Treatment Alternatives to Negotiate Peri-Implantitis

Abstract

Peri-implant diseases are becoming a major health issue in dentistry. Despite the magnitude of this problem and the potential grave consequences, commonly acceptable treatment protocols are missing. Hence, the present paper reviews the literature treatment of peri-implantitis in order to explore their benefits and limitations. Treatment of peri-implantitis may include surgical and nonsurgical approaches, either individually or combined. Nonsurgical therapy is aimed at removing local irritants from the implants' surface with or without surface decontamination and possibly some additional adjunctive therapies agents or devices. Systemic antibiotics may also be incorporated. Surgical therapy is aimed at removing any residual subgingival deposits and additionally reducing the peri-implant pockets depth. This can be done alone or in conjunction with either osseous respective approach or regenerative approach. Finally, if all fails, explantation might be the best alternative in order to arrest the destruction of the osseous structure around the implant, thus preserving whatever is left in this site for future reconstruction. The available literature is still lacking with large heterogeneity in the clinical response thus suggesting possible underlying predisposing conditions that are not all clear to us. Therefore, at present time treatment of peri-implantitis should be considered possible but not necessarily predictable.

Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment

“…Mechanical debridement alone may not completely remove the plaque because the instruments cannot access between the implant threads. 51 Adjunctive treatments are proposed for surface decontamination to increase the efficiency of the nonsurgical treatment of peri-implant diseases.…”

“…Surgical treatment includes access flap and debridement, access flap and bone recontouring or resective surgery, and regenerative approaches using bone grafts with or without a membrane. 51 Implant surface decontamination is critical and often performed. Incomplete surface debridement can obstruct bone regeneration on the previously exposed surface of diseased implants.…”

A nonsurgical treatment of peri‐implantitis using mechanic, antiseptic and anti‐inflammatory treatment: 1 year follow‐up

“…Nonsurgical treatments include debridement using various devices (e.g., manual instruments, ultrasonic/sonic instruments, plastic or carbon tips, air powder, photodynamic therapy), with antimicrobial agents including systemic or local antimicrobial treatment (Estefanía-Fresco, García-de-la-Fuente, Egaña-Fernández-Valderrama, Bravo, & Aguirre-Zorzano, 2019;Heitz-Mayfield & Mombelli, 2014;Machtei, 2014;Suárez-López Del Amo, Yu, & Wang, 2016). Outcomes of current nonsurgical treatments show limited success and low predictability (Lang, Salvi, & Sculean, 2019).…”

Management of Peri-Implantitis Lesions without the Use of Systemic Antibiotics: A Systematic Review

“…However, to the best of the authors’ knowledge, there no published reviews on the efficacy of debridement and decontamination techniques, not involving concurrent antibiotic therapy. As the accumulation of bacterial plaque plays a critical role in the pathogenesis of peri-implantitis, the need for implant debridement and/or decontamination to eliminate pathogenic bacterial flora becomes obvious [ 11 ]. The use of antibiotics as an adjunctive treatment modality can have a positive effect on treatment outcomes, however, it confounds the effectiveness of any given therapy.…”