Nonsurgical treatment of periimplantitis plus a free gingival graft. Case series validating a two-step procedure.

BACKGROUND: Periimplantitis is an inflammatory condition characterized by soft tissue inflammation and progressive bone loss. A lack of keratinized mucosa (KM) is associated with periimplant complications. The present case series evaluates a two-step approach combining nonsurgical treatment with KM augmentation. MATERIALS AND METHODS: Four nonconsecutive patients diagnosed with periimplantitis and a deficiency of periimplant KM were treated between January 2015 and December 2021 in a private practice setting in Barcelona, Spain. A standardized two-step protocol was performed: Initial nonsurgical debridement with antibiotics and chlorhexidine irrigation, followed by a free gingival graft (FGG) 8 weeks later to augment the KM. All procedures were performed by the same experienced periodontist. Follow-up periods ranged from 1 to 7 years. RESULTS: All patients showed resolution of inflammation, absence of bleeding or suppuration on probing, and radiographic bone gain. Soft tissue stability and an increase in the KM band were observed across all cases. No complications or adverse events were reported. CONCLUSIONS: The combination of nonsurgical periimplantitis treatment followed by an FGG appears to enhance disease resolution and long-term soft tissue stability. Further clinical trials are needed to validate this protocol.