• Daniela Cvetanovska Stojcevska Private dental clinic Vega Implatology, Skopje, North Macedonia
  • Daniela Veleska Stevkovska Department of implantology, Faculty of Dentistry, Ss.Cyril and Methodius University in Skopje, North Macedonia
  • Ana Aleksandrovska Private dental clinic Vega Implatology, Skopje, North Macedonia
  • Biljana Evrosimovska Department of oral surgery, Faculty of Dentistry, Ss.Cyril and Methodius University in Skopje, North Macedonia
  • Bobi Micevski Private dental clinic Vega Implatology, Skopje, North Macedonia
  • Branko Trajkovski Faculty of Dentistry, Kuwait University, Kuwait


Bacterial colonization of the peri-implant sulcus, development of inflammation of the soft peri-implant tissues, followed by progressive loss of the peri-implant bone results in  periimplantits development and subsequent implant failure. The aim of this case study is to prove that successful treatment of peri-implantitis integrates conservative and surgical approach with the accent on decontamination of the implant surface, complete elimination of microorganisms and their toxins, stabilization of progressive bone loss and regeneration of bone tissue. Case report : In this paper initial and surgical treatment of a periimplant case of 43 years old, non-smoker, in good general health is described. A nonsurgical periodontal supportive therapy was firstly conducted to reduce the inflammation, followed by the surgical treatment of the defect. After mechanical and chemical decontamination with chlorhexidine 0.2%, a regenerative approach consisting in the application of bovine bone mineral (Cerabone) and a CTG membrane  was performed. An antibiotic therapy was associated with the treatment according to molecular analysis findings for periodonthopatogenic bacteria. The decision for following the newest up-dates of the surgical protocols for periimplantitis results in predictable clinical improvement in the cases with periimplantitis. 

 Keywords: periimplantits, GBR, CTG.


1. Lang NP, Berglundh T, Working Group 4 of Seventh European Workshop on P. Periimplant diseases: where are we now?–Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38 Suppl. 11:178–181.
2. Sanz M, Chapple IL, Working Group 4 of the VEWoP. Clinical research on peri‐implant diseases: consensus report of Working Group 4. J Clin Periodontol. 2012;39 Suppl 12:202–206
3. Jepsen S, Berglundh T, Genco R, et al. Primary prevention of peri‐im‐ plantitis: managing peri‐implant mucositis. J Clin Periodontol. 2015;42 Suppl. 16:S152–157.
4. Lindhe J, Meyle J, Group DoEWoP. Peri‐implant diseases: consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008;35 Suppl. 8:282–285.
5.Laine ML, Leonhardt A, Roos‐Jansaker AM, et al. IL‐1RN gene poly‐ morphism is associated with peri‐implantitis. Clin Oral Implants Res. 2006;17:380–385.
6.Gruica B, Wang HY, Lang NP, Buser D. Impact of IL‐1 genotype and smoking status on the prognosis of osseointegrated implants. Clin Oral Implants Res. 2004;15:393–400.
7. Garcia‐Delaney C, Sanchez‐Garces MA, Figueiredo R, Sanchez‐Torres A, Gay‐Escoda C. Clinical significance of interleukin‐1 genotype in smoking patients as a predictor of peri‐implantitis: A case‐control study. Med Oral Patol Oral Cir Bucal 2015;20:e737–743.
8. Hamdy AA, Ebrahem MA. The effect of interleukin‐1 allele 2 genotype (IL‐1a(‐889) and IL‐1b(+3954)) on the individual's susceptibility to peri‐ implantitis: case‐control study. J Oral Implantol. 2011;37:325–334.
9. Lachmann S, Kimmerle‐Muller E, Axmann D, Scheideler L, Weber H, Haas R. Associations between peri‐implant crevicular fluid volume, concentrations of crevicular inflammatory mediators, and composite IL‐1A ‐889 and IL‐1B +3954 genotype. A cross‐sectional study on im‐ plant recall patients with and without clinical signs of peri‐implantitis. Clin Oral Implants Res. 2007;18:212–223
10. de Araujo Nobre M, Mano Azul A, Rocha E, Malo P. Risk factors of peri‐implant pathology. Eur J Oral Sci. 2015;123:131–139.
11. Renvert S, Aghazadeh A, Hallstrom H, Persson GR. Factors related to peri‐implantitis—a retrospective study. Clin Oral Implants Res. 2014;25:522–529.
12. Dalago HR, Schuldt Filho G, Rodrigues MA, Renvert S, Bianchini MA. Risk indicators for peri‐implantitis. A cross‐sectional study with 916 implants. Clin Oral Implants Res. 2017;28:144–150.
13. Máximo MB, de Mendonca AC, Alves JF, Cortelli SC, Peruzzo DC, Duarte PM. Peri‐implant diseases may be associated with increased time loading and generalized periodontal bone loss: preliminary re‐ sults. J Oral Implantol. 2008;34:268–273.
14. Daubert DM, Weinstein BF, Bordin S, Leroux BG, Flemming TF. Prevalence and predictive factors for peri‐implant disease and implant failure: a cross‐sectional analysis. J Periodontol. 2015;86:337–347.
15. Canullo L, Penarrocha‐Oltra D, Covani U, Botticelli D, Serino G, Penarrocha M. Clinical and microbiological findings in patients with peri‐implantitis: a cross‐sectional study. Clin Oral Implants Res. 2016;27:376–382.
16. Dvorak G, Arnhart C, Heuberer S, Huber CD, Watzek G, Gruber R. Peri‐implantitis and late implant failures in postmenopausal women: a cross‐sectional study. J Clin Periodontol. 2011;38:950–955.
17. Schwarz F, Herten M, Sager M, Bieling K, Sculean A, Becker J. Comparison of naturally occurring and ligature‐induced peri‐implantitis bone defects in humans and dogs. Clin Oral Implants Res. 2007;18:161–170
18. Casado PL, Otazu IB, Balduino A, de Mello W, Barboza EP, Duarte ME. Identification of periodontal pathogens in healthy periimplant sites. Implant Dent. 2011;20:226–235.
19. Renvert S, Roos‐Jansaker AM, Lindahl C, Renvert H, Rutger Persson G. Infection at titanium implants with or without a clinical diagnosis of inflammation. Clin Oral Implants Res. 2007;18:509–516.
20. Persson GR, Renvert S. Cluster of bacteria associated with peri‐im‐ plantitis. J
Res. 2016;51(6):689–698
21. Jankovic S, Aleksic Z, Dimitrijevic B, Lekovic V, Camargo P, Kenney B. Prevalence of human cytomegalovirus and Epstein‐Barr virus in sub‐ gingival plaque at peri‐implantitis, mucositis and healthy sites. A pilot study. Int J Oral Maxillofac Surg. 2011;40:271–276
22. Faot F, Nascimento GG, Bielemann AM, Campao TD, Leite FR, Quirynen M. Can peri‐implant crevicular fluid assist in the diagnosis of peri‐implantitis? A systematic review and meta‐analysis. J Periodontol. 2015;86:631–645.
23. Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T. Effectiveness of implant therapy analyzed in a Swedish population: prevalence of peri‐implantitis. J Dent Res. 2016;95:43–49.
24. Gulabivala K, Ng YL, Gilbertson M, Eames I. The fluid mechanics of root canal irrigation. Physiol Meas. 2010;31(12):R49-84.
25. Lee SJ, Wu MK, Wesselink PR. The effectiveness of ultrasonic irrigation to remove artificially placed dentine debris from different-sized simulated plastic root canals. Int Endod J 2004;37:607-12.
26. Weber C, Scott B, McClanahan SB, Miller GA, Diener-West M, Johnson JD. The effect of passive ultrasonic activation of 2% chlorhexidine or 5,25% sodium hypochlorite on residual antimicrobial activity in root canals. J Endod. 2003;29:562-4
27. de Moor RJ, Blanken J, Meire M, Verdaasdonk R. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 2: evaluation of the efficacy. Lasers Surg Med. 2009;41:520-3.
28. Ibrahim Elgali,Omar Omar,Christer Dahlin,Peter Thomsen (2017) Guided bone regeneration: materials and biological mechanisms revisited, Volume125, Issue5, 315-337
29. Moghaddas H, Soltani L, Moghaddas O. Efficacy of palatal connective tissue graft as a membrane in the treatment of intrabony defects. J Periodontol Implant Dent 2010;2:70-6.
30. Esfahanian V, Moghaddas H, Moghaddas O. Efficacy of connective tissue as a membrane with an organic bone using platelet-rich plasma in the treatment of intrabony vertical defects. Journal of Isfahan Dental School 2012;8:1-17.
31. Tomar GB, Srivastava RK, Gupta N, Barhanpurker AP, Pote ST, Jhaveri HM, et al. Human gingiva-derived mesenchymal stem cells are superior to bone marrow derived mesenchymal stem cells for cell therapy in regenerative medicine. Biochem Biophys Res Commun 2010;393:377-83
32. Finley JM, Acland RD, Wood MB.Revascularized periosteal grafts--a new method to produce functional new bone without bone grafting. Plast Reconstr Surg 1978;61:1-6
How to Cite
STOJCEVSKA, Daniela Cvetanovska et al. PERI-IMPLANTITIS- TIPS IN SURGICAL APPROACH. Journal of Morphological Sciences, [S.l.], v. 5, n. 3, p. 139-152, dec. 2022. ISSN 2545-4706. Available at: <>. Date accessed: 09 feb. 2023.