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.