Effective management of peri-implantitis aims to decontaminate the infected implant surface and reduce the peri-implant pocket depth to ≤5 mm.
To achieve this, various strategies have been proposed, drawing from periodontal therapy and encompassing both non-surgical and surgical interventions.
Despite numerous attempts to treat peri-implantitis through non-surgical means, such as mechanical debridement or flapless approaches, often coupled with adjunctive measures like antibiotics or laser therapy, clinicians have observed limited improvements in clinical parameters, such as peri-implant probing pocket depth (PPD) reduction and bleeding on probing (BoP).
The challenge lies in gaining proper access to implant surfaces for thorough decontamination and biofilm removal, particularly in cases with deep peri-implant pockets and diverse implant surface designs.
Accordingly, the European Federation of Periodontology (EFP) S3 clinical guidelines recommend using non-surgical protocols to establish healthier peri-implant soft tissue conditions before considering adjunctive surgical therapy.
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Surgical intervention necessitates a meticulous assessment of patient and implant factors influencing early healing and long-term outcomes.
The surgical procedure typically involves raising a full-thickness flap to access the contaminated implant surface, followed by degranulation of soft tissue defects and thorough peri-implant surface decontamination.
Various hand- and power-driven devices have been proposed over the years to maximise biofilm removal while preserving the integrity of the titanium implant surface.
However, no single device has demonstrated superiority in peri-implant surface decontamination.
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Recent advancements include a novel electrolytic cleaning device that applies a voltage to the implant fixture while delivering a sodium formate solution directly onto the titanium implant surface.
Despite promising pre-clinical and short-term clinical results, routine use of this device is not currently recommended.
In light of available evidence, a dual approach combining mechanical and chemical decontamination is advised before evaluating the configuration of peri-implant bone defects.
From a clinical standpoint, two major treatment modalities emerge:
a. Access flap procedures, possibly combined with resective techniques or implantoplasty, and
b. Reconstructive procedures aimed at restoring lost peri-implant bone using bone substitutes.
