Management of peri-implantitis

The European Federation of Periodontology (EFP) has developed a step-by-step treatment plan for managing peri-implantitis.

Once peri-implantitis has been diagnosed, the treating clinician and patient will need to decide whether the implant and/ or prosthesis is treatable.

The endpoints of treatment are:

• Residual PPD ≤5mm (± ≤1 BoP spot)
• No suppuration
• No progressive bone loss

It is also important to ensure that there is complication-free survival of the implant and prosthesis, and the patient is satisfied with the outcome (e.g. aesthetic outcome)

Interventions include:

• Oral hygiene instructions and evaluating patient motication
• Risk factor control including:
  • Glycaemic control
  • Smoking cessation
  • Peri-implant keratinised tissue
• Non-surgical management:
  • Prosthesis cleaning/ removal ± modification (if applicable)
  • Supra- and submarginal instrumentation with curettes and/or sonic/ ultrasonic devices
• Surgical management (this should be provided by dentists with specific training or specialist periodontists)
  • Prosthesis cleaning/ removal ± modification (if applicable)
  • Both access flap and pocket elimination procedures (soft tissue ± bony recontouring) have been shown to be effective. They aim to debride the submarginal biofilm and facilitate improved oral hygiene to the area
  • For vertical defects, access flap ± reconstructive procedures may be advised. Reconstructive procedures may involve bone grafts ± barrier membranes.
  • All surgical procedures require surface decontamination:
    • Supra- and submarginal instrumentation with curettes and/or sonic/ ultrasonic devices
    • Titanium brushes may be used
    • Air-polishing, Er:YAG laser, photodynamic therapy and chlorhexidine are not suggested due to conflicting and limited evidence at present
  • Routine use of systemic antibiotics is not recommended.

References

Herrera D, et al., EFP workshop participants and methodological consultant. Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023 Jun 4.