Non-surgical peri-implantitis treatment – gold standard ...?

PD Dr. Kristina Bertl, PhD MSc MBA

The treatment of established peri-implantitis lesions is still posing challenges for us, and we would love to have a reliable ‘gold standard’ treatment for this. Identifying such a treatment was one of the objectives of the 18th European Workshop on Periodontology, which was held in autumn 2022. The theme of the workshop was the treatment of peri-implant diseases – both peri-implant mucositis and peri-implantitis.

Non-surgical peri-implantitis treatment – gold standard ...?

As part of this workshop, a research group examined the different options for mechanical cleaning as part of non-surgical peri-implantitis treatment (Cosgarea 2022). The aim of this group was to compare the different options and, in the best case, define a clear treatment guideline.

But, unfortunately, we have to concede that there are still not enough well-conducted studies to come up with clear treatment guidelines for peri-implant conditions. The research group only managed to include nine studies relating to this area in its systematic review; all other studies available in the literature either included too few patients, or had a follow-up period that was too short and/or some other qualitative deficiency.

So, what could be concluded from these nine studies? Five of the nine studies examined the effect of laser therapy, while the other four studies looked at air polishing and/or ultrasonic devices. Unfortunately, the studies only provided a very brief and simple summary in relation to the clinical result. Based on the studies included, it was not possible to issue a clear treatment guideline. In some instances, the additional laser treatment showed certain advantages, as did treatment with air polishing devices.

In short, the recommendation for non-surgical treatment in patients with peri-implantitis lesions can be summarised as follows: 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. However, it is therefore still not possible to recommend a specific treatment method for mechanical cleaning.

Reference

1. R. Cosgarea, A. Roccuzzo, K. Jepsen, A. Sculean, S. Jepsen & G.E. Salvi. (2022). Efficacy of mechanical/physical approaches for implant surface decontamination in nonsurgical submarginal instrumentation of peri-implantitis. A systematic review. Journal of Clinical Periodontology, epub.