Microscope-assisted implant surface decontamination combined with surgical treatment for peri-implantitis: A retrospective case series study.

[BACKGROUND] This retrospective analysis aims to assess the efficacy of microscope-aided implant decontamination combined with surgical intervention for peri-implantitis and identify factors influencing its success.

[METHODS] Patients diagnosed with peri-implantitis in at least one implant and treated with microscope-assisted implant surface decontamination combined with surgery were evaluated. Clinical and radiographic parameters were assessed at baseline, 1-year, and 3-year intervals. Disease resolution, defined as ≤1 bleeding site, probing depth (PD) ≤5 mm, and no bone loss >0.5 mm, was the primary outcome. Multilevel regression analysis identified predictors affecting disease resolution.

[RESULTS] Thirty-three patients with 50 implants were included. The 1-year success rate was 92% (N = 46), declining to 80% (N = 40) at 3 years and 76% (N = 38) at final evaluation (37-98 months). At the final visit, 89.4% of implants had PD ≤5 mm, with no suppuration (SUP) in 95.7% of cases. Deepest PD at baseline negatively impacted outcomes.

[CONCLUSIONS] Microscope-assisted implant decontamination combined with surgical treatment is effective for peri-implantitis management long-term, serving as a potential reference for implant decontamination procedures. Further randomized controlled trials should investigate this approach's effectiveness compared to non-microscope-assisted decontamination.

[KEY POINTS] This is the first clinical study to our knowledge to demonstrate the long-term efficacy (up to 8 years) of a microscope-assisted, multi-step decontamination protocol combined with surgery for treating peri-implantitis. The presented protocol achieved high disease resolution rates of 76%-92%, with significant improvements in probing depth, bleeding, and bone level. Microscopic visualization ensures thorough implant surface cleaning, addressing a critical limitation of conventional blind debridement techniques. This study establishes a potential new standard of care for achieving predictable and sustainable outcomes in the management of advanced peri-implantitis.

[PLAIN LANGUAGE SUMMARY] Dental implants occasionally develop severe infections (peri-implantitis) that damage supporting bone and gums, often leading to implant failure. To improve treatment, we combined surgery with high-magnification dental microscopes for precise cleaning of contaminated implant surfaces-enabling clinicians to visually confirm thorough decontamination-followed by bone grafting to regenerate lost tissue. Evaluating 33 patients (50 infected implants) over 3+ years (average 4.5 years), we found 92% of implants successfully controlled infection at 1 year (minimal bleeding, shallow pockets ≤5 mm, no pus, stable bone), declining to 80% at 3 years and 76% at final follow-up. Bleeding, pus, and deep pockets decreased significantly, while bone levels improved. Implants with deeper initial infections had lower success rates. This microscope-assisted approach provides effective, lasting management of peri-implantitis by enhancing cleaning accuracy during surgery, offering a promising clinical strategy. Future studies should compare it directly with non-microscopic methods.