Non-Surgical Treatment of Peri-Implantitis

Abstract

Peri-implantitis is a multifactorial disease that presents an infectious origin modulated by the host response and affects the implant's tissues. Its management consists of decreasing periodontal pathogens' charge to restore a host/bacteria's favorable balance to achieve periodontal healing. Several treatment alternatives have been proposed in the scientific literature to achieve this result, and non-surgical therapy should constantly be the initial treatment option, no matter the grade of peri-implantitis. Indeed, the latter provides more time for the clinician to evaluate the disease's evolution, how the tissues are healing and check if there is a regression of the inflammation. For this purpose, we will explore various studies among non-surgical treatments, and we will evaluate its effectiveness and limitations. Literature research was conducted through the following bibliographic databases: PubMed, Medline, Cochrane and reviews; and we selected articles that focused on mechanical debridement, adjunctive antiseptic therapy, adjunctive antibiotic therapy and laser-assisted therapy. Ninety articles were utilized in total. We concluded that depending on the disease's degree, non-surgical therapy associated with patient compliance might result in a significant improvement. Dental implant scaling with or without applying adjunctive material such as antiseptics, antibiotics or lasers has shown positive results, such as reducing the number of bleeding sites, clinical attachment level, and a decrease in the number of periodontal pockets. The use of antiseptic as an adjuvant remains controversial. In combination with mechanical debridement, the local administration of antibiotics, contrary to the antibiotics' systemic ingestion, has positively impacted clinical and microbiological parameters. Some lasers also have a promising future in resolving peri-implantitis; indeed, they lead to effective bacterial reduction and have a lower tendency to damage the implant's surface. However, the non-surgical treatment seems to be effective only in a short term and can damage the implant micromorphology. It also presents some weakness, especially in the case of advanced lesions. We also need further studies to understand the best adjuvant option, depending on the case. We are still struggling to determine the optimal remedy for treating this disease because most of the treatments have similarities in their degree of effectiveness. Unfortunately, a therapy that will lead to the disease's complete resolution has not been found yet.