Combined Surgical Resective and Regenerative Therapy for Advanced Peri-implantitis with Concomitant Soft Tissue Volume Augmentation: A Case Report

This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 +/- 0.5 mm), and CAL (4.4 +/- 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 +/- 0.4 mm) and a decrease in KM (-1.3 +/- 0.5 mm) values at 12 months. However, a regain in mucosa/ height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.