)

PD reduction

Test: 1.7 (1.1) mm, p < 0.001

Control: 1.6 (1.5) mm, p < 0.001)

No significant difference between groups (p = 0.5)

RBL

Test baseline: 4.6 (1.6) mm; 12 months: 4.0 (1.6) mm

Control baseline: 4.9

(1.7), mm; 12 months: 4.5 (1.5) mm

No significant difference between groups (p = 0.4)

During the study, participating individuals received professional prophylaxis every third month

Adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with access flap surgery alone

Albaker et al. (2018)

RCT, parallel

24 patients

Tests: 11; mean age: 58.4 (8.0) years; 82% male; current smokers: 45%

Control: 13; mean age: 61.5 (9.9) years; 69% male; current smokers: 54%

Bone loss ≥ 2 mm compared with previous examination or ≥ 3 mm (in the absence of previous radiograph) + PD ≥ 5 mm + BOP/SUPP

12 months

Access flap + implant cleaning with curettes and irrigation with sterile saline + aPDT (0.005% methylene blue photosensitizer, diode laser 670 nm 1 min + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks

Access flap + implant cleaning with curettes and irrigation with sterile saline + Augmentin 625 mg three times daily, 7 days + 0.2% CHX mouthrinse for 2 weeks

Subject level

BOP

Test baseline: 35.9 (10.6)%, 12 months: 17.4 (5.5)%

Control baseline: 26.5 (8.4)%, 12 months: 14.8 (3.1)%

Between-group comparison: p = 0.22

Test baseline: 5.0 (1.2) mm, 12 months: 3.7 (1.1) mm,

Control baseline: 5.4 (1.0) mm, 12 months: 3.9 (1.1) mm. Between group comparison: p = 0.51

Radiographic bone level

Test baseline: 4.1 (1.4) mm, 12 months: 43.4 (1.4) mm;

Control baseline: 4.5 (1.5) mm, 12 moths: 3.8 (1.4) mm

Between-group comparison: p = 0.19

During the study, all patients received professional prophylaxis every third month

Single application of aPDT does not provide additional benefit in improving clinical and radiographic parameters

Toma et al. (2019)

RCT, parallel

47 patients, 70 implants

Test 1: 16 patients, 23 implants, mean age: 67.5 (12.9) years; 95% female; history of periodontitis: 73% patients

Test 2: 16 patients, 23 implants; mean age: 61.7 (13.4) years; 81% female; history of periodontitis: 82%

Control: 15 patients, 25 implants; mean age: 68.9 (15.8) years; 77% female; history of periodontitis: 84%

PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm

6 months

Test 1:

Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + air abrasive device with glycine powder + CHX mouthrinse 0.2% for 10 days

Test 2:

Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + titanium brush for 30 s with oscillating handpiece + CHX mouthrinse 0.2% for 10 days

Access flap + mechanical debridement with plastic curettes + irrigation with sterile saline + CHX mouthrinse 0.2% for 10 days

Implant level

BOP

Test 1 baseline: 59 (5.2)%; 6 months: 23 (2.3)%; p < 0.001

Test 2 baseline: 62 (4.7)%; 6 months: 16 (3.7)%; p < 0.001

Control: 54 (4.4)%; 6 months: 29 (3.4)%; p < 0.001

Significantly higher reduction in test 2 groups (p < 0.001)

Test 1 baseline: 6.94 (1.29) mm; 6 months: 4.71 (1.24) mm; p < 0.001

Test 2 baseline: 6.45 (1.87) mm; 6 months: 3.98 (1.43) mm; p < 0.001

Control: 7.11 (1.15) mm; 6 months: 5.44 (0.69) mm; p > 0.001

Significantly great reduction in test 1 and test 2 groups (p < 0.001)

RBL

Test 1 baseline: 7.34 (1.29) mm; 6 months: 6.44 (1.46) mm;

Test 2: 7.09 (1.23) mm, 6 months: 5.88 (1.3) mm

Significantly less bone loss in test 2 group

3- and 6-months after surgery patients received professional supragingival cleaning

Test treatments were more effective, but treatment success remained low

Cha et al. (2019)

RCT, parallel

46 patients

Test: 24 patients/24 implants; mean age: 63 (range: 46–84) years; female 60%

Control: 22 patients/ 22 implants; mean age: 60.2 (range: 40–83) years; female: 40%

Peri-implant bone loss > 2 mm + PD > 5 mm + BOP

6 months

OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive minocycline ointment

Repeated applications after 1, 3 and 6 months

OHI + mechanical debridement with titanium-coated curettes, metallic copper-alloy scaler tip, titanium brush and air abrasive device + adjunctive placebo ointment

Repeated applications after 1, 3 and 6 months

Subject level

BOP/SUPP (%) change

At the deepest site

Test: 0.58 (0.50)

Control: 0.32 (0.57); Intergroup comparison p = 0.102

Mean change: test: 0.49 (0.35), control: 0.31 (0.46); Between-group comparison: p = 0.141

PD changes

At the deepest site

Test: 3.58 (2.32) mm

Control: 2.45 (2.13) mm; Between-group comparison: p = 0.094

Mean change

Test: 2.68 (1.73) mm, control: 1.55 (1.86) mm, Between-group comparison: p = 0.039

RBL

Test baseline: 6.33 (1.91) mm, 6 months: 7.05 (1.85) mm

Control baseline: 5.16 (1.74) mm, 6 months: 5.47 (1.51) mm; p = 0.014

2.3-fold higher increase in test group (9.7 (0.56) mm vs control 0.31 (0.49) mm)

Treatment success (PD < 5 mm + no BOP/SUPP + no further bone loss):

Test: 55.7%,

Control: 36.3%

All participants were recalled at 1, 3, and 6 mo to receive professional supragingival debridement and oral hygiene reinforcement

Repeated local application of minocycline combined with access flap surgery provides significant benefits in terms of clinical parameters and radiographic bone fill, with a higher treatment success

De Waal et al. (2013)

RCT,

parallel

30 patients

Test: 15; mean age: 59.4 (14.0) years; female: 10; current smokers: 4; former smokers: 3; history of periodontitis: 6

Control: 15; mean age: 61.5 (10.0) years; female: 10; current smokers: 7; former smokers: 1; history of periodontitis: 5

79 implants machined,

rough- and medium-rough

surfaces

Test: 15 patients, 31 implants

Control: 15 patients, 48 implants

BOP/SUPP + PD ≥ 5 mm and bone loss ≥ 2 mm

12 months

OHI/mechanical debridement +

resective therapy (apical re-positioned flap + bone

re-contouring) + surface

debridement using surgical

gauzes soaked in saline +

decontamination using 0.12%

CHX + 0.05% cetylpyridinium

chloride (CPC)

OHI/mechanical debridement +

resective therapy (apical

re-positioned flap + bone

re-contouring) + surface

debridement using surgical gauzes

soaked in saline + decontamination

using placebo solution

Implant level

BOP (% of implants with BOP)

Test baseline: 96.8 (30)%, 12 months: 96.8 (30)%

Control baseline: 95.8 (46)%, 12 months: 94.7 (36)%

No significant difference between groups (p = 0.965)

Test baseline: 6.6 (1.6) mm, 12 months: 4.3 (2.1) mm

Control baseline: 5.5 (1.4) mm, 12 months: 3.7 (0.8) mm. No significant difference between groups (p = 0.563)

% of implants with SUPP

Control baseline: 31.3 (15)%1; 12 months: 5.8 (6)%

Test baseline: 64.5 (20)%; 12 months: 29.0 (9)%

No significant difference between groups

(p = 0.977)

RBL

Test baseline: 4.3 (2.1) mm, 12 months: 5.0 (2.5)

Control baseline: 3.6 (1.9) mm, 12 months: 3.9 (2.0)

No significant difference between groups

(p = 0.949)

During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants and teeth were cleaned as necessary

Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri-implantitis does not lead to superior clinical results

De Waal et al. (2015)

RCT, parallel

44 patients

Test: 22; mean age: 58.6 (10.2) years; female: 17; current smokers: 7; former smokers: 1; history of periodontitis: 10

Control: 22; mean age: 60.5 (11.6) years; female: 14; current smokers: 6; former smokers: 5; history of periodontitis: 10

108 implants machined,

rough- and medium-rough

surfaces

Test: 22 patients, 49 implants

Control: 22 patients, 59 implants

BOP and/or SUPP on probing + PD ≥ 5 mm and bone loss ≥ 2

12 months

OHI/mechanical debridement +

resective therapy (apical

re-positioned flap + bone

re-contouring) + surface

debridement using surgical

gauzes soaked in saline +

decontamination using 0.12%

CHX + 0.05% cetylpyridinium chloride

OHI/mechanical debridement +

resective therapy (apical

re-positioned flap + bone

re-contouring) + surface

debridement using surgical

gauzes soaked in saline +

decontamination using 2.0% CHX

Implant level

BOP (% of implants with BOP)

Test baseline: 98.0 (47)%, 12 months: 77.1 (37)%

Control baseline: 94.9 (56)%, 12 months: 68.5 (37)%

No significant difference between groups (p = 0.583)

Test baseline: 4.7 (1.0) mm, 12 months: 3.0 (0.7) mm

Control baseline: 5.0 (1.2) mm, 12 months: 2.9 (0.7) mm. No significant difference between groups

% of implants with SUPP

Baseline test:: 57.1 (28)%; 12 months: 10.4 (5)%

Control baseline: 49.2 (29)%; 12 months: 1.9 (1)%

No significant difference between groups

(p = 0.222)

RBL

Test baseline: 4.0 (1.5) mm, 12 months: 4.3 (1.7) mm

Control baseline: 4.1 (1.6) mm, 12 months: 4.1 (1.7) mm

No significant difference between groups

(p = 0.950)

During follow‐up examinations, patients were re‐instructed in oral hygiene measures and implants, and teeth were cleaned as necessary

The use of a 2% CHX solution for implant surface decontamination during resective peri-implantitis therapy does not lead to improved clinical and radiographic results compared with a 0.12% CHX + 0.05% CPC solution

Carcuac et al. (2016, 2017)

RCT,

parallel

67 patients

Group 1: systemic antibiotics/implant surface decontamination with CHX: 27; mean age: 65.7 (range: 23–90) years; female: 20; smokers: 33.3%; history of periodontitis: 77.8%

Group 2: systemic antibiotics/implant surface decontamination with saline: 25; mean age: 67.9 (range: 21–88) years; female: 17; smokers: 36%; history of periodontitis: 84%

Group 3: no systemic antibiotics/implant surface decontamination with an CHX: 24; mean age: 64.6 (range: 27–81) years; female: 14; smokers: 33.3%; history of periodontitis: 87.5%

Group 4: no systemic antibiotics/implant surface decontamination with saline: 24; mean age: 66.9 (range: 30–88) years; female: 14; smokers: 29.2%; history of periodontitis: 87.5%

121 implants: 25.6% non-modified, 74.4% modified surface

Group 1 + 2: 68 implants

Group 4 + 3: 53 implants

PD ≥ 6 mm + BOP/SUPP + bone loss > 3 mm

3 years

Debridement with titanium-coated curettes +

Group 1 and group 3 decontamination with 0.2% CHX

+ Group 1 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery

Debridement with titanium-coated curettes + Group 2 and 4

decontamination with saline for 2 min. + Group 2 Amoxicillin 2*750 mg, 10 days, 3 days prior surgery

Implant level

BOP reduction

1 year

Group 1: 39.1%

Group 2: 34.8%

Group 3: 44.4%

Group 4: 51.4%

No significant difference among groups (p < 0.05)

3 years:

Presence of BOP/SUPP (%)

Group 1: 66.2%

Group 2: 52.8%

Group 3: 70%

Group 4: 32.3%

PD reduction 1 year

Group 1: 2.80 (1.87) mm

Group 2: 3.44 (1.66) mm

Group 3: 2.16 (1.79) mm

Group 4: 1.69 (2.22) mm

Significantly greater in group 2 than in groups

3 and 4 (p < 0.05)

PD reduction 3 years

Overall PD reduction compared to baseline: reduction of 2.73 ± 2.39 mm

Group 1: 3.00 (2.44) mm

Group 2: 2.38 (2.55) mm

Group 3: 2.67 (2.48) mm

Group 4: 2.90 (2.12) mm

PD reduction was more pronounced at non-modified surface implants

SUPP

Baseline: mean: 68.7%

Group 1: 72.3%

Group 2: 65.2%

Group 3: 67.3%

Group 4: 70.3%

After 1 year:

Mean 17.4%

Group 1: 13%

Group 2: 6.5%

Group 3: 22.2%

Group 4: 31.4%

RBL 3 years

Group1: gain 0.32 ± 1.64 mm

Group 2: loss − 0.51 ± 1.87 mm

Group 3: loss − 0.28 ± 1.78 mm

Group 4: gain 0.65 ± 0.86 mm

During the 12-mo follow-up period, supragingival polishing was performed and oral hygiene reinforced in 3-mo intervals

The local use of chlorhexidine had no overall effect on treatment outcomes

Potential benefits of systemic antibiotics are not sustained over 3 years

Non-reconstructive therapy with implantoplasty

Romeo et al. (2005, 2007)

RCT,

parallel

17 patients

22 implants rough surfaces

Test: 10 patients, 19 implants

Control: 7 patients, 16 implants

BOP/SUPP +

PD > 4 mm horizontal

peri-implant

translucency

36 months

Full mouth disinfection/

mechanical debridement +

resective therapy (apical

re-positioned flap + bone

re-contouring) +

decontamination

using metronida zole + tetracycline hydro

chloride (3 min) + implantoplasty using diamond and

Arkansas burs/silicone

polishers + Amoxicillin 50 mg/kg/day for 8 days + CHX mouthrinse for 2 weeks

Full mouth disinfection/

mechanical debridement +

resective therapy (apical

re-positioned flap + bone

re-contouring) + decontamination using metronidazole

+ tetracycline hydrochloride

(3 min) + Amoxicillin 50 mg/kg/day for 8 days

Implant level

mBI

Test baseline: 2.83 (0.47), 3 years: 0.61 (0.67)

Control baseline: 2.86 (0.35),

2 years: 2.33 (0.74)

Between group comparison: Student’s t-value of + 9.61

Test baseline: 5.70 (1.69) mm, 2 years: 3.58 (1.06) mm, 3 years: 3.21 (0.56) mm

Control baseline: 6.52 (1.62) mm, 2 years: 5.5 (1.47) mm. Significantly higher PD values in control group (Student’s t-value + 5.5)

ML (recession)

Test baseline: 0.5 (0.91) mm,

3 years: 1.96 (1.42) mm

Control baseline: 0.23 (0.84) mm, 2 years: 1.64 (1.29) mm

Between group comparison: Student’s t-value of + 9.61

Recession index in control group significantly lower (Student’s t-value of − 2.14)

RBL mesial and distal

Test baseline: 3.82 mm and 3.94 mm; 3 years: 3.81 mm and 3.94 mm

Control baseline: 3.45 mm and 3.49 mm

3 years: 5.35 mm and 5.42 mm

The mean variation of marginal bone level values mesial and distal

Test: 0 and 0.001 mm (p > 0.05)

Control: 1.44 and 1.54 mm (p < 0.05)

Implantoplasty was an effective treatment of peri-implant infection and peri-implantitis progression

Lasserre et al. (2020)

RCT,

parallel

29 patients

Smokers excluded

42 implants with modified surface

Test: 15 patients; mean age: 62.3 (range: 42–74) years; female: 11; history of periodontitis: 13; 22 implants

Control: 14 patients; mean age: 71 (range: 59–92) years; female: 11; history of periodontitis: 13; 20 implants

PD > 5 mm + bone loss ≥ 2 mm + BOP/SUPP

6 months

OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + implantoplasty + 0.1% CHX mouthrinse for 10 days

OHI + access flap + mechanical debridement with curettes + irrigation with sterile saline + air abrasive device with amino acid glycine powder + 0.1% CHX mouthrinse for 10 days

p < 0.008

Implant level

BOP

Test baseline: 94.7 (10.7)%, 6 months: 33.3 (24.2)%, p < 0.008

Control baseline: 87.4 (22.3)%, 6 months: 26.3 (23.2)%

Test baseline: 6.72 (1.78) mm, 6 months: 2.73 (1.59)

Control baseline: 5.61 (1.56) mm, 6 months: 2.33 (1.49) mm

ML (recession)

Test baseline: 0.23 (0.48) mm, 6 months: 0.75 (0.71) mm, p < 0.008

Control baseline: 0.57 (0.85) mm, 6 months: 1.11 (0.89) mm

RBL

Test baseline: 4.73 (2.67) mm, 6 months: 4.47 (3.06), p < 0.008

Control baseline: 5.21 (2.06) mm, 6 months: 4.67 (2.05) mm, p < 0.008

No differences in any parameter between two groups (p > 0.008)

After 3 and 6 months careful professional supragingival cleansing was performed

Implantoplasty is as effective as glycine air polishing

b) Studies comparing reconstructive therapy versus access flap surgery

Wohlfahrt et al. (2012)

RCT,

parallel

32 patients (13 female; 19 male)

Test: 16; mean age: 65.0 (10.0) years; smokers:

6 (37.5%)

Control: 16; mean age: 57.2 (12.3) years; smokers 10 (58.8%)

32 implants

medium rough

surfaces

PD ≥ 5 mm,

BOP +

intrabony

defects

≥ 4 mm

12 months submerged

healing for 6 months

Access flap surgery + mechanical

debridement (titanium curettes) +

conditioning using 24%

ethylenediaminetetraacetic acid gel (2 min) + augmentation of intrabony

defect components using porous titanium granules

Open flap surgery + mechanical

debridement (titanium currettes) +

conditioning using 24%

ethylenediaminetetraacetic acid gel (2 min)

Implant level

BOP (bleeding sites pro implant) reduction

Test: 0.38 (2.1) %

Control: 0.56 (2.9) %

Not significant improvement compared to baseline

No significant difference between groups (p = 0.60)

PD reduction

Test: 1.7 (1.7) mm

Control: 2.0 (2.3) mm

Significant improvement compared to baseline (p < 0.001)

No significant difference between groups (p = 0.66)

RDF

Test: 57.0 (45.1) mm

Control: − 14.8 (83.4) mm

Significantly higher in test group (p < 0.001)

Radiographic defect height reduction:

Test: 2.0 (1.7) mm

Control: 0.1 (1.9) mm

Significantly higher in test group (p < 0.001)

Test group showed significantly better radiographic peri-implant defect fill compared with controls. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated

Andersen et al. (2017)

(Wolhlfahrt et al. continuum)

12 patients

12 implants

Test: 6 patients, 6 implants

Control: 6 patients, 6 implants

7 years

Implant level

PD changes

Test baseline: 6.5 (1.9) mm, 7-years: 4.3 (2.4) mm

Control baseline: 6.5

(2.3) mm, 7 years: 3.5 (1.2) mm

RDF

Mean radiographic osseous defect fill:

test: 1.9 (2) mm

control: 1.3 (1.4) mm

Comparative statistical analysis was not performed

Follow-ups were handled by the referring dentists

Surgical treatment of peri-implant osseous defects showed unpredictable results

Hamzacebi et al. (2015)

RCT, split-mouth design

19 patients, 38 implants

Test: 19 implants

Control: 19 implants

Mean age: 60.98 (11.90) years

BOP/ SUPP + PD ≥ 5 mm + radiographic bone loss ≥ 2 mm

6 months

Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days

Access flap + mechanical debridement with PeriBrush + 4% pH 1 citric acid for 3 min or tetracycline chloride solution + intrabony defect fill with platelet-ruch fibrine (PRF) plugs and membranes + postoperative mertonidazole (500 mg; 3 times per day; 7 days) + 0.12% CHX mouthrinse for 7 days

Implant level

BOP

Test baseline: 79.31 (31.7)%; 6 months: 25.29 (14.51)%; p < 0.001

Control baseline: 65.47 (36.08)%; 6 months: 21.43 (16.57)%; p > 0.001

Between group comparison not conducted

Test baseline: 6.13 (1.05) mm; 6 months: 3.30 (0.49) mm

Control baseline: 5.78 (0.71) mm; 6 months:3.71 (0.42) mm

Between-group comparison: p < 0.001 (higher reduction in test group)

Test baseline: 0.62 (0.49) mm; 6 months: 0.14 (0.28) mm

Control baseline: 0.83 (0.65) mm; 6 months: 1.04 (0.62) mm

Between-group comparison: p < 0.001 (higher reduction in test grouo)

Supportive therapy NR

PRF application led to better clinical results

Jepsen et al. (2016)

Multicenter RCT,

parallel

63 patients (27 female, 36 male)

63 implants

Test: 33 patients; mean age: 57.5 (12.6) years; current smokers:

11 (33.3%); former smokers: 9 (27.3%); history of periodontal treatment: 17 (51.5%); 33 implants

Control: 30 patients; mean age: 59.1 (12.2) years; current smokers:

7 (23.3%); former smokers: 11 (36.7%); history of periodontal treatment: 20 (66.7%);

30 implants

PD ≥ 5 mm + BOP/SUPP

+ intraosseous circumferential three-wall defects ≥ 3 mm

12 months

Access flap + mechanical debridement with rotary titanium brush and H₂O₂ 3% (1 min) followed by rinsing with saline (60 s) + Titanium granules + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery

Access flap + mechanical debridement with rotary titanium brush and H₂O₂ 3% (1 min) followed by rinsing with saline (60 s) + Amoxicillin 500 mg 3 times/day + Metronidazole 400 mg 2 times/day, 8 days, starting 1 day before surgery

Subject level

BOP reduction

Test: 56.1 (30.5)%

Control: 44.9 (38.2)%

Significant reduction compared to baseline (p < 0.001)

No significant difference between groups (p > 0.05)

PD reduction

Test: 2.8 (1.3) mm

Control: 2.6 (1.4) mm

Significant reduction compared to baseline (p < 0.001)

No significant difference between groups (p > 0.05)

SUPP reduction

Test: 23.2 (32.8) %

Control: 25.6 (32.7) %

Significant reduction compared to baseline (p < 0.001)

No significant difference between groups (p > 0.05)

Radiographic defect height reduction:

mesial/distal:

test: 3.61 (1.96)/3.56 (2.07) mm

control: 1.05 (1.42)/1.04 (1.34) mm

Significantly higher in test group (p < 0.0001)

RDF

mesial/distal:

test: 79.00 (29.85)%/74.22 (36.33)%

control: 23.11 (46.28)%/21.89 (30.16)%

Significantly higher in test group (p < 0.0001)

Patients were recalled at 6 wk and 3, 6, 9, and 12 mo after

surgery for professional oral hygiene procedures with supragingival debridement and hygiene instructions provided as

needed

Test group showed significantly enhanced radiographic defect fill compared with control group. Similar improvements according to clinical measures were obtained after both surgical treatment modalities

Renvert et al. (2018)

RCT, parallel

41 patients

41 implant

Test: 21 patients; female: 13; 21 implants

Control: 20 patients; female: 9; 20 implants

PD ≥ 5 mm + BOP/SUPP + marginal bone loss, defined as a crater like defect ≥ 3 mm

12 months

Access flap +

mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ + application of bovine-derived deproteinized bone particles + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4

Access flap +

mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ + Zitromax (Sandoz AS; Copenhagen, Denmark) 500 mg day one and 250 mg days 2–4

Implant level

BOP

Test baseline: 100%,

12 months: 47.6%

Control baseline: 100%, 12 months: 35%

No difference between groups (p = 0.41)

Test baseline: 6.5 (1.9) mm, 12 months: 2.9 (1.4) mm, p > 0.001

Control baseline: 6.7 (1.8) mm, 12 months:

4.2 (2.8) mm, p > 0.001

Significantly greater reduction in the test group (p < 0.01)

ML (mid-buccal recession)

Test: 1.2 m

Control: 1.9 mm

No difference between groups (p = 0.76)

RDF

Test:

0.7 (0.9) mm

Significant compared to the baseline ( p = 0.004)

Control:

0.2 (0.2) mm

Not significant compared to baseline (p = 0.10)

Successful treatment outcome (defect fill ≥ 1.0 mm, PPD values at implant ≤ 5 mm, no BOP, and no SUPP):

Test: 9/21 (42.9%) patients

Control: 1/20 (5.0%) patients; Between-group comparison: p < 0.01

Based on individual needs, professional prophylaxis was performed every 3rd month

Successful treatment outcome using a bone substitute was more predictable when a composite therapeutic endpoint was considered

Isehed et al. (2016, 2018)

RCT, parallel

23 patients

23 implants

Smokers inlcuded

Test: 10 patients, 10 implants

Control: 13 patients, 13 implants

PD ≥ 5 mm + BOP/ SUPP + angular bone loss ≥ 3 mm

5 years

Access flap + mechanical debridement with

ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + application of Emdogain (EMD) (0.3 ml) + non-submerged healing

Access flap + mechanical debridement with

ultrasonic device and titanium hand instruments + cotton pellets soaked in sodium chloride + non-submerged healing

Implant level

BOP-positive sites

5 years

Test: 5/11 (55.6%) implants

Control: 2/9 (40%) implants

Presence of SUPP:

Test baseline:

9/15 (60%); 1 year: 1/15 (7%)

Control baseline: 6/14 (43%); 1 year: 1/14 (7%)

SUPP at 3 years

Test: 2/13 (20%) implants

Control: 3/12 (33%) implants

MBL changes

5 years

Test: 4.1 mm

Control: 3.3 mm

Change: test: + 1.4 mm

Control: + 1.3 mm

p = 0.90

Between 1 and 5 years after the peri‐implant surgical treatment, supportive therapy was performed based on individual needs at the specialist clinic or by the patient's general dental clinic, usually with 3‐ or 6‐month intervals

Test group showed increased bone levels 12 months after treatment

Renvert et al. (2021)

RCT

66 patients

66 implants

Test: 34; female 54%; age: 62.2 (10.2) years

Smokers 8 (22%)

Control: 32; female 50%; age: 62.9 (10) years; smokers: 9 (26%)

Heavy smokers (> 10 cig./day) excluded

PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 3 mm + intraosseous defect component of at least 3 mm depth and a circumference at least 270 ◦ detected intraoperatively

1 year

Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H₂O₂ 1 min + saline rinsing + defect fill with bovine bone mixed with bloos + bilaminar collagen membrane + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks

Access flap + debridement with titanium curettes + titanium brush + decontamiantion with 3% H₂O₂ 1 min + saline rinsing + postoprative antibiotics (Azithromycin 500 mg, 4 days; + CHX 0.2% moutrinse for 3 weeks

Subject level

BOP (severity of blleding pro implant)

Test baseline: 1.3 (0.9), 12 months: 0.4 (0.6)

Control baseline: 1.4 (1.0); 12 months: 0.5 (0.6);

Between-group comparison: p = 0.992

Test baseline: 6.7 (1.5) mm, 12 months: 4.8 (1.5);

Control baseline: 6.8 (1.3); 12 months: 4.5 (1.5) mm

Between-group comparison: p = 0.578

SUPP (sites per implant)

Test baseline: 1.8 (1.4); 12 months: 0.3 (0.9);

Control baseline: 1.6 (1.5), 12 months: 0.3 (0.9)

Between-group comparison: p = 0.879

ML (recession)

Test baseline: 0.4 (1.8) mm, 12 months: 0.8 (1.2) mm

Control basleine: 0.6 (0.9); 12 months: 1.4 (1.5) mm

Between-group comparison: p = 0.136

RDF at the deepest site

Test: 2.7 (1.3) mm

Control: 1.4 (1.2) mm;

Between-group comparison: p < 0.001

Mean RDF

Test: 2.3 (1.2)mm

Control: 1.1 (1.1)

Between-group comparison: p = 0.001

Oral hygiene insructions were provided after 3, 6, 9 and 12 months following the surgery

Reconstructive therapy resulted in significantly more RDF. No difference in clinical paramenetrs was noted

c) Reconstructive therapy

Adjunctive and alternative measures for implant surface decontamination following reconstructive therapy

Deppe et al. (2007)

CCT,

parallel

16 patients

32 implants machined,

rough- and

medium-rough

surfaces

Test: 9 patients, 17 implants

Control: 7 patients, 15 implants

PD ≥ 5 mm, BOP + progressive

vertical

bone loss

5 years

3 weeks prior to surgery: CHX gel applications (0.3%)

Group 2 OHI + access flap surgery + air abrasive device + carbon dioxide laser

(cw mode, 2.5 W, 12 × 5 s)

decontamination + beta tricalcium

phosphate + cortical bone chips

harvested from the retromoar area

(50:50) + nonresorbable synthetic

barrier membrane

3 weeks prior to surgery: CHX gel applications (0.3%)

Group 4 OHI + access flapb surgery + air abrasive device + beta tricalcium

phosphate + cortical bone chips

harvested from the retromoar area

(50:50) + nonresorbable synthetic

barrier membrane

Implant level

SBI

Test baseline: 0.5 (0.8), 5 years: 2.1 (1.4)

Control baseline: 1.2 (0.6), 5 years: 1.9 (1.0)

Test baseline: 5.0 (1.3) mm, 5 years: 2.5 (1.4) mm

Control baseline: 4.8 (1.4) mm, 5 years: control: 2.5 (1.1). No significant difference between the groups (p > 0.05)

Radiographic DIB (distance from the implant shoulder to the first bone contact)

Test baseline: 2.3 (0.9) mm

5 years: 4.5 (1.2) mm

Control baseline: 4.1 (0.9) mm, 5 years: 4.7 (1.1) mm

No significant difference between the groups (p > 0.05)

Over the 5-year period, if plaque and bleeding scores indicated poor oral hygiene, remotivatino and reinstruction of OHI were performed

There seems to be no difference between laser and conventional decontamination

Isler et al. (2018a)

RCT, parallel

41 patients

60 implants

Test: 20 patients; mean age: 54.4 (8.08) years; female: 9; current smokers: 5 (25%); history of periodontitis: 9 (45%); 30 implants

Control: 21 patients; mean age: 54.18 (10.36) years; female: 10; current smokers: 6 (28.5%); history of periodontitis: 8 (38%); 30 implants

≥ 2 mm marginal bone loss + BOP/SUP with or without deepening of PDs

12 months

Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + ozone application + bovine bone mineral mixed with pieces of concentrated growth factors (CGF) + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week

Access flap + mechanical debridement with titanium curettes + irrigation with saline (3 min.) + bovine bone mineral mixed with CGF + coverage with CGF membranes + Amoxicillin (500 mg) + Metronidazole (500 mg) 3 times/day for 1 week

Implant level

BOP

Test baseline: 96.6 (10.5), 12 months: 15.8 (19.1), p < 0.001

Control baseline: 97.5 (10.06), 12 months:

25 (21.7), p < 0.001

No difference between groups (p = 0.575)

Test baseline: 6.27 (1.42) mm, 12 months: 2.75 (0.7) mm, p < 0.001

Control baseline: 5.73 (1.11) mm, 12 months:

3.34 (0.85) mm, p < 0.001

No difference between the groups (p = 0.158)

ML (recession):

Tests baseline: 0.12 (0.14) mm, 12 months: 0.48 (0.75) mm, p < 0.01

Control baseline: 0.25 (0.42) mm, 12 months: 0.55 (0.64) mm, p < 0.01

No difference between groups (p = 0.753)

RDF

Test: 2.32 (1.28) mm

Control: 1.17 m (0.77) mm

Significantly higher fill in test group (p = 0.02)

The patients were re-evaluated at 1, 3, 6, 9, and 12 months postoperatively and supportive care was given at the same time points

Higher radiographic defect fill in the test group

Reconstruction of the defect with different bone fillers, with and without a membrane

Khoury et al. (2001)

CCT,

parallel

25 patients; mean age: 48.2 (6.3) years; 22 female

41 implants

Test 1: 20 implants

Test 2: 9 implants

Control: 12 implants

Bone loss > 50% of implant length + intrabony crater-form defect

3 years

Test 1

Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H₂O₂ + Test 1

autogenous bone + non-resorbable membrane

Test 2

autogenous bone + resorbable membrane

+ submerged healing + Antibiotics administered 4 weeks prior to surgery (for 1 week), and later starting 1 day and finishing 7 days after surgery according to the individual susceptibility test results

Access flap + decontamination with 0.2% CHX, citric acid (pH = 1) (1 min.) and rinsed with H₂O₂ + autogenous bone

Implant level

PD changes

Test 1: 5.4 (3.0) mm

Test 2: 2.6 (1.6) mm

Control: 5.1 (2.7) mm

Significant improvement compared to baseline in all groups (p > 0.001)

Significantly less improvement in test 2 group compared to test 1 and the control (p ≤ 0.05)

Radiographic vertical intrabony defect height reduction:

Test 1: 2.8 (3.1) mm

Test 2: 1.9 (3.2) mm

Control: 2.4 (2.7) mm

Significantly less improvement in test 2 group compared to baseline (p = 0.102)

No difference among the groups (p ≤ 0.05)

The patients wereenrolled in a supportive maintenance program and monitored on a 3- to 6-month recall schedule including repeated oral hygiene instructions and a full-mouthtooth cleaning according to their individual needs

17 out of 29 barrier-treated implants (58.6%) were compromised by early post-therapy complication (e.g., dehiscence, exposure, fistula, or sequester formation)

Schwarz et al. (2006, 2008, 2009)

RCT,

parallel

20 patients; 14 female; mean age: 54.4 (12.5) years; 1 patient light smoker (< 10 cig./day)

21 implants

Test: 9 patients, 9 implants

Control: 10 patients, 11 implants

PD > 6 mm + BOP/SUPP + intrabony component > 3 mm

4 years

OHI + initial non-surgical therapy

Access flap surgery + mechanical

debridement (plastic curettes) +

nanocrystalline hydroxyapatite paste + non-submerged healing

OHI + initial non-surgical therapy

Access flap surgery + mechanical

debridement (plastic curettes) +

bovine-derived xenograft + native

collagen barrier membrane + non-submerged healing

Subject level

BOP reduction

Test: 32%

Control: 51%

PD reduction

Test: 1.1 (0.3) mm

Control: 2.5 (0.9) mm

BOP and PD reductions significantly

higher at control sites

A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene were performed at 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48 months after treatment

Long-term outcome obtained in test group without barrier membrane must be considered as poor

Aghazadeh et al. (2012)

RCT,

parallel

45 patients

71 implants medium-rough

surfaces

Test: 23 patients; mean age: 67.0 (7.5) years; smokers: 69.6%;

37 implants

Control: 22 patients; mean age: 70.1 (6.2) years; smokers: 40.9%; 34 implants

PD ≥ 5 mm + BOP/SUPP + radiographic bone loss ≥ 2 mm + angular peri-implant bone defect ≥ 3 mm

12 months

Access flap surgery + mechanical

debridement (titanium instruments) +

decontamination using hydrogen

peroxide 3% cortical bone chips

harvested from the mandibular ramus

+ resorbable synthetic barrier

Membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days

Access flap surgery + mechanical

debridement (titanium

instruments) + decontamination

using hydrogen peroxide 3%

bovine-derived xenograft + resorbable

synthetic barrier membrane + Azithromycin 2 × 250 mg 1 day, 1 × 250 mg 2–4 days

Implant level

BOP reduction

Test: 50.4 (5.3)%

Control: 44.8 (6.3)%

No significant difference between the groups (p > 0.05)

PD reduction

Test: 3.1 (0.2) mm

Control: 2.0 (0.2) mm

Significantly higher in the test group (p < 0.01)

SUPP reduction

Test: 25.2 (4.3)%

Control: 11.5 (5.2)%

Significantly higher in the test group (p < 0.01)

RDF

Test: 1.1 (0.3) mm

Control: 0.2 (0.3) mm

Significantly higher in test group (p < 0.05)

Six weeks after surgery the first supportive therapy was given, and the subjects were enrolled in a maintenance program with visits everythird month. Allexisting teeth and implants werecleaned using a rubber cup and alow-abrasive paste

Bovine xenograft provided more radiographic bone fill than authogenous bone

Roos-Jansaker et al. (2007, 2011, 2014)

CCT,

parallel

25 patients

45 implants

Test: 13 patients; mean age: 64.9 (7.5) years; current smokers: 10 (76.9%); former smokers: 2 (15.4%); 23 implants

Control: 12 patients; mean age: 65.7 (7.4) years; current smokers: 8 (66.7%); former smokers: 3 (25%); 22 implants

Bone loss > 3 threads (≥ 1.8 mm) one-to-four intrabony defect + BOP and/or SUPP

5 years

Removal of the suprastructure

Access flap surgery + debridement +

decontamination using

3% H₂O₂ + algae-derived xenograft

+ resorbable synthetic barrier

membrane + non-submerged healing +

systemic antibiotic medication

(Amoxicillin + Metronidazole for

10 days)

Removal of the suprastructure

Access flap surgery + debridement +

decontamination using

3% H₂O₂ + algae-derived xenograft

non-submerged healing +

systemic antibiotic medication

(Amoxicillin + Metronidazole for

10 days)

Implant level

PD reduction at the deepest site

Test: 3.0 (2.4) mm

Control: 3.3 (2.0) mm

No significant difference between the groups (p = 0.60)

ML(recession changes at the deepest site)

Test: − 1.6 (1.5) mm

Control: − 1.7 (2.1) mm

No significant difference between the groups (p = 0.89)

RDF

Test: 1.5 (1.2) mm

Control: 1.1 (1.2) mm

No significant difference between the groups (p = 0.24)

The participants were then enrolled in a maintenance program with visits every third month. At these visits, full‐mouth plaque scores were obtained. Re‐instruction in oral hygiene procedures was performed as necessary. Teeth and implants were cleaned using a rubber cup and a low‐abrasive paste

Additional use of a membrane did not improve the outcome

Güler et al. (2017)

CCT, parallel

24 patients (9 female, 15 male). mean age: 45.36 (14.1) years

35 implants

Test: 18 patients; 19 implants

Control: 6 patients, 16 implants

Light smokers included (< 10 cig.7 day):

Test: 3 (18.75%)

Control: 3 (50%)

PD > 5 mm + BOP/SUPP

Class Ib° defects (vestibular dehiscence + circumferential bone resorption)

Class Ic°° defects (vestibular dehiscence + circumferential bone resorption)

Class Id defects (circumferential bone resorption)

6 months

OHI + access flap + mechanical cleaning with rotating titanium brush + titanium granules + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days

OHI + access flap + mechanical cleaning with rotating titanium brush + xenograft + resorbable collagen membrane + PRF (platelet-rich fibrin membrane) + non-submerged healing + systemic antibiotics Amoxicillin clavulanate 2 × 1000 mg/day, 7 days

Implant level

BOP

Test baseline: 50.17 (25.19)%, 6 months: 24.32 (11.22)%

Control baseline: 63.51 (24.38)%, 6 months:

33.00 (15.51)%

Significantly higher reduction in test group (p = 0.02)

Test baseline: 5.28 (1.06) mm, 6 months: 3.34 (0.82) mm

Control baseline: 4.72 (1.02) mm, 6 months:

3.34 (0.82) mm

No significant difference between groups (p = 0.698)

ML (recession)

Test baseline: 0.01 (0.003) mm, 6 months: 0.42 (0.58) mm

Control baseline: 0.208 (0.452) mm, 6 months:

0.51 (0.48) mm

No significant difference between groups (p = 0.476)

RDF

Test: 1.74 (0.65) mm

Control: 1.05 (0.54) mm

Significantly higher reduction in test group (p = 0.006)

Radiographic bone filling was significantly higher in the test group

Isler et al. (2018b)

RCT,

parallel

52 patients

105 implants

Test: 26 patients; female: 10; current smokers: 6; history of periodontitis: 11; 52 implants (23% on-modified, 77% modified)

Control: 26 patients; female: 15; current smokers: 9; history of periodontitis: 13; 52 implants (19.2% non-modified, 80.8% modified)

Bone loss ≥ 2 mmbased on baseline radiograph + BOP /SUPP

12 months

OHI + supra/subgingival mechanical debridement 4–6 weeks prior to surgery

Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + concentrated growth factor (CGF) membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks

OHI + supra/subgingival mechanical debridement 4–6 weeks priot to surgery

Access flap + mechanical debridement with titanium curettes and saline-soaked cotton gauses + bovine bone filler + collagen membrane + systemic antibiotics Amoxicillin 500 mg + metronidazole 500 mg, 3 times a day, 1 week + 0.12% CHX mouthrinse 2 weeks

Implant level

BOP

Test baseline: 97.12 (10.79)%, 12 months: 35.58 (30,.14)%, p < 0.001

Control baseline: 97.12 (8.15)%, 12 months: 29.81 (30.02), p < 0.001

Between-group comparison: p = 0.503

Test baseline: 5.92 (1.26) mm, 12 months: 3.71 (1.09) mm, p < 0.001

Control baseline: 5.41 (1.16) mm, 12 months: 2.70 (0.80) mm, p < 0.001

Between-group comparison: p = 0.001

ML (recession)

Test baseline: 0.04 (0.20) mm, 12 months: 0.25 (0.39) mm, p = 0.007

Control baseline: 0.06 (0.20) mm, 12 months: 0.27 (0.44) mm, p = 0.026

Between-group comparison: p = 0.925

RDF

Test: 1.63 (1.0) mm

Control: 1.98 (0.75) mm, p = 0.154

Treatment success (PD < 5 mm + no BOP/SUPP, no further bone loss):

Test: 26.9% implants

Control: 42.3% implants

All patients were enrolled in postoperative maintenance care programs at three different time points during the study periods (3, 6, and 9 months). Supragingival/mucosal mechanical debridement and reinforcement of oral hygiene were performed during postoperative period. When necessary localized subgingival/mucosal instrumentation was done except for the area of surgery

Control group showed better results

Polymeri et al. (2020)

RCT, parallel

24 patients, 24 implants

Test: 13; mean age: 57.3 (15.1) years; female: 5 (38%); smokers: 2 (15%); history of periodontal treatment: 6 (46%)

Control: 11; mean age: 65.5 (11.2) years; female: 6 (55%); smokers: 3 (27%); history of periodontal treatment: 4 (36%)

Bone loss ≥ 3 mm + PD ≥ 5 mm + BOP/SUPP + intra-osseous defect component ≥ 3 mm at the deepest part and presence of at least three walls

12 months

Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ 1 min + xenogrfat (EndoBone) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX

Access flap + mechanical debridement with titanium curettes + decontamination with 3% H₂O₂ 1 min + xenogrfat (BioOss) + non-submerged healing + systemic antibiotics Amoxicillin 500 mg twice a day, 8 days, starting 1 day prior to surgery + 4 weeks mouthrinse with 0.12% CHX

Subjest level

BOP

Test basleine: 100 (0.0)%, 12 months: 50 (10.2)%, p < 0.001

Control baseloine: 100 (0.0)%, 12 months: 45.5 (33.2)%, p < 0.001

Between-group comparison: p = 0.670

Test basleine: 7.1 (1.2)%, 12 months: 3.4 (0.5)%, p < 0.001

Control baseloine: 7.0 (1.8)%, 12 months: 3.4 (0.6)%, p < 0.001

Between-group comparison: p = 0.910

Radiographic defect depth

Test baseline:; 5.9 (1.8) mm, 12 months: 2.9 (1.3), p < 0.001

Control baseline: 4.9 (0.9) mm, 12 months: 2.4 (0.6) mm, p < 0.001

Bestween-group comparison: p = 0.183

RBL

Test baseline: 4.9 (1.1) mm, 12 months: 2.1 (1.3)mm, p < 0.001

Control baseline: 5.3 (1.2) mm, 12 months: 3.1 (1.3) mm, p < 0.001

Between-group comparison: p = 0.073

Treatment success (PD ≤ 5 mm + no BOP/SUP + no further bone loss): test: 13%, control: 18% of patients

Patients

were recalled at 6 weeks and 3, 6, 9, and 12 months after the surgery

for professional oral hygiene procedures that included supragingival debridement and polishing with a rubber cup and a low-abrasive

paste

Test and control groups showed comparable outcomes

d) Combined therapy

Schwarz et al. (2011, 2012, 2013, 2017)

RCT,

parallel

15 patients

11 females, 4 males; median age: 63 years

Heavy smokers (≥ 10 cigarettes/day) excluded

15 patients

Test: 6 patients, 6 implants

Control: 9 patients, 9 implants

PD ≥ 6 + BOP/SUPP +

intrabony component > 3 mm + supracrestal component > 1 mm

7 years

Initial non-surgical therapy + OHI

Access flap + Er:YAG laser device (cone-shape glass fiber tip) at 11.4 J/cm2 + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft +

native collagen membrane + non-submerged healing

Initial non-surgical therapy + OHI

Access flap mechanical debridement with plastic curettes and saline-soaked cotton gauses + implantoplasty at buccally and supracrestally exposed implant parts + bovine-derived xenograft +

native collagen membrane + non-submerged healing

Subjest level

BOP reduction

Test: 86.66 (18.26)%

Control: 89.99 (11.65)%

Significant improvement compared to baseline (p < 0.001)

PD reduction

Test: 0.74 (1.89) mm

Control: 2.55 (1.67) mm

Significant improvement compared to the baseline (p < 0.001)

ML (reduction of recession)

Test: 1.36 (1.04) mm

Control: 0.49 (0.92) mm

A supragingival professional implant/tooth cleaning and reinforcement of oral hygiene wereperformed at 1, 3, and 6 months after therapy. Afterwards, recall appointments to provide a professionally administered plaque removal and reinforcement of oral hygiene were scheduled on an annual basis

Combined surgical therapy of advanced peri-implantitis was not influenced by the initial method of surface decontamination

De Tapia et al. (2019)

RCT,

parallel

30 patients

Heavy smokers (≥ 10 cigarettes/day) excluded

30 patients

Test: 15 patients; mean age: 65.53 (10.29) years; female: 11 (73.3%); light smokers: 6 (40%); 15 implants

Control: 15 patients; mean age: 55.47 (11.75) years; female: 9 (60%); light smokers: 4 (26.7%); 15 implants

PD ≥ 6 mm + BOP/SUPP + bone loss > 30% of the implant surface + intrasurgically osseous defect with at least two bone walls and depth of 3 mm of intrabony component

12 months

Initial non-surgical therapy:

OHI

Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H₂O₂ 3%

+ titanium brush with an oscillating low speed + non-submerged healing + combination of 500 mg Amoxicillin and 500 mg Metronidazole 3 times a day, for 7 days

Initial non-surgical therapy:

OHI

Access flap + implantoplasty supracrestally with diamond burs and Arkansas stone + debridement using plastic ultrasonic scalers + rinsing with H₂O₂ 3%

+ non-submerged healing + combination of 500 mg Amoxicillin and500 mg Metronidazole 3 times a day, for 7 days

Subject level

BOP

Test baseline: 100%, 12 months: 79%

Control baseline: 100%, 12 months: 55%,

between-group comparison: p = 0.147

Test baseline: 6.16 (1.27) mm; 12 months: 3.31 (0.72)

Control: 6.17 (0.98) mm; 12 months: 3.87 (0.81) mm Between-group comparison: p = 0.04

SUPP

Test baseline: 43%; 12 months: 0%

Control baseline: 47%; 12 months: 23%; p = 0.053

ML (recession)

Test: 0.4 (0.45) mm

Control: 0.6 (0.62) mm; Between-group comparison: p = 0.374

RBL

Test: 2.51 (1.21) mm,

Control: 0.73 (1.26) mm; Between-group comparison: p = 0.003

RDF:

Test: 81 (22)%

Control: 52 (55)%; Between-group comparison: p = 0.111

Patients were seen at weekly intervals for the first 4 weeks to monitor healing and, then, at 3‐month intervals during the first year

The additional use of a titanium brush during combined treatment of peri-implantitis resulted in statistically significant benefits in terms of PD reduction

RCT randomized clinical trial, OHI oral hygiene instructions, BOP bleeding on probing, PD probing depth, SUPP suppuration, BI bleeding index, mBI modified bleeding index, RBL radiographic bone level, RDF radiographic bone defect fill, ML soft-tissue level, H₂O₂ hydrogene peroxide