The Osteology Foundation joined the ISPRD Congress in Boston as a collaboration partner, delivering a well-attended and clinically focused session on peri-implant disease on 12 June 2025. Held as part of the main scientific program, the session drew a full room of up to 400 participants and offered a deep dive into the aetiology, treatment, and surgical reconstruction of peri-implant conditions.

The session was moderated by Sejal Thacker and Pooyan Refahi, both members of the National Osteology Group (NOG) USA leadership, who also introduced the group’s growing network and educational activities. Frank Schwarz opened the session with an overview of the Osteology Foundation and its mission to advance oral regeneration through research and clinical education.

From dysbiosis to defect reconstruction: a full spectrum of peri-implant disease

The three invited speakers Purnima Kumar (USA), Frank Schwarz (Germany), and Istvan Urban (Hungary) covered key aspects of peri-implant pathology from different clinical perspectives.

Purnima Kumar presented on the aetiology of peri-implant diseases, pointing to microbial dysbiosis as a primary driver of disease progression. Highlighting findings from molecular and computational studies, she emphasised that peri-implantitis represents more than just bacterial overload, it is a chronic, non-healing wound shaped by the patient’s immune response.

Kumar challenged the routine use of prophylactic antibiotics or aggressive surface decontamination, warning that they may disrupt beneficial bacteria. “Peri-implant health depends on a balanced microbiome,” she noted. She urged clinicians to tailor treatment to individual risk profiles and consider implant surface characteristics carefully, particularly in patients with systemic disease or inflammatory tendencies. Early identification and treatment of peri-implant mucositis, she argued, remains the best opportunity to prevent progression.

Frank Schwarz focused on surgical versus non-surgical management of peri-implantitis. He underscored the limited efficacy of non-invasive approaches and reviewed current evidence supporting reconstructive techniques. Citing recent data from a 2025 review by Ramanauskaite et al., Schwarz explained that bone substitutes with low resorption rates show better outcomes than autogenous grafts in defect regeneration. “Reconstructive treatment is viable, especially in contained defects,” he said, but added that barrier membranes and biologics have not yet demonstrated clear additional benefit in controlled studies.

Istvan Urban addressed one of the field’s most technically demanding procedures: vertical defect reconstruction. With the rise in implant failures, trauma, and graft loss, Urban noted that clinicians are increasingly confronted with large vertical deficiencies. He shared protocols for Guided Bone Regeneration (GBR), emphasising tension-free flap design, stable membrane placement, and patient selection. His case series illustrated both the complexity and the potential of GBR in restoring severe defects.

Clinical Dialogue and Shared Experience

The session concluded with a panel discussion moderated by Thacker and Refahi. Clinical cases were used to explore treatment decision-making, from early-stage mucositis to advanced peri-implantitis. Questions from the audience covered practical challenges such as decontamination strategies, graft selection, and maintenance protocols.

The Osteology Foundation thanks congress chairs Gustavo Avila-Ortiz and Oscar Gonzalez-Martin, as well as Quintessence Publishing, for their support in making the session possible.