Comprehensive treatment protocol for peri-implantitis: an up-to date narrative review of the literature

Abstract

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.

Figure 1. Examples of (A) failed and (B) failing implants.

Figure 2. Examples of resective surgery including bone recontouring and implantoplasty.

Figure 3. Examples of reconstructive surgery. A pre-op photo of the implant is shown in Figure 1B. A glycine air abrasive and chlorhexidine were applied for surface decontamination.

Figure 4. Examples of combined surgery. Implantoplasty was applied to the supracrestal part, and reconstructive surgery was applied to the infraosseous part. A titanium brush can be applied for surface decontamination of the infraosseous defect.

Figure 5. Comprehensive treatment protocol of peri-implantitis.

ISQ: implant stability quotient, GBR: guided bone regeneration, BOP: bleeding on probing, CBCT: cone-beam computed tomography, Ti: titanium, EDTA: ethylenediaminetetraacetic acid, CHX: chlorhexidine, IDRA: implant disease risk assessment.