Non-surgical Treatment

Initial treatment of peri-implant disease includes localized non-surgical mechanical debridement in combination with home care therapy. The concept of cause related therapy should be applied, targeting the etiologic factor, dental plaque around dental implants. Clinicians should educate their patients about the main etiologic factor, dental plaque, and guide them to remove dental plaque effectively at home. Clinicians should carefully review and update patients’ medical and dental history to reveal any potential risk indicators such as smoking habit and diabetic conditions.^7,17

After eliminating and correcting the aforementioned contributing factors, non-surgical mechanical debridement should be initiated. For peri-implant mucositis with inflammation confined in soft-tissue without apparent alveolar bone loss surrounding the fixture, conventional non-surgical mechanical therapy in combination with home care therapy is the standard treatment for peri-implant mucositis, resulting in 0.5–1 mm pocket depth reduction and 15–40% reduction in bleeding on probing. For peri-implantitis with alveolar bone loss around the fixture, clinicians should assume that implant fixture surface is heavily contaminated and should use both conventional automated and hand scalers to ensure effective removal of dental plaque or biofilm around the contaminated implant fixture.^1,4,16,17

Non-surgical treatment should, usually, not be considered predictable for the resolution of peri-implantitis in the long-term, avoiding implant loss. Nevertheless, non-surgical treatment was associated with the reduction of peri-implant pocket depth and inflammation. Studies had reported pocket reduction after implant debridement (alone) that varied from 0.2 mm to 1.8 mm. This heterogeneity in the outcomes may be explained by some elements including different conditions at baseline and diverse ability of operators.

Both peri-implant mucositis and peri-implantitis are characterized by tissue inflammation. Even though it is difficult to define the role of tissue inflammation on the progression from mucositis to peri-implantitis, the transition was commonly noted noted. It could be speculated that prolonged tissue inflammation is a main risk factor for progression. Non-surgical treatment was effective in reducing bleeding values between 5.3 to 57.1%. However, the results were heterogeneous and residual inflammation was present at majority of the treated implants. Thus, further treatments might be warranted.¹⁷

Figure 8: Non-surgical treatment.

Figure 8: Non-surgical treatment.