Peri-implantitis surgery: submerged or not matters less than the patient in front of you

Reconstructive surgery is a common approach to peri-implantitis, but clinicians still debate whether covering the graft with a submerged healing approach offers real advantages over a non-submerged (open) approach. This retrospective study compared both modalities over 2 years, including their relative cost-effectiveness.

The authors analyzed records of 33 patients (53 implants) treated for peri-implantitis with reconstructive surgery, using either submerged or non-submerged healing, combined with grafting alone or grafting plus a collagen membrane. Treatment success was defined by a composite of absence of suppuration, minimal or no bleeding on probing, probing depth reduction, no additional marginal bone loss, and limited mucosal recession. Clinical, radiographic, and patient-reported outcomes were recorded, alongside a cost-effectiveness analysis by treatment-cost category.

Overall treatment success did not differ significantly between submerged and non-submerged healing, though the submerged approach trended toward higher success across follow-up. Both approaches produced significant improvements in plaque index, bleeding on probing, probing depth, and suppuration over time. Patient-reported outcomes favored the submerged group, with less pain/discomfort and higher esthetic and satisfaction scores. A history of periodontitis and a greater baseline probing depth independently predicted worse outcomes at 2 years, regardless of technique.

Clinical relevance: for practical purposes, submerged and non-submerged healing achieve comparable clinical success in peri-implantitis reconstructive surgery — so the choice can reasonably be guided by patient comfort and esthetics, where submerged healing has a documented edge, rather than by an assumption that one technique is clinically superior. The stronger predictors of failure were patient-related — a periodontitis history and deeper baseline pockets — a reminder that case selection matters as much as surgical technique.