Managing Peri-Implant Disease

Peri-Implant Mucositis: Early, Reversible Stage

Peri-implant mucositis is inflammation confined to the soft tissues without bone loss; it is reversible if caught and treated appropriately. The foundation for therapy remains professional mechanical disruption of biofilm using ultrasonic devices, air-polishing devices with glycine powder, curettes, and as new data suggest, lasers. However, complete clinical resolution (no bleeding, no inflammation) is achieved in a minority of cases (often ~30-40%) with standard non-surgical care.

Peri-implantitis: Deeper Challenge, Surgical Considerations

When inflammation progresses to bone loss, we enter the realm of peri-implantitis. The therapeutic goal expands: arrest bone loss, reduce probing depths, resolve inflammation, and ideally regenerate lost supporting structures. While non-surgical therapy is often the first line treatment for peri-implantitis, it has limited efficacy for moderate-to-severe cases. Surgical therapy is often required once non-surgical measures are insufficient. Flap access, debridement, implant surface decontamination, possibly resective or reconstructive surgery, often with grafting materials or membranes, are indicated. There is evidence that surgical therapy can reduce probing depths by 30-50%.

Practical Takeaways

1. Early detection is key – regular maintenance, probing and palpation to detect bleeding and/or suppuration, and radiographs to pick up peri-implant mucositis before it becomes peri-implantitis.

2. Non-surgical therapy can be effective for peri-implant mucositis, and can be first line for early peri-implantitis but set expectations for the patients that many sites will need more therapy.

3. Surgical intervention should be considered when: pockets persist, bone loss is evident, or access is suboptimal. Tyler Periodontics is here for your non-surgical and surgical treatment needs, with a variety of options to offer patients!

4. Risk factor control (smoking, glycemic control, prosthetic design, patient hygiene) remains essential for success.