Surgical Approach
Select based on defect morphology.
Periodontist
Hero illustration · Surgical Approach
Surgical treatment of peri-implantitis should be provided by dentists with specific training or by specialists (R8.2).
Evidence Guidelines & evidence
- EFP S3 R8.1
We recommend not to perform surgical treatment of peri-implantitis in patients not achieving and maintaining adequate levels of self-performed OH.
- EFP S3 R8.2
Since surgical treatment of peri-implantitis is complex, we recommend that it is provided by dentists with specific training or by specialists.
- EFP S3 R8.4
Implant-supported prostheses that do not allow access for self-performed OH should be adjusted prior to surgical therapy.
- EFP S3 R8.5
Where non-surgical end points have not been achieved, we recommend performing surgical therapy.
1 Pre-surgical prerequisites
Do not perform surgical treatment in patients not achieving adequate self-performed OH (R8.1). Adjust prostheses that block OH access prior to surgery (R8.4). Surgical treatment should be provided by dentists with specific training or specialists (R8.2).
Illustration · Step 1
2 Select approach by defect morphology
Access flap → decontamination-only when no resective or reconstructive indication. Suprabony / horizontal → resective: apically repositioned flap, osseous recontouring, ± implantoplasty. Intrabony / circumferential ≥3 mm → reconstructive: grafting with or without barrier membrane (R8.8, R8.9).
Illustration · Step 2
Your decision
Access flap
Decontamination-only — shallow defects
- Shallow defect
- No containing walls
- Patient unsuitable for resective/reconstructive
Resective
Suprabony / horizontal defects
- Suprabony defect (no containing walls)
- Horizontal bone loss
- Moderate pocket depth
Reconstructive
Intrabony / circumferential defects ≥3 mm
- Intrabony defect depth ≥3 mm
- Circumferential or 2–3 containing bone walls
- Regenerative potential