Treatment Strategies

Just as mechanically disrupting the causative biofilm from the surface of a tooth can reverse the effects of gingivitis and prevent progression to periodontitis, so too is the case for peri-implant mucositis.9 Therefore, the treatment of peri-implant mucositis and initial therapy for frank peri-implantitis aims to eliminate the biofilm from the surface of the dental implant.

Non-surgical Treatment

Conventional non-surgical therapy appears to successfully reverse peri-implant mucositis. Laser therapy alone or as an adjunct to conventional therapy has been evaluated, however, the superiority of laser treatment has not be established.49 Adjunctive antibiotic therapy (both locally applied and systemic) in association with mechanical removal of plaque had only limited success.51,52 Failure may be related to the frequent presence of bacteria resistant to clindamycin, amoxicillin, doxycycline, or metronidazole.53

Surgical Treatment

Non-surgical therapy reduces local inflammation and infection, but it does not resolve the underlying osseous defect.54-56 Reversing frank peri-implantitis successfully hinges on bone regeneration.57,58 The process, however, is complicated by the fact that there is no cementum on the surface of dental implants and the periodontal ligament, which communicates with marrow spaces in bone, is also absent.

The first step in successful regeneration of bone, as with bone regeneration around natural teeth, is predicated on effective decontamination of the affected site, i.e., establishment of surgical access followed by removal of granulation tissue, calculus, and biofilm. Air powder abrasive treatment of the implant surface offers no advantage over traditional decontamination.59 Similarly, Er:Yag laser decontamination was also found to be less effective than traditional decontamination.60

Implantoplasty, removal of the micro- and macro-roughened implant surface has also been evaluated as a means to attain absolute decontamination of the implant surface.61,62 However, procedure-related complications, e.g., heat production, deposits of implant material into the surgical field, damage to the implant surface, and weakening of the implant structure appear to negatively affect prognosis.