Peri-implantitis is a treatable disease that affects functioning osseointegrated implants. Although unfavorable mechanical loading may play a contributing role, peri-implantitis seems to be mediated primarily by the endotoxins from gram-negative bacteria and the host response around the implant site. Many patients who were previously considered unfavorable candidates for implant therapy are being treated successfully when certain treatment considerations and implant maintenance programs are implemented. It is essential that implant surgeons have a firm understanding of the favorable aspects of implant design and the potential liabilities when these systems are placed in unfavorable clinical conditions. Studies have demonstrated that the same potential benefits of implant materials and surface characteristics also may lead to increased failure rates when these implants are affected by peri-implantitis. In the presence of adequate apical osseointegration, compromised implants that present with peri-implantitis must undergo thorough dbridement and be decontaminated before any attempt at GBR. GBR may be accomplished successfully with many different types of membranes and grafting materials if the implant surface is thoroughly decontaminated before regenerative therapy. Implant salvage is an important, yet often ignored, component of clinical practice that can prevent implant and prosthetic failure if the principles of decontamination, biomodification, and guided tissue regeneration are understood and followed.
