[Constructive complications in dental implantology (clinical case series)]. / Konstruktivnye oslozhneniya v dental'noi implantologii (na primere klinicheskikh sluchaev).

The aim the study. Analyze errors in planning orthopedic treatment using dental implants using the example of clinical cases. MATERIALS AND METHODS: Two patients are presented who applied for a consultation at the orthopedic and surgical department of the Federal State Budgetary Institution National Medical Research Center Central Research Institute of Chronic and Peripheral Surgery of the Russian Ministry of Health regarding a fracture of a previously installed orthopedic structure on an implant. For diagnostic purposes, computed tomography was performed to determine the condition of the implants and teeth of the upper and lower jaws. RESULTS: The patients were found to have: a fracture of an implant 4.0*10 with a single orthopedic structure in the area of tooth 4.6 (the patient did not undergo restoration of the missing tooth 4.7 in the presence of an antagonist), a fracture of small diameter implants (3.5*9) in the area of 3.6, 3.7, prosthetic combined orthopedic crowns. CONCLUSIONS: During surgical and orthopedic treatment of patients, it is necessary to strictly follow the instructions developed by the manufacturer of dental implants and the STaR recommendations.

Complications and treatment errors in periodontal and implant therapy.

The assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the "net benefit ratio" between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.

Surgical peri-implantitis treatment with and without guided bone regeneration. A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of reconstructive peri-implantitis treatment. MATERIALS AND METHODS: Forty participants, with peri-implantitis and a contained intraosseous defect, were randomized to access flap (control) or access flap with xenograft and collagen membrane (test). All received systemic antimicrobials. Blinded examiners recorded probing depths (PD), bleeding and suppuration on probing (BOP & SOP), soft tissue levels, and marginal bone levels (MBL) at baseline and 12 months. Patient reported outcomes were recorded. The primary outcome was PD change. RESULTS: All 40 participants (40 implants) completed the 12-month study. The mean (standard deviation) PD reduction (deepest site) was 4.2 (1.8) mm in the control and 3.7 (1.9) mm in the test group. MBL gain (deepest site) was 1.7 (1.6) mm in the control and 2.4 (1.4) mm in the test group. Absence of BOP & SOP was observed at 60% of both control and test implants. Buccal recession was 0.9 (1.6) mm in the control and 0.4 (1.1) mm in the test group. A successful outcome (absence of PD ≥ 5 mm with BOP, absence of SOP and absence of progressive bone loss) was achieved for 90% of the control and 85% of test group implants. No statistically significant differences in clinical or radiographic parameters were found between treatment groups. 30% of participants experienced mild gastro-intestinal disturbances. Reporting followed CONSORT guidelines. CONCLUSION: Similar clinical and radiographic improvements at 12 months were observed with high levels of patient satisfaction for both the access flap and xenograft covered by collagen membrane groups. Registered clinical trials.gov. ID:NCT03163602 (23/05/2017).

[Sublingual artery injury during dental implantation using a surgical navigation guide]. / Povrezhdenie pod"yazychnoi arterii pri dental'noi implantatsii s primeneniem khirurgicheskogo navigatsionnogo shablona.

The article presents a clinical case of hemorrhage due to sublingual artery injury during the installation of four dental implants in the lower jaw using a surgical navigation guide. In a detailed analysis of the case and the surgery, the main cause of this complication was determined. It must be taken into account while planning a surgery on edentulous jaws or with the single-stage full dental extraction on the lower jaw. Ensuring strict guide immobility is essential for correct drilling, wherefore it is necessary to make a fixing key in the occluder or articulator.

[Long-term results of dental implantation in military personnel]. / Otdalennye rezul'taty dental'noi implantatsii u voennosluzhashchikh.

BACKGROUND: Currently, the use of the dental implantation method for the medical service of the Armed Forces of the Russian Federation is quite new. The method of dental implantation makes it possible to eliminate defects in the dentition of military personnel and other contingents eligible for medical care in military medical institutions of the Ministry of Defense of Russia. OBJECTIVE: The aim of the study is to substantiate the medical effectiveness of the use of dental implantation in military healthcare. MATERIAL AND METHODS: The study was conducted on the basis of the Department of Maxillofacial Surgery and Surgical Dentistry of the Military Medical Academy named after S.M. Kirov. The study is based on the analysis of long-term results of dental implantation according to medical histories and outpatient records. The study was conducted in 3 stages: stage 1 - study of the medical histories of patients who underwent dental implantation; stage 2 - examination of patients with dental implants and analysis of long-term results; stage 3 - a patient questionnaire was conducted to determine the effectiveness of dental implantation. RESULTS: The structure of complications during dental implantation was revealed. Clinical examples of long-term results of prosthetics using dental implants are presented. It has been established that due to the peculiarity of military service and the remoteness of the locations of military units from the military medical organization, it is not always possible to conduct regular medical examinations and examinations of patients. To identify early symptoms of peri-implantitis, which is more often asymptomatic, preventive examinations of military personnel should be carried out 1-2 times a year. CONCLUSION: To increase the service life of an orthopedic structure with installed dental implants, regular preventive examinations of patients to identify pathological processes are important. In favor of implantation, there is a choice for some categories of military personnel. This is especially important for flight and naval personnel, since dentures installed on dental implants are the only way to preserve their professional suitability in the military accounting specialty. The presence of teeth and the absence of removable dentures is an important requirement when performing combat missions.

Which experimental models and explorations to use in regenerative endodontics? A comprehensive review on standard practices.

Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.

Postmortem evaluation of neuromuscular damages more extensive than the surgical intervention area after iliac crest bone graft.

Several complications may occur following iliac bone grafting, one of the common sites for autologous bone harvesting. Of these, it is difficult to localize the damage in neurological complications due to the presence of several nerves in a similar distribution area with variations among individuals. To minimize these complications, conventional clinical anatomical studies using normal human cadavers have estimated the theoretical neurological damage area corresponding to the surgical intervention area. We report a case of neuromuscular damage in a 93-year-old woman who had an iliac crest defect after a bone graft, based on the virtual and physical dissections with histological confirmations.In this study, the patient was confirmed to have severe neuromuscular complications with major complications including a hernia protruding through the iliac defect. One of the two ilioinguinal nerves was extracted with the hernia sac through the iliac defect, and its distal part was completely damaged. The iliohypogastric nerve, which was far from the defect foramen, also showed remarkable fibrosis and demyelination, affected by the degeneration of the transversus abdominis muscles.The present anatomical findings show that the area of eventual neuromuscular damage should be estimated to larger than the conventionally predicted area of direct nerve damage, which is usually concomitant with the surgical intervention area.

Frequency and location of the zygomaticofacial foramen and its clinical importance in the placement of zygomatic implants.

PURPOSE: Anatomical knowledge of the zygomatic region is important, because the zygomatic nerve and its branches may suffer lesions during surgical procedures in the periorbital region. The position and frequency of zygomaticofacial foramina (ZFF) may vary between individuals, and between one side and the other in the same individual. In the present study, we analysed the presence and location of ZFF, as well as the distance between them and the orbital cavity, in macerated skulls of adult individuals. METHODS: We examined 287 macerated skulls, of individuals of both sexes, analysing the frequency and location of ZFF and the distance from the ZFF to the margin of the orbital cavity (OC). RESULTS: Zygomaticofacial foramina are very frequent structures which tend to appear singly. They are generally located in the temporal process of the zygomatic bone, but in many cases, they may be located in the mid portion of the bone. They also tend to appear at the same distance from the OC when left and right sides are compared. Sex was an important factor in determining differences in ZFF; the distance from the ZFF to the margin of the OC was greater in males than in females. Sex, age, side and skin colour did not affect the frequency and location of the ZFF. CONCLUSION: We consider that the mid portion of the zygomatic bone is the safest place to anchor zygomatic implants (ZI), since ZFF are less frequently located there than in the temporal process of the zygomatic bone.

Removal of the Dental Implant Displaced Into the Maxillary Sinus Through the Inferior Nasal Meatus via Transnasal Endoscopy.

Worldwide, the reconstruction of the posterior edentulous maxilla with dental implants has become a common practice in clinical settings. However, the poor bone condition in this area is sometimes accompanied by complications. Dental implant displacement into the maxillary sinus is viewed as a rare complication. A case of a 72-year-old man in whom an endoscopic technique was used to remove a dental implant that had been mistakenly planted into the maxillary sinus was reported in this study. The authors approached the sinus through the inferior nasal meatus, and the dental implant was removed through the widened ostium. The endoscopic surgical approach described in this study is reliable and minimally invasive for removing residual roots displaced into the maxillary sinus. Therefore, it has been concluded that this clinical procedure is worth using.

Effect of cleaning methods on retentive values of saliva-contaminated implant-supported zirconia copings.

OBJECTIVE: The aim of this study was to evaluate the effect of different cleaning regimens on retentive strength of saliva-contaminated implant-supported zirconia copings. MATERIAL AND METHODS: Seventy solid titanium abutments with 5.5 mm height (Straumann) were attached to the regular neck implant analogs (Straumann). The abutment-analog complex was mounted vertically in an autopolymerized T-shaped acrylic resin block. Seventy zirconia copings with an occlusal loop were made. The copings were contaminated with fresh human saliva for 1 min (except the control group). Afterward, the specimens were washed with water spray for 15 s and dried for 15 s. The copings were divided into seven groups according to cleaning methods (n = 10). Group 1: no contamination (control group); Group 2: water spray rinsing; Group 3: airborne particle abrasion; Group 4: immersion in 96% isopropanol; Group 5: applying Ivoclean (Ivoclar Vivadent); Group 6: applying 1% sodium hypochlorite; and Group 7: applying Monobond Plus (Ivoclar Vivadent). The copings were luted with a resin luting agent (RelyX Unicem; 3M ESPE). After 5,000 thermal cycles, the retentive values of the restorations were tested using universal testing machine. The dislodging forces were analyzed using one-way analysis of variance and the Tukey's HSD tests (α = 0.05). RESULTS: The copings, which were cleaned with Ivoclean and 96% isopropanol, showed the highest retentive values (204.79 ± 44.49 and 232.65 ± 71.36, respectively). There was a significant difference between the studied groups (F = 2.735; p = .02). Tukey's HSD showed that there was no significant difference between the different cleaning procedures and control group except water rinsing group (p = .14). The lowest retentive value was related to the saliva-contaminated group, which were only cleaned with water rinsing method. CONCLUSION: The retentive values of zirconia-based restorations were adversely affected by saliva contaminations. These restorations can be cleaned by Ivoclean, 96% isopropanol, airborne particle abrasion, 1% sodium hypochlorite, or applying Monobond Plus before luting procedures.

Intense, Instantaneous, and Shooting Pain During Local Anesthesia for Implant Surgery.

Administration of local anesthetics is daily routine for most dental practitioners. Normally, the effect is achieved, and no adverse effects are seen. In this article, the authors describe the complications of immediate, intense and shooting pain, numbness, and marked pallor of the cheek, which occurred during infiltration of a local anesthetic in buccal vestibule infiltration. The patients moved suddenly because of pain and marked pallor of the cheek near the root of the nose and lower eyelid pallor was observed. The pain was very short and the injection was performed again after a few minutes. Two patients also reported an alteration of vision or paralysis of the extra-ocular muscles and drooping eyelid due to paralysis of the levator palpebrae superioris muscle and signs of numbness in the infraorbital area on the same side as the anesthesia. While 3 patients were also apprehensive and started to scare with heart palpitations, as they did not understand what was happening. Probably the anesthetic solutions were injected into an intravascular artery and passed from the extraosseous branch of posterior superior alveolar artery through to the infraorbital artery, which could produce the clinical signs observed in the present study. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist. In fact, in the absence of vascular disease, anomalies documented by the dentist, they would, however, respond to professional liability and be liable for damages caused to the patient. In conclusion, despite the fact that this condition requires no treatment, it could lead to the recognition of clinical signs in patient with injection of local anesthesia into the artery. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist.

Perioperative management in a patient with type 1 diabetes mellitus who presented severe hypoglycemia during dental implant surgery: a case report.

BACKGROUND: Patients with type 1 diabetes mellitus (DM) have poor glycemic control owing to extreme impairments in glucose tolerance. There are few reports regarding dental implant surgery in patients with type 1 DM. We describe herein the perioperative glycemic management in an outpatient with type 1 DM who experienced a rare case of severe hypoglycemia during dental implant surgery. Only one such case has previously been reported. CASE PRESENTATION: A 60-year-old male patient diagnosed with type 1 DM was scheduled for dental implant primary surgery. Premedication with peroral antibiotics was carried out to prevent possible systemic infection as a complication of DM. The patient was treated to control intraoperative hypertension with diligent attention to cardiovascular conditions by using a bolus administration of nicardipine and diltiazem. During surgery, he abruptly complained of hypoglycemic symptoms and had a blood glucose level of 32 mg/dL. Following oral administration and electrolyte-combined infusion of glucose, he immediately recovered from the critical situation. The surgical procedure, involving a lower jaw implant fixture placement, was performed as planned and resulted in less invasion, limited to the area of implant fixture placement within the right mandibular region of the two molars, compared to implant surgery that spans the entire lower jaw. CONCLUSIONS: The present case suggests that it is essential to promptly monitor possible signs of hypoglycemia-precipitated acute symptoms in patients with DM. In addition, it is also necessary to appropriately administer insulin with an electrolyte-combined infusion of glucose for deliberate glycemic control; this is particularly true in patients with type 1 DM undergoing relatively highly-invasive oral surgical manipulation such as commonly performed dental implant surgery spanning the entire jaw.

Foreign bodies in the interior of the maxillary sinus: diagnosis by cone beam computed tomography.

To avoid complications, the intimate relation between the maxillary sinus and dental roots deserves attention during surgical procedures. Accidental introduction of foreign bodies, such as dental implants, may irritate the maxillary sinus mucosa, causing sinusitis. Cone beam computed tomography (CBCT) has been proven to be suitable for diagnosis in these cases by providing the exact location of the foreign body. The present article reports 3 cases of foreign bodies inside the maxillary sinus associated with inflammatory processes. Imaging examinations, such as CBCT, are an important tool to assist dentists in diagnosing the presence of foreign bodies in the interior of the maxillary sinus.

A Proposal of New Classification for Dental Implant Complications.

AIM: The aims of this study are to review the available literature related to implant complications and propose a new classification method for dental implant complications. MATERIALS AND METHODS: Dental literature was reviewed via PubMed focusing on articles published in English, which included data regarding dental implants, complications, and classification from January 2000 to January 2018. The author, who has experience with implant placement and restorations for 15 years, and ten of his colleagues, formed a list of implant complications that they have encountered in their practices. RESULTS: After 3,736 articles were found in the initial search, a total of 613 potentially relevant review articles were identified in the database. After the full-text analysis of 25 articles, only 6 review articles with complication classifications were utilized in this study. In addition, a clinically based classification named "Turkyilmaz's Classification of Implant Complications" including three categories was created. Types of complications in these three groups (Mild, Moderate, and Severe) were listed, and some of them were illustrated. Also, recommendations for clinicians were made on how to avoid these problems and/or overcome them. CONCLUSION: It has been suggested that categorical data regarding complications of dental implants are limited, and the new complication classification presented in this article may help clinicians identify and overcome commonly encountered implant complications. CLINICAL SIGNIFICANCE: For clinicians, it is important to know possible complications regarding dental implants. In this article, a group of dentists created and suggested a new classification for implant complications, which may help clinicians identify commonly encountered complications and how to handle them in the clinic.

Microbiome of dental implants and its clinical aspect.

Although dental implants are most common prosthetic treatment used to replace missing tooth, it gained considerable importance over a decade owing to the availability of advanced imagery techniques that can help in achieving a greater success rate and much better osseointegration. However, the chances that the implanted tooth can be rejected due to inflammation caused by oral microflora still persist. This review gives the viewers an overall idea of the dental implants, role of advanced imaging in implantation and instances of peri-implantitis that occur after implantation process. This review also entails the latest research on the different treatment modalities against peri-implantitis documented in peer-review journals.

The predictive value of microbiological findings on teeth, internal and external implant portions in clinical decision making.

AIM: The primary aim of this study was to evaluate 23 pathogens associated with peri-implantitis at inner part of implant connections, in peri-implant and periodontal pockets between patients suffering peri-implantitis and participants with healthy peri-implant tissues; the secondary aim was to estimate the predictive value of microbiological profile in patients wearing dental implants using data mining methods. MATERIAL AND METHODS: Fifty participants included in the present case─control study were scheduled for collection of plaque samples from the peri-implant pockets, internal connection, and periodontal pocket. Real-time polymerase chain reaction was performed to quantify 23 pathogens. Three predictive models were developed using C4.5 decision trees to estimate the predictive value of microbiological profile between three experimental sites. RESULTS: The final sample included 47 patients (22 healthy controls and 25 diseased cases), 90 implants (43 with healthy peri-implant tissues and 47 affected by peri-implantitis). Total and mean pathogen counts at inner portions of the implant connection, in peri-implant and periodontal pockets were generally increased in peri-implantitis patients when compared to healthy controls. The inner portion of the implant connection, the periodontal pocket and peri-implant pocket, respectively, presented a predictive value of microbiologic profile of 82.78%, 94.31%, and 97.5% of accuracy. CONCLUSION: This study showed that microbiological profile at all three experimental sites is differently characterized between patients suffering peri-implantitis and healthy controls. Data mining analysis identified Parvimonas micra as a highly accurate predictor of peri-implantitis when present in peri-implant pocket while this method generally seems to be promising for diagnosis of such complex infections.

Floor-of-Mouth Hematoma Following Dental Implant Placement: Literature Review and Case Presentation.

PURPOSE: The authors provide a structured review of reported cases of floor-of-mouth hematoma during or after dental implantation and frequent causes and management and present a related case. MATERIALS AND METHODS: An online search of the medical literature was conducted from 1990 through 2016. The following search terms were used: floor of mouth hematoma, sublingual hematoma, dental implant hematoma, implant in mandible, and complication of dental implant. Abstracts were screened for relevance to the aims of the review. Relevant reports in the English language were included and referenced. The articles were reviewed for patient demographics, implant location, coagulopathy, pre- or postoperative imaging, airway management, treatment of the hematoma, and management of the offending implant. RESULTS: The literature search identified 25 reported cases. Hemorrhage was caused by perforation of the lingual cortex in 84% of cases (n = 21). Airway obstruction resulted in emergency intubation or tracheostomy in 68% of patients (n = 17). Most cases (n = 18; 72%) required surgical management in the hospital setting. Management of the offending implant was reported inconsistently. Of 17 reported cases, 5 implants had to be removed, 9 remained in situ, and in 3 cases implant placement was abandoned. Only 1 case involved preoperative 3-dimensional (3D) imaging before implant insertion. The authors report on an additional case with a serious floor-of-mouth hematoma that required immediate surgical evacuation and hemostasis. CONCLUSION: Serious complications, such as floor-of-mouth hematoma after dental implant insertion, can occur, which could be life-threatening. Preoperative 3D imaging helps to visualize the individual mandibular shape, which could decrease the incidence of serious complications. If injury to vessels of the floor of the mouth cannot be confidently excluded, then further assessment and treatment are recommended before the patient is discharged.

Primary Stability of Cylindrical and Conical Dental Implants in Relation to Insertion Torque-A Comparative Ex Vivo Evaluation.

INTRODUCTION: The aim of this ex vivo study was to investigate the influence of different insertion torques on primary stability of a conical and a cylindrical implant system. MATERIALS AND METHODS: Thirty-two dental implants (Astra Tech OsseoSpeed 5.0 S × 11 mm cylindrical [n = 16] and 5.0 × 11 mm conical [n = 16]) were inserted with 20, 30, 40, and 45 N·cm into fresh porcine bone of mixed trabecular-cortical quality. Before insertion, bone quality was assessed via cone beam tomography. After insertion, resonance frequency analysis was reported using the implant stability quotient (ISQ). Implant insertion depths were evaluated, and the implants were pushed out of the bone by force (measured in N). All experiments were done with n = 4 per group. RESULTS: The highest ISQ (mean 78.25 ± 2.9) and pushout values (mean 675 N ± 5.8) were measured for the cylindrical implant after insertion using 30 N·cm. The conical implant showed the highest primary stability by means of ISQ (mean 76.25 ± 2.2) and pushout force (mean 502.5 N ± 9.6) after an insertion torque of 40 N·cm. If more insertion force was used, primary stability was reduced in all cases. CONCLUSION: The data indicate that different forms of an implant system need different insertion torques to obtain an optimal primary stability. These results have to be verified clinically.

A Survey of the Opinion and Experience of UK Dentists: Part 2: Risk Assessment Strategies and the Management of Iatrogenic Trigeminal Nerve Injuries Related to Dental Implant Surgery.

BACKGROUND: Dental implant-related iatrogenic injuries are proportionally increasing with dental implant surgery. This study assessed the experience of implant-related trigeminal nerve (TG) injuries among UK dentists. Risk management strategies and management of implant-related inferior alveolar nerve (IAN), mental nerve (MN), and lingual nerve injuries were investigated. METHODS: A survey was distributed among 405 dentists attending an Association of Dental Implantology (ADI) congress, of which 187 completed the survey. RESULTS: Most dentists (76% of 134 responses) allowed a 2 to 4 mm safety zone radiologically above the IAN when placing implants, and over half of the responders (56%) used implants that were 10 mm in length. The most frequent precautionary measure used by 73 (80%) responders was antibiotic coverage routinely to reduce the risk of infection when placing grafts in the posterior mandible. Other precautionary measures included unilateral staging of implant placement (57%), and 43% always identified the MN when placing implants. Nineteen dentists used steroids (eg, dexamethasone) routinely preoperatively and postoperatively. Twenty-six dentists used basic cone-beam CT (CBCT) minimally invasive techniques, and drill stops during implant placement were used by 14 responders. Although it is not highly recommended, steroids were used to manage the neuropathic pain and discomfort experienced by patients with IAN injuries in 40% of cases. CONCLUSION: Further training of dentists undertaking implant surgery is required so that they acquire up-to-date and evidence-based knowledge and skills in the prevention, diagnosis, and management of dental implant-related TG injuries. This training should also involve the justification and interpretation of CBCTs.

Management of peri-implantitis - A contemporary synopsis.

Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.