Peri-implantitis is a serious inflammatory condition affecting the tissues supporting a dental implant, ultimately leading to bone loss. This destructive process begins as reversible gum inflammation (peri-implant mucositis) but progresses to irreversible bone loss if left unaddressed. The primary goal of treatment is to halt bone loss, eliminate the infection, and save the dental implant. Professional intervention is necessary because the complex surface of the implant threads makes thorough cleaning impossible with standard home care.
Initial Non-Surgical Treatment Steps
The first line of defense for early or mild peri-implantitis involves non-surgical, mechanical cleaning to remove bacterial biofilm from the exposed implant surface. This phase focuses on decontaminating the implant without surgical access to the underlying bone. Specialized instruments, such as plastic or titanium curettes, are used to mechanically debride the surface while avoiding scratching the titanium material. Ultrasonic scalers with non-metal tips or air-polishing devices using low-abrasive powders like glycine are also highly effective at biofilm removal.
Following mechanical cleaning, chemical disinfection is often employed to further reduce the bacterial load within the tissue pocket. Antiseptic agents like chlorhexidine are commonly used for irrigation or in gel form to help control the infection. Localized application of antibiotics can be a beneficial adjunct to this treatment, as the slow-release formulation can maintain an effective concentration of the medication directly in the pocket.
These non-surgical steps are frequently successful in resolving inflammation when bone loss is minimal or the condition is still mucositis. However, effectiveness is limited by the depth of the pocket and the complex geometry of the implant threads, which can harbor bacteria out of reach. If deep pockets persist and inflammation does not resolve, particularly with moderate to advanced bone loss, surgical treatment becomes necessary.
Surgical Access and Debridement
Surgical intervention is indicated when non-surgical methods fail or when significant bone loss has occurred, requiring better access for thorough cleaning. The procedure begins by lifting a full-thickness surgical flap, separating the gum tissue from the bone and implant surface. This controlled access allows the clinician to directly visualize the contaminated implant surface and the extent of the surrounding bone defect.
Meticulous debridement involves removing infected granulation tissue from the bone defect and thoroughly cleaning the implant surface. Various methods are employed for surface detoxification, aiming to eliminate the bacterial biofilm without causing excessive damage to the titanium. Techniques include mechanical cleaning with titanium brushes, chemical treatment with agents like saline or citric acid, and the use of lasers such as Er:YAG, which can remove biofilms while being less damaging to the implant surface.
The goal of this phase is complete decontamination of the exposed implant threads, which is a prerequisite for healing or regeneration. Resective surgery may also be performed, involving recontouring the bone and implant surface (implantoplasty) to create a smoother, easier-to-clean profile. This surgical debridement focuses purely on infection control and preparing the site for subsequent reconstructive efforts.
Reconstructive and Regenerative Procedures
Following successful surgical decontamination, reconstructive procedures are often employed to rebuild lost bone support, a key factor for the implant’s long-term survival. This approach is recommended for contained defects, meaning they have at least three bony walls surrounding the implant and a depth of at least three millimeters. The primary technique used is Guided Bone Regeneration (GBR), which leverages the body’s natural ability to create new bone.
In GBR, the bone defect is filled with a bone graft material after the implant surface has been detoxified. These grafts can be autogenous (from the patient’s own body), allografts (from a human donor), or xenografts (from an animal source). The graft acts as a scaffold, providing a framework for new bone cells to migrate and grow. A barrier membrane, which can be resorbable or non-resorbable, is then placed over the bone graft and the implant defect.
The membrane physically excludes faster-growing soft tissue cells, preventing them from occupying the space needed for slower-growing bone cells to regenerate. This exclusion principle guides the bone regeneration process to occur directly against the implant surface. If the gum tissue around the implant is thin or receded, simultaneous soft tissue grafting may be performed to improve the quality and volume of the surrounding tissue for better long-term stability.
Maintaining Implant Health After Treatment
Once active treatment is complete, the long-term success of the implant depends on a strict and consistent post-treatment maintenance protocol. The patient’s role is paramount and involves meticulous daily oral hygiene specifically tailored for implants. This includes using specialized aids such as implant-specific dental floss, interdental brushes, and water flossers to effectively disrupt the bacterial biofilm around the abutment and implant neck.
Professional recall visits are a non-negotiable component for preventing disease recurrence, as peri-implantitis has a significant rate of progression even after successful treatment. These professional cleanings should occur at frequent intervals, typically every three to four months. During these appointments, the clinician performs cleaning, checks for bleeding or pus, assesses probing depths, and takes periodic radiographs to monitor bone levels.
Lifestyle factors also play a significant role in the long-term prognosis of treated implants. Smoking cessation is strongly recommended, as smoking impairs healing and increases the risk of recurrence. Systemic conditions like diabetes must also be well-controlled, as uncontrolled disease can exacerbate inflammation. Full compliance with both home care and the professional recall schedule is the most important factor in securing the long-term health of the implant.