Peri-implantitis in the esthetic zone: a guideline for decision making and treatment modalities

A clinical case series is presented in this practice guideline review that identifies the various types of peri-implantitis defects in the esthetic zone along with their therapeutic management. Remediation of problems in the esthetic zone requires meticulous attention to preserving the pre-existing esthetics and the employment of biologically-sound surgical approaches that allow for such, all while resolving the underlying disease. The aim of this report is to provide a clinically-oriented guideline for the clinician who is often faced with treating such complex problems. Diagnosing and identifying the various factors that may influence the clinical end result is critical. There are three possible scenarios of peri-implantitis in the esthetic zone, categorized dependent upon the absence or presence of bone loss or soft tissue loss. The first scenario consists of a peri-implant soft tissue deformity with no accompanying bone loss; the second, a peri-implant hard tissue defect with no soft tissue loss; and the third describes a combination of both hard and soft tissue loss. In addition to elaborating on these different scenarios, this report will explain the biologicallyand prosthetically-based decision making process and treatment modalities for each and demonstrate via a case series the clinical management of such defects.