Biological Reset Protocol for the Regenerative Treatment of Advanced Peri-implantitis Defects: A Proof of Concept

: This study presents the Biologic Reset Protocol (BRP), a reproducible workflow that integrates prosthetic and surgical phases to improve the predictability of regenerative treatment in intrabony peri-implantitis lesions. The protocol is designed to re-establish peri-implant conditions favorable to long-term tissue stability and proper implant function. The BRP is structured into three sequential phases: (1) a pre-surgical phase, involving the removal of the existing prosthesis to improve diagnostic accuracy, facilitate non-surgical decontamination, and promote soft tissue healing; (2) a regenerative surgical phase based on principles of guided bone and tissue regeneration, favoring a submerged healing approach. This phase involves meticulous implant surface decontamination using air-polishing to preserve the fixture's original biocompatibility, followed by the placement of particulate bone grafting combined, when necessary, with a stabilized membrane; and (3) a final prosthetic phase which may include prosthetic refinement or replacement to ensure biologically favorable design and prevent disease recurrence. By integrating current evidence with comprehensive biological, surgical, and prosthetic principles, the BRP offers a structured and predictable framework for the treatment of complex peri-implantitis cases, promoting both regenerative success and the long-term preservation of implant health.