Non-surgical peri-implantitis treatment – chemical cleaning ...?

PD Dr. Kristina Bertl, PhD MSc MBA

Efficient and successful cleaning of the implant surface is certainly one of the most important factors in treating peri-implantitis cases. In an earlier report (‘Non-surgical peri-implantitis treatment – gold standard ...?’), the results of the 18th European Workshop for Periodontology, which was held in autumn 2022 and covered the topic of mechanical cleaning for the treatment of peri-implantitis cases, were discussed. However, there is, of course, also the option of supporting this mechanical cleaning of the implant surface with additional chemical cleaning.

Non-surgical peri-implantitis treatment – chemical cleaning ...?

The existing evidence on the additional chemical cleaning of the implant surface was summarised by de Waal and colleagues (2022). But, unfortunately – similarly to mechanical cleaning – we also have to conclude here that there are still too few well-conducted studies to come up with clear treatment guidelines for peri-implant conditions. This research group could therefore only identify and summarise three studies on the subject of ‘chemical cleaning’ in the systematic review.

Two studies examined the effect of anti-microbial photodynamic therapy and the other study examined the effect of a gel, specifically for cleaning the implant surface. In all three studies, these chemical methods were also used for submucosal, mechanical cleaning, which consisted, for example, of ultrasonic and/or air polishing treatment. All three studies showed better results in relation to the reduction of probing pocket depths, while all other parameters, such as bleeding on probing or treatment success, were inconclusive.

In short, chemical additives specifically for cleaning the implant surface may make sense, but there is a shortage of well-conducted studies with a sufficient number of patients and a long-enough follow-up period to really be able to recommend a specific method and/or a specific product. For this reason – as already summarised in the report on mechanical cleaning – the following still applies: 1) optimisation of access to home oral hygiene, 2) optimal patient education, 3) mechanical cleaning of the implant surface, 4) removal of the superstructure to ensure better access, if necessary, 5) early evaluation of the treatment result, and 6) check-ups at short intervals, as there is often still a low success rate for non-surgical treatment of peri-implantitis lesions as well as frequent recurrence.

Reference

1. de Waal, Y. C. M., Winning, L., Stavropoulos, A., & Polyzois, I. (2022). Efficacy of chemical approaches for implant surface decontamination in conjunction with sub-marginal instrumentation, in the non-surgical treatment of peri-implantitis: A systematic review. Journal of Clinical Periodontology, 1–12.