Peri-Implantitis Management: Non-Surgical vs Surgical Approaches

Dental implants are now a routine part of everyday dental practice. From single-tooth replacements to full-mouth rehabilitations, implants have given dentists predictable, long-term solutions for missing teeth. However, with the rapid increase in implant placements, one complication is becoming more visible in clinics, i.e. peri-implantitis. 

Peri-implantitis is no longer a rare complication. Many dentists encounter it during recall visits, routine cleanings, or when patients report discomfort around implants. The real question that most clinicians face is: Can this be managed non-surgically, or is surgery unavoidable?  

This blog breaks down peri-implantitis management in a clear, practical way, comparing non-surgical and surgical approaches, so you can confidently choose the right treatment for your patient. 

Understanding Peri-Implantitis 

Peri-implantitis is an inflammatory disease affecting the tissues surrounding a dental implant. 
Unlike peri-implant mucositis (which is reversible), peri-implantitis involves bone destruction, making timely intervention critical. 

Why Peri-Implantitis Develops 

Peri-implantitis is multifactorial. Some of the most common contributing factors include:- 

• Poor plaque control 
• History of chronic periodontitis 
• Residual cement around cement-retained crowns 
• Improper implant positioning 
• Inadequate keratinized tissue 
• Occlusal overload 
• Smoking 
• Poorly controlled diabetes 

In most cases, peri-implantitis results from a combination of biological and mechanical factors, not a single cause. 

Goals of Peri-Implantitis Treatment 

Whether you choose a non-surgical or surgical approach, the objectives remain the same: – 

• Eliminate bacterial biofilm 
• Reduce inflammation 
• Halt further bone loss 
• Maintain implant stability 
• Improve long-term prognosis 

The severity of disease determines which treatment approach will be effective. 

Non-Surgical Management of Peri-Implantitis 

When Is Non-Surgical Treatment Appropriate? 

Non-surgical management is best suited for: 

• Early peri-implantitis 
• Shallow probing depths (≤5 mm) 
• Minimal radiographic bone loss 
• Patients with good oral hygiene compliance. 

It is often the first line of treatment, especially in early diagnosis. 

Components of Non-Surgical Therapy 

1. Mechanical Debridement 

Mechanical removal of plaque and calculus from implant surfaces is the foundation of non-surgical care. 

Commonly used instruments include: – 

• Curettes such as Titanium, Plastic or Carbon. 
• Ultrasonic scalers with implant-safe tips. 

The goal is to disrupt the biofilm without damaging the implant surface. 

2. Antimicrobial Therapy 

Antimicrobials are used as an adjunct, not a replacement, for mechanical cleaning.  

Options include: 

• Chlorhexidine gels and mouth rinses. 
• Local antibiotic delivery systems (minocycline, doxycycline). 
• Systemic antibiotics in selected cases. 

These help reduce bacterial load and inflammation. 

3. Air-Polishing Systems  

Air-polishing with low-abrasive powders such as glycine or erythritol has gained popularity because: – 

• It is minimally invasive 
• It effectively removes biofilm 
• It preserves implant surface integrity 
• It improves patient comfort 

This method is particularly useful during maintenance therapy. 

4. Occlusal Adjustment  

Excessive occlusal forces can accelerate peri-implant bone loss. 

Non-surgical management should include: 

• Check for premature contacts. 
• Adjusting occlusion if required. 
• Managing bruxism or parafunctional habits. 

Ignoring occlusion can compromise treatment outcomes. 

Advantages of Non-Surgical Treatment 

• Minimally invasive 
• Cost-effective 
• Reduced patient discomfort 
• Shorter chair time. 
• Ideal for early disease. 

Limitations 

• Limited access to deep defects 
• Ineffective in advanced bone loss 
• Often insufficient for long-term stability in severe cases 

Non-surgical therapy can control disease but may not always resolve it completely.  

Surgical Management of Peri-Implantitis 

When Is Surgical Intervention Required? 

Surgery becomes necessary when: 

• Probing depths exceed 5–6 mm 
• Radiographic bone loss is significant 
• Non-surgical therapy fails 
• Implant surfaces are heavily contaminated 

At this stage, conservative treatment alone is usually inadequate. 

Types of Surgical Approaches 

1. Open Flap Debridement  

This involves:  

• Elevation of a flap to expose the implant surface. 
• Complete removal of granulation tissue. 
• Thorough decontamination of implant surfaces. 

It provides direct access to deep defects that cannot be cleaned non-surgically.  

2. Implant Surface Decontamination 

Various methods are used to clean exposed implant surfaces, including: 

• Mechanical instruments 
• Air-abrasive systems 
• Laser therapy 
• Chemical agents such as hydrogen peroxide or citric acid 

The aim is to reduce bacterial contamination without damaging the implant. 

3. Resective Surgery 

Resective procedures include: 

• Removal of inflamed tissue. 
• Bone recontouring. 

This approach is commonly used in non-esthetic areas where regeneration is not feasible.   

4. Regenerative Surgical Approach 

In selected cases, bone regeneration may be attempted using: 

• Bone graft materials 
• Barrier membranes 
• Growth factors 

Regenerative surgery is most successful in containing defects and esthetic zones.  

Advantages of Surgical Treatment 

• Better access to infected areas 
• More predictable results in advanced cases 
• Potential for bone regeneration 
• Improved long-term implant survival 

Limitations 

• Higher cost 
• Longer healing time 
• Increased patient discomfort 
• Technique-sensitive procedure

Surgical vs Non-Surgical Approach:

Importance of Maintenance Therapy 

No treatment will succeed without long-term maintenance. 

Key elements include: – 

• Regular professional cleanings 
• Reinforcement of oral hygiene instructions 
• Periodic radiographic evaluation 
• Monitoring probing depths 
• Smoking cessation counseling 

Maintenance visits are often scheduled every 3–6 months, depending on patient risk factors. 

Clinical Insight for Dentists 

The earlier peri-implantitis is diagnosed, the more conservative the treatment can be. Delaying treatments often lead to surgical complexity and reduced implant survival. 

Final Thoughts 

Peri-implantitis is a growing challenge in implant dentistry, but it is manageable with the right approach. Non-surgical therapy works well in early stages, while surgical intervention becomes essential in advanced cases. 

Successful management depends on: – 

• Early detection 
• Proper case selection 
• Patient compliance 
• Structured maintenance protocols 

Ultimately, peri-implant health is a shared responsibility between the clinician and the patient. 

Frequently Asked Questions (FAQs)