Peri-implant mucositis – are chemical adjunctive therapies effective?

PD Dr. Kristina Bertl, PhD MSc MBA

The 18th European Workshop in Periodontology was held in autumn 2022. The theme of the workshop was the treatment of peri-implant diseases – both peri-implant mucositis and peri-implantitis.

Peri-implant mucositis – are chemical adjunctive therapies effective?

In principle, peri-implant mucositis on implants is equivalent to gingivitis on natural teeth. However, in many respects there are indeed some crucial differences between these two conditions, one of which is the much lower success rate in treating peri-implant mucositis in comparison to treating gingivitis. This can be attributed to numerous factors, such as the consistency and thickness of the peri-implant soft tissue situation, access to home oral hygiene, access to mechanical cleaning, etc. Chemical adjunctive therapies are often used in order to improve the success rate after treating peri-implant mucositis. However, do these chemical adjunctive therapies actually have a significant positive effect in comparison with debridement alone?

As part of this 18th workshop, a group looked at this precise question (Dommisch 2022). In a systematic review, they summarised the evidence available on this subject. They only included studies with a minimum of a three-month follow-up and the product must have been applied in the dental practice, i.e. no home applications carried out by the patient. It was slightly surprising that they were able to include only seven studies; five studies with additional photodynamic therapy and one study each with chlorhexidine (0.12%) or sodium hypochlorite (0.95%) as chemical adjunctive therapy.

Unfortunately, summarising the results is a quick and easy process. Based on the included studies, it was not possible to demonstrate any decisive effect of the tested products, meaning that the treatment result of mechanical cleaning in patients with peri-implant mucositis was not improved by the tested chemical adjunctive therapies.

In short, the treatment recommendation for patients with peri-implant mucositis primarily continues to be: 1) optimisation of access to home oral hygiene and optimum education of the patients, and 2) mechanical cleaning of the prosthetic restoration. In addition, it is recommended that there should be close follow-ups, because it must be expected that there will be a lower success rate and also frequent recurrence.

Reference

1. Dommisch, H., Hoedke, D., Valles, C., Vilarrasa, J., Jepsen, S., & Pascual La Rocca, A. (2022). Efficacy of professionally administered chemical agents as an adjunctive treatment to sub-marginal instrumentation during the therapy of peri-implant mucositis. Journal of Clinical Periodontology, 1–15.