Apical approach to the treatment 
of peri-implantitis in the esthetic zone: nonincised papillae surgical approach (NIPSA). Case reports.

Objective: Advanced peri-implantitis treatment is a clinical challenge. Reconstructive surgery is not suggested in defects with limited bony walls and/or in those with a suprabony defect. All studies of peri-implantitis reconstructive surgery have considered a marginal surgical approach. However, in the present case report, a new apical approach is presented for the reconstruction of an advanced peri-implantitis lesion.
Materials and method: First, a non-surgical phase combines prosthetic, mechanical, and chemical strategies. Second, a surgical phase combines the apical nonincised papillae surgical approach (NIPSA) with biomaterials and a connective tissue graft.
Conclusion: Successful results have been obtained when using a NIPSA for the treatment of peri-implantitis, despite the unfavorable characteristics of the peri-implant defect.