Branemark et al. conducted the first experimental trial with titanium dental implants and created a new vision by defining the term “osseointegration” in the 1960s. Despite the advances in implant technology and protocols and the accumulating evidence in the literature, implant failure/loss may still occur due to several reasons. On the other hand, although dental implant therapy is a successful treatment option for edentulous patients, it may lead to undesired complications after the insertion of the implant such as implant mobility, radiolucency around the implant, and inflammation of peri-implant tissues, or subjective complaints from the patients. Peri-implantitis is a major complication of implant treatment characterized by inflammation of the soft tissues surrounding implants combined with loss of bone. If this complication is not treated appropriately, implant retrieval may be necessary. On the other hand, the primary reasons for an unsuccessful implant treatment include anatomical complexity, inexperience of the surgeon, poor oral hygiene, and smoking.

The most undesired complication in implant therapy is peri-implantitis which leads to retrieval of a dental implant. Similar to gingivitis and periodontitis, the main etiologic factor for peri-implant mucositis and peri-implantitis is microbial dental plaque. Once an implant is inserted, bacterial colonization begins to occur on its surface. The primary goal in nonsurgical treatment of peri-implant mucositis and peri-implantitis is to eliminate or reduce the bacteria levels in the peri-implant area and, ultimately, to re-establish a clinically healthy environment. However, with conventional treatment modalities, it is often difficult to eradicate microorganisms from threads and rough surfaces. Instead, a number of techniques including laser treatment, air abrasion, citric acid application and conventional mechanical therapy have been used in peri-implantitis therapy. Nevertheless, despite the use of different techniques, complete elimination of pathogens around the implants may not always be possible. In particular, adequate decontamination may not be achieved due to the difficulty of attaining sufficient access to all the dental implant surfaces.

In the present study, a novel approach for peri-implantitis treatment is described, in which the infected implants are removed and the surface treatment is performed extra-orally due to the difficulty of implant surface decontamination inside the bone, and the implants are inserted into the bone for a second time after decontamination.

The aim of this study was to evaluate the implant-bone integration after the removal of an infected implant from the bone and to compare the success rate of this approach with that of new implants by using resonance frequency analysis and histomorphometry.