This narrative review describes up-to-date treatment options for peri-implantitis and proposes a treatment protocol and flowchart based on the current scientific evidence. Peri-implantitis treatment should be based on the phased treatment protocol for periodontitis, which is a continuous flow of decisions for extraction, nonsurgical and surgical treatments with step-by-step re-evaluation. The protocol's goals are to fulfill the success criteria for peri-implantitis treatment (probing depth of ≤5 mm, and absence of bleeding on probing, suppuration, and progressive bone loss) and to halt disease progression. Fixtures with peri-implantitis can initially be classified as failed or failing. A failed implant needs to be removed. In contrast, nonsurgical and surgical treatments can be applied to a failing implant. Nonsurgical treatment should be the initial treatment for failing implants; however, sole nonsurgical treatment was regarded as inefficient for peri-implantitis. Recent studies have found that the adjunctive use of antibiotics to nonsurgical debridement increased the success of nonsurgical treatment for peri-implantitis. Surgical treatments can be classified into resective, access, and reconstructive surgeries. The technique should be selected according to the patient's bone defect configuration, which relate to regenerative potential. Various combinations of decontamination methods (e.g., mechanical, chemical, and pharmacological approaches) are required to achieve absolute surface decontamination. Clinicians should select an appropriate surface decontamination strategy according to the purpose of surgery. After signs of disease disappear and its progression is halted through active peri-implantitis treatment, it is necessary to enroll patients into maintenance programs. Compliance of patients with the maintenance program reduces the recurrence of peri-implantitis and sustains clinical success after treatment. Maintenance visits should include professional plaque control and hygiene care reinforcement for patients, and their interval should be set according to individual peri-implantitis risk. Clinicians should remind that peri-implantitis treatment is not a single procedure, but rather a continuing cycle of treatment and re-evaluation.
Keywords: Clinical protocols; Dental implants; Flowchart; Peri-implantitis.
Copyright © 2024. Korean Academy of Periodontology.
No potential conflict of interest relevant to this article was reported.
César Neto JB, Dos Reis INR, Lazarin RO, Naenni N, Villar CC, Pannuti CM. César Neto JB, et al. Clin Adv Periodontics. 2024 Aug 9. doi: 10.1002/cap.10310. Online ahead of print. Clin Adv Periodontics. 2024. PMID: 39119848
Khoury F, Keeve PL, Ramanauskaite A, Schwarz F, Koo KT, Sculean A, Romanos G. Khoury F, et al. Int Dent J. 2019 Sep;69 Suppl 2(Suppl 2):18-22. doi: 10.1111/idj.12505. Int Dent J. 2019. PMID: 31478576 Free PMC article. Review.
Diachkova E, Corbella S, Taschieri S, Tarasenko S. Diachkova E, et al. Dent J (Basel). 2020 Jul 27;8(3):78. doi: 10.3390/dj8030078. Dent J (Basel). 2020. PMID: 32727061 Free PMC article.
Esposito M, Grusovin MG, Worthington HV. Esposito M, et al. Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD004970. doi: 10.1002/14651858.CD004970.pub5. Cochrane Database Syst Rev. 2012. PMID: 22258958 Free PMC article. Review.
Etemadi A, Sabri H, Enssi M. Etemadi A, et al. Clin Adv Periodontics. 2023 Nov 29. doi: 10.1002/cap.10275. Online ahead of print. Clin Adv Periodontics. 2023. PMID: 38029379