Non-surgical therapy for the management of peri-implantitis: a systematic review

Peri-implantitis is characterized by mucosal inflammation and loss of supporting peri-implant bone.

Objective: The objective of this systematic review was to evaluate the efficacy and safety of non-surgical treatment of peri-implantitis.

Materials and methods: MEDLINE, Embase, and Web of Science were searched to identify randomized clinical trial studies that assessed non-surgical treatment of peri-implantitis with a minimum follow-up period of 3 months.

Results: From a total of 29 abstracts, nine trials were included in this systematic review. Adjunctive local delivery of antibiotics, submucosal glycine powder air polishing, or Er:YAG laser treatment resulted in greater reduction in bleeding on probing compared with submucosal debridement using curettes with adjunctive irrigation with chlorhexidine. In addition, greater reductions in probing depths were found following adjunctive local delivery of antibiotics. The evidence neither supported nor refuted the clinical efficacy of submucosal debridement using curettes or ultrasonic scalers alone. No progressive bone loss was found following any of the assessed treatments over a maximum observation period of 12 months. Only two studies reported implant survival rates, which were 100% over 6 months.

Conclusions: The available evidence suggested that submucosal debridement with adjunctive local delivery of antibiotics, submucosal glycine powder air polishing, or Er:YAG laser treatment may reduce clinical signs of peri-implant mucosal inflammation to a greater extent relative to submucosal debridement using curettes with adjunctive irrigation with chlorhexidine. Long-term randomized controlled trials are needed to assess the efficacy of non-surgical therapy on progressing bone loss, implant survival rates, and measures of oral health-related quality of life.