Such preventive measures begin before implant placement (“Primordial prevention”) by addressing the underlying risk factors that may induce disease development (e.g., preventing noncommunicable diseases (diabetes type-II) by healthy behavior promotion such as not smoking, increasing physical activity, and healthy diets)
[49][28]. Once implant placement occurs, preventive measures (“Primary prevention”) are implemented to maintain the peri-implant tissues healthy over time and address any risk factors that may trigger disease onset, such as regularly controlling biofilm accumulation around implants and practically educating and motivating patients on oral hygiene measures). Then, early management and control of peri-implant mucositis should be implemented to prevent peri-implantitis progression (“Secondary prevention”)
[49][28].
5. Treatment Strategies
Nonsurgical Treatment
Nonsurgical therapy includes mechanical debridement, oral hygiene instructions, and possibly local antiseptics, which are indicated in managing mucositis and peri-implantitis with mild bone loss (<25% of implant height)
[51][29]. Mechanical debridement of the implant surface aimed to reduce the adhered biofilm and restrict bacterial colonization to maintain peri-implant health. That debridement could be achieved by curettes ultrasonic instruments, titanium brushes, air power abrasion, laser, chemical agents, and photodynamic therapy
[52,53][30][31].
Surgical Treatment
Surgical therapy is often recommended for treating peri-implantitis (with moderate loss, i.e., 25–50% of the implant height) since nonsurgical therapy, despite being conservative, has a high recurrence rate and typically does not resolve peri-implant disease
[77,78,79,80][32][33][34][35]. The surgical treatment aims to decontaminate the implant surface, create a healthy hard and soft tissue peri-implant anatomy that allows easy cleaning, and regenerate the infrabony defect (if possible)
[81,82][36][37]. Surgical approaches for treating peri-implantitis include open-flap debridement (OFD), apically positioned flap (APF), and guided bone regeneration (GBR). The surgical approach is often determined by the bone defect configuration, as the resective approach with APF (possibly with implantoplasty) is indicated for horizontal or one-wall defects, regenerative therapy is indicated for vertical two or three-wall defects, and combining approaches with combined defects.
Implant Removal
When there is osseointegration failure (severe loss, i.e., >50% of height), implant fractures, complicated implant designs (i.e., hollow-cylinder implant), or intricate infections affecting the surrounding anatomical structures (e.g., inferior alveolar nerve, maxillary sinus), the implant should be removed
[93,94,95][38][39][40].