Microscope‐assisted implant surface decontamination combined with surgical treatment for peri‐implantitis: A retrospective case series study

Abstract Background This retrospective analysis aims to assess the efficacy of microscope‐aided implant decontamination combined with surgical intervention for peri‐implantitis and identify factors influencing its success. Methods Patients diagnosed with peri‐implantitis in at least one implant and treated with microscope‐assisted implant surface decontamination combined with surgery were evaluated. Clinical and radiographic parameters were assessed at baseline, 1‐year, and 3‐year intervals. Disease resolution, defined as ≤1 bleeding site, probing depth (PD) ≤5 mm, and no bone loss >0.5 mm, was the primary outcome. Multilevel regression analysis identified predictors affecting disease resolution. Results Thirty‐three patients with 50 implants were included. The 1‐year success rate was 92% (N = 46), declining to 80% (N = 40) at 3 years and 76% (N = 38) at final evaluation (37–98 months). At the final visit, 89.4% of implants had PD ≤5 mm, with no suppuration (SUP) in 95.7% of cases. Deepest PD at baseline negatively impacted outcomes. Conclusions Microscope‐assisted implant decontamination combined with surgical treatment is effective for peri‐implantitis management long‐term, serving as a potential reference for implant decontamination procedures. Further randomized controlled trials should investigate this approach's effectiveness compared to non‐microscope‐assisted decontamination. Key points This is the first clinical study to our knowledge to demonstrate the long‐term efficacy (up to 8 years) of a microscope‐assisted, multi‐step decontamination protocol combined with surgery for treating peri‐implantitis. The presented protocol achieved high disease resolution rates of 76%–92%, with significant improvements in probing depth, bleeding, and bone level. Microscopic visualization ensures thorough implant surface cleaning, addressing a critical limitation of conventional blind debridement techniques. This study establishes a potential new standard of care for achieving predictable and sustainable outcomes in the management of advanced peri‐implantitis. Plain Language Summary Dental implants occasionally develop severe infections (peri‐implantitis) that damage supporting bone and gums, often leading to implant failure. To improve treatment, we combined surgery with high‐magnification dental microscopes for precise cleaning of contaminated implant surfaces—enabling clinicians to visually confirm thorough decontamination—followed by bone grafting to regenerate lost tissue. Evaluating 33 patients (50 infected implants) over 3+ years (average 4.5 years), we found 92% of implants successfully controlled infection at 1 year (minimal bleeding, shallow pockets ≤5 mm, no pus, stable bone), declining to 80% at 3 years and 76% at final follow‐up. Bleeding, pus, and deep pockets decreased significantly, while bone levels improved. Implants with deeper initial infections had lower success rates. This microscope‐assisted approach provides effective, lasting management of peri‐implantitis by enhancing cleaning accuracy during surgery, offering a promising clinical strategy. Future studies should compare it directly with non‐microscopic methods.