Advanced peri-implantitis in the esthetic zone: a case for staged explantation over early re-implantation

Advanced peri-implantitis in the esthetic zone represents one of the most demanding clinical scenarios in implant dentistry: bone loss is often extensive, soft tissue architecture is compromised, and the stakes — both functional and esthetic — are high. This article by Spînu and colleagues addresses a question that many clinicians face but few protocols clearly answer: when explantation is inevitable, how should it be staged, and when is the right moment to re-implant?

The authors present a case-based investigation centered on a staged approach — deliberate explantation followed by a structured healing and regenerative phase before delayed re-implantation. The methodology draws on a systematic clinical sequence: implant removal using minimally traumatic techniques to preserve residual bone, thorough decontamination of the site, guided bone regeneration (GBR) with appropriate barrier membranes and grafting materials, and a defined waiting period before new implant placement. Soft tissue management is integral to the protocol, particularly given the esthetic demands of the anterior maxilla.

The findings support the viability of this staged approach in achieving adequate bone volume restoration and favorable soft tissue contours prior to re-implantation. Sites treated with GBR following explantation demonstrated sufficient ridge dimensions to accommodate new implants with primary stability. The delayed timeline — allowing full graft maturation before loading the regenerated site — appears to be a key determinant of success. Peri-implant tissue health at follow-up was maintained, with no recurrence of peri-implantitis reported in the re-treated cases.

The clinical relevance of this work is substantial. It challenges the reflex toward immediate or early re-implantation after explantation, arguing instead for patience and biological sequencing. In the esthetic zone, where marginal bone levels and mucosal zenith directly affect the final restorative outcome, rushing re-implantation into an inadequately healed or incompletely regenerated site risks repeating the same failure. The staged protocol reframes explantation not as a defeat, but as the first step of a deliberate reconstructive strategy.

For periodontists and implantologists managing peri-implantitis cases with advanced bone loss, the take-home message is clear: a staged, biologically driven approach — explant, regenerate, wait, re-implant — can yield predictable outcomes even in compromised esthetic sites. Patient selection, meticulous surgical execution, and adherence to healing timelines remain the pillars of success. This protocol does not eliminate complexity, but it structures it.