Diederik Hentenaar

157 General discussion and conclusions etiopathogenesis, risk factors and treatment of inflammatory reactions around ceramic implants studies are needed. Based on the various studies described in this thesis, the following specific conclusions can be drawn: • Levels of IL-1β and MMP-8 in PICF show the potential to discriminate between peri- implant health and disease. Non-surgical therapy does not seem to influence the inflammatory immune response ( chapter 2 ); • Limited treatment success should be expected from non-surgical peri-implantitis treatment using either erythritol air-polishing or piezoelectric ultrasonic scaling. Hence, the majority of patients seem to require further surgical treatment after a non-surgical treatment ( chapter 3 ); • Erythritol air-polishing as implant surface cleansing method result the same treatment effect as saline soaked gauzes in the surgical resective treatment of peri-implantitis. However, both therapies seem to result in low treatment success up to 1-year after treatment. ( chapter 4 ); • The application of 35% phosphoric acid after mechanical debridement is superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant does not seem to enhance clinical outcomes on a 3-month follow-up. ( chapter 5 ); • The cervical crown contour at platform-switched, posteriorly placed, two-piece implants does not seem to show a correlation with peri-implant marginal bone loss and soft-tissue health up to 5 year after implant placement ( chapter 6 ). 7