Peri-implantitis is a progressive inflammatory condition affecting the soft and hard tissues surrounding dental implants, characterized by peri-implant bone loss.
In recent years, both non-surgical and surgical treatment approaches have been refined, supported by strong clinical evidence.
This post aims to provide dental professionals with a comprehensive and up-to-date guide on managing peri-implantitis effectively.
Non-Surgical Management of Peri-Implantitis
Non-surgical treatment is considered the first-line approach, especially in mild to moderate cases. Its primary goals are to reduce microbial load, control inflammation, and improve peri-implant health without invasive procedures.
Main Interventions
✔ Submucosal Instrumentation
Use of plastic, titanium, or carbon-fiber curettes, sonic/ultrasonic scalers, and air-polishing systems for biofilm and calculus removal.
✔ Adjunctive Therapies
Application of local antimicrobials (e.g., 2% chlorhexidine gel) and, in selected cases, systemic antibiotics such as metronidazole—though evidence for systemic antibiotics remains limited.
✔ Risk Factor Control
Patient education, smoking cessation, prosthesis design adjustments, and improved oral hygiene techniques.
Outcome Assessment
A re-evaluation should be conducted 6–12 weeks post-treatment. Clinical success is typically defined as:
✔ Probing depth ≤ 5 mm
✔ No bleeding on probing at ≥50% of sites
✔ Absence of suppuration
Failure to meet these outcomes may indicate the need for surgical intervention.
Surgical Management of Peri-Implantitis
Surgical treatment is indicated when non-surgical therapy fails or when the disease presents with advanced bone defects and deep peri-implant pockets.
Surgical Techniques
✔ Access Flap Surgery
Flap elevation allows for direct decontamination of the implant surface.
✔ Resective Surgery
Bone and soft tissue recontouring to reduce pocket depth.
✔ Regenerative Surgery
Use of grafting materials and barrier membranes to regenerate lost peri-implant bone.
Key Considerations
✔ Patient Compliance
Excellent oral hygiene before and after surgery is essential for long-term success.
✔ Prosthetic Design
Must allow for proper cleaning; in some cases, temporary or permanent removal may be necessary.
✔ Clinician Expertise
Surgical interventions should be performed by trained periodontists or implant specialists.
Sequential Treatment Protocol
A stepwise strategy is essential for the successful treatment of peri-implantitis:
1. Diagnosis & Risk Assessment
2. Non-Surgical Therapy
3. Clinical Reevaluation
4. Surgical Intervention (if indicated)
5. Supportive Periodontal Therapy and Maintenance
Conclusion
Staying up to date with current evidence-based protocols in the treatment of peri-implantitis is essential for ensuring long-term implant survival.
A tailored, stepwise approach—starting with non-surgical methods and progressing to surgery when necessary—offers the best prognosis for affected patients.
Scientific References
- British Dental Journal (2024) – Surgical management update.
- Journal of Periodontal & Implant Science – Systematic review on peri-implantitis protocols.
- EFP Article – Limitations of non-surgical therapy in peri-implantitis.
