Treatment

Peri-Implant Mucositis (Reversible Soft Tissue Inflammation)

Treatment Approach:

  • Phase-contrast microscopy to educate and personalize care
  • Biofilm salivary test
  • Air polishing with glycine or erythritol
  • Mechanical debridement with plastic, titanium, or PEEK scalers
  • Antimicrobial agents
  • Ozone water, Molecular Iodine
  • Laser therapy (e.g., diode or Nd:YAG) – bactericidal and biostimulatory
  • Improved oral hygiene education
  • Prebiotics
  • Maintenance recall every 3–4 months

Prognosis: Good, especially with early intervention

Peri-Implantitis (Bone Loss + Infection) Non-Surgical Options (Early to Moderate Cases):

Same as mucositis plus:
  • Systemic antibiotics in some cases (e.g., amoxicillin + metronidazole)
Surgical Treatment (Moderate to Severe Bone Loss):
  • Open flap debridement to access contaminated surfaces
  • Decontamination of the implant surface (laser, chemical, mechanical)
  • Bone grafting/regeneration if the defect is favorable
  • Use of growth factors (e.g., EMD, PRF)
  • Resective therapy (implantoplasty) in non-regenerative defects

Prognosis: Variable, depends on amount of bone loss, implant surface, and maintenance



Mechanical Failures:

(e.g., loose abutment, fractured screw, broken implant)

Treatment:
  • Replace or tighten loose components
  • Remove fractured screws (using kits or ultrasonic scalers)
  • If the implant fractured below the bone → explantation is often required

Prognosis: If prosthetic components are replaced and occlusion is adjusted, implant can often be saved

Implant Explantation (When Salvage Is Not Possible)

Indications:
  • 50% bone loss with mobility
  • Non-responsive to therapy
  • Implant fracture
  • Severe infection or pain
Techniques:
  • Reverse torque removal (atraumatic)
  • Trephine bur if osseointegrated
  • Socket grafting may be performed to preserve bone
  • After healing (typically 4–6 months), options include:
  • New implant (possibly guided bone regeneration first)
  • Fixed/removable prosthesis
  • Leaving site edentulous (if esthetically and functionally acceptable)

Supportive Maintenance Therapy

Long-term strategies:
  • Regular professional cleanings (every 3–4 months)
  • Customized home care protocols (prebiotic, brushes, water flossers, rinses)
  • Splinting of prostheses if bruxism is present
  • Occlusal guard for night-time wear