Implantoplasty for peri-implantitis: how far into the defect is worth the recession risk?

Peri-implantitis management remains one of the most clinically demanding challenges in implant dentistry. A central unresolved question concerns the role of implantoplasty — mechanical surface decontamination through carbide bur recontouring — and specifically how far it should extend into the defect architecture to maximize outcomes.

This single-center, prospective, quasi-randomized controlled trial by Monje and colleagues addressed precisely that question, comparing two approaches within a combined surgical protocol: partial-length implantoplasty (PLIP), limited to the supracrestal implant surface, versus full-length implantoplasty (FLIP), extending the surface modification to include the intrabony component as well. All cases presented with peri-implantitis and an intrabony defect depth of at least 3 mm — a subset of defects considered amenable to regenerative reconstruction.

The surgical protocol combined implantoplasty with guided bone regeneration of the intrabony compartment, and outcomes were evaluated at 12 months. The primary endpoint was probing pocket depth reduction, with sample size calculated accordingly. Disease resolution was assessed through a composite endpoint integrating clinical (probing depth, bleeding on probing, suppuration) and radiographic criteria. Statistical analysis used generalized estimating equations to produce both unadjusted and adjusted odds ratios, accounting for patient-level clustering.

Thirty-three patients were enrolled. Results indicated that combined surgical therapy — regardless of implantoplasty extent — was effective in arresting disease progression and improving peri-implant health at one year. However, FLIP demonstrated superior clinical and radiographic outcomes compared to PLIP, suggesting that extending surface recontouring into the intrabony defect provides measurable additional benefit. The likely mechanism is enhanced biofilm elimination and improved surface characteristics at the regenerative interface.

This benefit, however, was not without consequence. FLIP was associated with greater mucosal recession, which carries aesthetic and biological implications — particularly in sites with thin phenotypes or in the anterior zone. This trade-off is clinically significant and demands careful pre-surgical planning.

The take-home message for the practicing implantologist and periodontist is threefold. First, the combination of implantoplasty and regeneration represents a valid and effective strategy for contained intrabony peri-implant defects. Second, when the defect morphology allows it, extending implantoplasty to the intrabony compartment may improve disease resolution rates. Third — and critically — this decision must be weighed against the risk of recession, which requires thorough patient counseling and case selection based on phenotype, implant position, and aesthetic expectations. As peri-implantitis protocols evolve toward greater individualization, studies like this one provide the granular, technique-level evidence that clinicians need to make informed intraoperative decisions.