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

Abstract

Despite the success rates of dental implants, peri-implantitis presents as the most common complication in implant dentistry. This review discusses various factors associated with peri-implantitis and various available treatments, highlighting their advantages and disadvantages. Relevant articles on peri-implantitis published in English were reviewed from August 2010 to April 2020 in MEDLINE/PubMed, Scopus, and ScienceDirect. The identified risk indicators of peri-implant diseases are plaque, smoking, history of periodontitis, surface roughness, residual cement, emergence angle >30 degrees, radiation therapy, keratinized tissue width, and function time of the implant, sex, and diabetes. Peri-implantitis treatments can be divided into nonsurgical (mechanical, antiseptic, and antibiotics), surface decontamination (chemical and laser), and surgical (air powder abrasive, resective, and regenerative). However, mechanical debridement alone may fail to eliminate the causative bacteria, and this treatment should be combined with other treatments (antiseptics and surgical treatment). Surface decontamination using chemical agents may be used as an adjuvant treatment; however, the definitive clinical benefit is yet not proven. Laser treatment may result in a short-term decrease in periodontal pocket depth, while air powder abrasive is effective in cleaning a previously contaminated implant surface. Surgical elimination of a pocket, bone recontouring and plaque control are also effective for treating peri-implantitis. The current evidence indicates that regenerative approaches to treat peri-implant defects are unpredictable.

Fig. 1

Peri-implant mucositis demonstrating soft-tissue inflammation.

Fig. 2

Peri-implantitis: ( A ) clinical photograph, ( B ) radiograph showing bone loss around an implant, and ( C ) clinical photograph showing buccal bone loss.

Fig. 3

Retained cement results in peri-implantitis: ( A ) retained cement at the crown margin and excess cement in the peri-implant inflamed tissue, and ( B ) excess cement around the abutment. Reproduced from Ref. with permission from John Wiley & Sons A/S.

Fig. 4

Various treatments for peri-implant diseases.

Fig. 5

Mechanical treatments of peri-implantitis: ( A ) plastic curettes, ( B ) air abrasive, and ( C ) metallic brush. Reproduced from Ref. under the Creative Commons Attribution License (CC BY 4.0) from Frontiers Media S.A.