Assessment of modified reconstructive technique effectiveness to treat chronic peri-implantitis

Relevance. The article presents positive clinical outcomes of using a modified reconstructive technique around 20 implants in 14 patients. Its effectiveness was statistically assessed using linear regression analysis.

Material and methods. Clinical data of 20 patients treated from 2014 to 2021 for chronic peri-implantitis around 27 teeth provided the basis for the study. The patients formed two groups: control (6 patients (7implants)) and study (14 patients (20 implants)) groups. A staged treatment approach was applied to all patients and included anti-inflammatory, reconstructive and maintenance stages. In the control group of patients, we finished the treatment at the first stage, as stable clinical remission was achieved after the surgery. In the study group, there were two stages: anti-inflammatory treatment and reconstructive treatment with a modified reconstructive technique. Before and after treatment, we isolated biomarkers specific to surgery results, represented by independent and dependent variables. The received data were statistically evaluated using linear regression analysis (Gretl) to assess the effectiveness of a new surgical technique by studying numerical relationships between two groups of variables.

Results. The modified reconstructive technique as a part of a staged approach increased the effectiveness of chronic peri-implantitis treatment up to 74%. The statistical analysis demonstrated a significant influence of the baseline bone resorption level (vr1), defect shape (fd) and inflammation level (s) on the formation of new tissue attachment around the implants (gz2). The intensity of surgically induced stress response (str) directly correlated with surgery injury (hm) and baseline inflammation level (s). Surgical wound healing (pk), most closely related to implant survival (del), did not have a meaningful relationship with surgery-induced stress response intensity (str), which indicates the crucial role of the microbial fac tor in surgical wound healing around implants.

Conclusion. A new modified surgical technique increases the effectiveness of chronic peri-implantitis treatment to 74% due to the stability of a pedicled vascularized submucoperiosteal flap in the inflammation area. The study did not detect the direct impact of the periosteal reparative-regenerative potential on the radiological bone level restoration. However, it demonstrated clinically significant positive results. Inability to fully control microbial biofilm on the implant surface remains the main problem of chronic peri-implantitis treatment.

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