Threshold for Implant Removal in Peri-implantitis Defects. Is There Any?
This article aims to comprehensively address and discuss the thresholds for implant removal in cases of severe peri-implantitis. Electronic databases were searched comprehensively, electronically, and manually. Studies focusing on criteria for explantation of dental implants were included and reviewed comprehensively. Based on the latest evidence, explanation thresholds were proposed. Moreover, the included studies were evaluated and summarized. Current guidelines for implant removal are primarily based on expert opinions rather than actual data. Standardized data encompassing the extent of peri-implant bone loss for assessing treatment outcomes after surgical intervention for peri-implantitis is scarce. Nevertheless, newly available data confirms a poor prognosis for implants with more than 50% bone loss. This supports the recommendation for implant removal in cases of more than 50% bone loss due to peri-implantitis. Implant mobility resulting from the total loss of osseointegration necessitates the removal of the implant. While probing depth provides information about disease severity, it should not be used as the sole diagnostic tool. In the decision-making process for treatment or explantation, factors such as the number of affected implants, the implant’s position within the bony housing, intraosseous defect morphology, type of implant restoration, and patient characteristics should be considered. The removal of severely compromised dental implants with peri-implantitis and bone loss exceeding 50% is supported. Moreover, factors related to the restoration, the implant itself, and the patient must be considered when deciding whether to remove or salvage a compromised implant. Clear clinical guidelines for explanting dental implants in cases of severe peri-implantitis need to be included. This poses significant challenges to clinicians when determining whether to explant or treat dental implants compromised by substantial bone loss.

(a) Periapical radiograph depicting implants #18 and #19 with peri-implantitis and severe bone loss at implant #18. (b) CBCT scan displaying implant #18. (c) Site after the removal of implant #18. (d) Explanted implant #18.

The survival rate of all implants, including respective and regenerative surgery (a), implants treated with resection surgery only (b), or regenerative surgery only (c) after surgical treatment of peri-implantitis according to initial % of bone loss (Ravidà et al 2022).

Illustration of the percentage of bone loss within a periapical radiograph of a single bone-level implant. Measurements are taken from the implant shoulder to the base of the bone defect.

(a) Single implant #4 with severe bone loss due to peri-implantitis. (b) Explantation of implant #4.

(a) Implant #10 with buccal placement. (b) Periapical radiograph implant 10 with peri-implant bone loss. (c, d) Removal of implant #10.

(a) Implant-supported bridge #28-30 with signs of inflammation (eg, bleeding on probing). (b) Periapical radiograph implant #30 with severe peri-implant bone loss. (c) Peri-implant bony defect after flap deflection. (d) Situation after removal implant #30.
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