Peri-Implant Mucositis
Peri-implant mucositis is analogous to gingivitis and can be reversed with effective treatment (Lang et al., 2011; Salvi and Ramseier, 2015). Current evidence suggests that non-surgical mechanical therapy, such as supra- and subgingival debridement using curettes and ultrasonic devices with modified tips, is effective for treating peri-implant mucositis, even without adjunctive measures like antiseptic mouth rinses or antimicrobials (Schwarz et al., 2015b; Figuero et al., 2014). Patient adherence to effective plaque control using manual or powered toothbrushes and interproximal cleaning aids is crucial for successful outcomes (Renvert and Polyzois, 2015).
Peri-implantitis
Non-surgical treatment for peri-implantitis, including mechanical debridement, generally yields modest and unpredictable results (Suarez-Lopez del Amo et al., 2016). While various adjunctive therapies, such as antibiotics, photodynamic therapy, lasers, and air-abrasive devices, may enhance the effectiveness of non-surgical interventions, they often fall short of delivering significant clinical improvements (Mizutani et al., 2016; Schwarz et al., 2015a, 2015c).
In cases of advanced peri-implantitis, surgical intervention is often necessary when non-surgical methods are insufficient. Before surgery, it is critical to ensure optimal oral hygiene and address systemic risk factors like smoking and diabetes, as well as local factors such as poorly designed prostheses that may hinder proper cleaning (Figuero et al., 2014).
The goal of surgical treatment is to allow for thorough implant surface decontamination, reduce the risk of disease progression, and promote healing of both hard and soft peri-implant tissues (Renvert and Polyzois, 2015). Surface modification, including the removal of implant threads, has been suggested to reduce plaque retention; however, implantoplasty should be limited to non-aesthetic areas since rough surfaces are better for reosseointegration (Persson et al., 2001; Schwarz et al., 2011).
Various methods, including mechanical brushing, lasers, photodynamic therapy, air abrasion, and chemical agents like citric acid, hydrogen peroxide, chlorhexidine, and delmopinol, have been used for implant surface decontamination. However, no single protocol has been proven superior (Froum et al., 2016).
The choice between resective and regenerative surgical approaches depends on the defect's morphology and aesthetic considerations. Resective surgery is preferred for suprabony defects, particularly in posterior implants, while regenerative surgery, which may involve autogenous bone, bone substitutes, or barrier membranes, is better suited for intrabony defects in aesthetic zones. Although literature shows improvements in clinical outcomes following surgical treatment, more research is needed to clarify the benefits of regenerative approaches compared to non-regenerative treatments (Daugela et al., 2016; Schwarz et al., 2015c).