Introduction

Peri-implantitis has been defined as an inflammatory process that affects the soft and hard tissues surrounding an osseointegrated implant in function demonstrating loss of supporting marginal bone.^4,19 Peri-implantitis is, in many ways, an analogous disease to periodontitis, in that it affects the hard and soft tissues around implants and it is initiated by oral bacterial biofilms.^10,20,21 The definitive treatment of peri-implantitis may be more challenging than that of periodontitis. In a recent review of studies examining peri-implantitis treatment with at least a one-year follow up, peri-implantitis was shown to be difficult to fully resolve with up to 100% of cases recurring with some treatment modalities.¹⁵ This and other reports indicate that frequent monitoring and retreatment of this chronic disease may be necessary.^15,17,18, Furthermore, a practitioner’s ability to effectively treat peri-implantitis may differ based upon the severity of the presenting levels of attachment loss and the treatment modality used for treatment.^12,15,22,23, Based upon this, early intervention and preventive therapy of peri-implant diseases should be an integral part of therapy to maintaining implants in health and function.^12,24

There are several risk factors that can lead to inflammation, peri-implant mucositis, and, later, peri-implantitis.^4,6,10 These include dental plaque accumulation, smoking, patients’ systemic health conditions, implant design, surgical technique, prosthetic design/procedures, and occlusal forces.^10-12 While these systemic and environmental factors certainly play a role in disease progression and susceptibility, peri-implant diseases are initiated by accumulation of bacterial biofilm.^4,13,14 Therapies to treat peri-implant diseases have focused upon dental plaque removal and implant surface detoxification as a part of surgical and/or nonsurgical treatments.^12,16 Many methods have been used to remove bacteria from dental implant surfaces and the surrounding inflamed tissues. These include: mechanical debridement, chemical detoxification, and laser therapy.^25-27