Sub-Periosteal Peri-Implant Augmented Layer Technique to Treat Peri-Implantitis Lesions

INTRODUCTION: The efficacy of surgical regenerative procedures to treat peri-implantitis lesions has been extensively reviewed. Regenerative treatment showed a variable rate of success, in terms of pocket reduction, gain in bone support, and elimination of signs of infection/inflammation. The aim of the present case report is to illustrate the use of the sub-periosteal peri-implant augmented layer (SPAL) technique to correct peri-implantitis defects CASE PRESENTATION: Surgical treatment of three class Ib and one class Ic peri-implantitis lesions in three patients was performed by means of the SPAL technique. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was in turn elevated to create a pouch, which was used to stabilize a bovine-derived xenograft (deproteinized bovine bone mineral) at the peri-implant buccal bone defect. No barrier membrane was used. In case of insufficient dimensions of peri-implant mucosa, a connective tissue graft (CTG) was buccally positioned at the most coronal portion of the implant. Treatment resulted in substantial reconstruction of peri-implant support associated with reduced probing depth and absence of inflammation. CONCLUSIONS: SPAL technique with or without additional CTG may be a suitable option to obtain clinical remission of peri-implantitis defects associated with buccal bone dehiscence.