Peri‐implantitis surgical treatment with L‐PFR xenograft block – Clinical cases

Background Peri-implantitis (PI) has been defined has the presence of radiographic bone loss (RBL) ≥ 3 mm and or probing depth (PD) ≥ 6 mm and profuse bleeding on probing (BoP). Evidence regarding surgical treatment of PI does not allow any specific recommendation. Leucocyte-platelet rich fibrin (L-PRF) retains cytokines and growth factors being released for a period of 7-11 days. Systematic reviews confirmed the clinical benefits of L-PRF at periodontal wound healing, bone regeneration and osseointegration. Aim/Hypothesis To present the clinical and radiographic results after 6 months of peri-implantitis surgical treatment with L-PRF xenograft block. Material and Methods Five patients (5 implants) were diagnosed with PI (RBL ≥ 3 mm+ PD ≥ 6 mm+ BOP). Mucosal recession (MR), PD, BoP, clinical attachment level (CAL)) and periapical X-Ray (RBL) were taken at baseline. L-PRF membranes were prepared (Choukroun's protocol) and chopped mixed with xenograft (Creos® Xenogain, Nobel Biocare, Switzerland). Fibrinogen was added to form a block. A mucoperiosteal flap was elevated, the implant rinsed with saline, calculus removed with a titanium curette (Deppeler®, Switzerland) and implant cleaned with an air-flow system glycine (Perio-mate, NSK®, Japan). The peri-implant defects (no Cl Ie) were filled with L-PRF xenograft block and covered with L-PRF membranes. Flaps were sutured. When possible implants were left submerged. Suture was removed after 10-15. At month 6 clinical and radiographic data were recorded. Changes between 0 and 6 months were analyzed (Wilcoxon test). Statistical analyses used SPSS v24 (SPSS Statistics for Windows, IBM). Significance level of P ≤ .0 Results One female patient was a smoker (7 cigarettes day). There were no healing complications. The baseline clinical data were PD = 8.43 ± 1.65 mm+ MR = 0.00 ± 0.00 mm+ BoP = 73.33 ± 24.95 and CAL = 8.43 ± 1.65 mm. Regarding radiographic data RBL = 5.86 ± 1.21 mm. At the 6 months evaluation PD = 3.63 ± 0.71 mm+ MR = 0.07 ± 0.25 mm+ BoP = 16.67 ± 0.00 and CAL = 3.70 ± 0.69 mm. Regarding radiographic data RBL = 1.75 ± 1.08 mm. The variation between 6-0 months (treatment effect) was PD=−4.80 ± 1.12 mm ([−6.19 ± 3.41], P = 0.042) + MR = 0.07 ± 0.09 mm ([−0.05 + 0.18], P = 0.157) + BoP=−0.57 ± 0.28 ([−0.91 ± 0.22], P = 0.041) and CAL=−4.73 ± 1.17 mm ([−6.19 ± 3.28], P = 0.043), RBL=−4.11 ± 1.39 mm ([−5.84 ± 2.39], P = 0.043). Conclusion and Clinical Implications Our clinical cases refer to peri-implantitis biologically more demanding defects (other than circumferential Cl Ie). Both clinical and radiographic statistical significant results were obtained with glycine decontamination and peri-implant defect fill with L-PRF xenograft block, after a 6 months follow-up. Peri-implantitis surgical treatment with a block of L-PRF xenograft may have a positive clinical effect.