Treatment of peri-implantitis: antibiotics, biofilm and implant decontamination

Peri-implantitis is an inflammation of the tissues surrounding a dental implant, associated with bacterial biofilm and progressive bone loss. Treatment aims to remove the biofilm and decontaminate the implant. Antibiotics may be used as an adjunct, but they do not, on their own, remove the biofilm adhering to the implant surface. 

The treatment of peri-implantitis aims to control inflammation, remove bacterial biofilm and limit bone loss around the implant. Depending on the severity of the condition, the dentist may recommend non-surgical treatment, surgical treatment or a combination of the two approaches.

The treatment plan may include:

• professional cleaning and removal of deposits;
• mechanical cleaning of the implant surface;
• the use of antiseptics;
• antibiotics, in certain situations, as an adjunctive treatment;
• decontamination using a laser or electrochemical methods;
• surgical intervention to gain access to the implant surface;
• bone regeneration, where the bone defect permits this procedure.

The choice of treatment depends on the depth of the peri-implant pockets, the extent of bone loss, the stability of the implant and the patient’s risk factors. If the implant is loose or the condition is too advanced, it may need to be removed.

Antibiotics may be used as an adjunct in the treatment of peri-implantitis in certain clinical situations, but they do not, on their own, remove the bacterial biofilm from the implant surface. Local treatment and decontamination of the implant remain necessary to control the infection.

Biofilm consists of communities of bacteria protected by an adherent matrix. This structure reduces the effectiveness of antibiotics and makes it difficult to eliminate the bacteria without directly cleaning the implant surface.

Depending on the case, the dentist may recommend local or systemic antibiotics, in combination with:

• mechanical cleaning of the implant;
• the use of antiseptic solutions;
• decontamination using a laser or electrochemical methods;
• surgical treatment, where necessary.

Antibiotics should only be taken on the doctor’s advice. Using them without local decontamination does not treat the underlying cause and may promote bacterial resistance. 

Bacterial biofilm adheres to the rough surface and the threads of the dental implant, including in areas that are difficult for instruments to reach. The bacteria are protected by a matrix that reduces the effectiveness of antiseptics and antibiotics.

Decontamination is difficult due to:

• the microstructure of the implant surface;
• the spaces between the threads;
• the shape of the bone defect;
• limited access beneath the gum;
• the presence of the prosthetic restoration;
• the risk of damaging the implant surface during cleaning.

For this reason, treatment may involve a combination of cleaning methods and, in advanced cases, surgery to expose and decontaminate the affected surface. 

There is no single method that suits all patients. The treatment plan is drawn up following an assessment of the implant, the peri-implant tissues and bone loss.

Electrochemical cleaning uses a low voltage and an electrolytic solution to generate hydrogen microbubbles on the surface of the implant. These penetrate beneath the bacterial biofilm and dislodge it, even from hard-to-reach areas between the threads.

The GalvoSurge® system utilises this principle in the surgical treatment of peri-implantitis. After exposing the implant and removing the inflamed tissue, the non-osseointegrated surface is cleaned electrochemically. If the clinical situation permits, the dentist may subsequently perform a bone regeneration procedure.

Electrochemical cleaning is the decontamination stage, not the entire treatment for peri-implantitis. The indication depends on the stability of the implant, the extent of bone loss and the condition of the surrounding tissues.

Find out more about the treatment of peri-implantitis with GalvoSurge®.

The risk of recurrence can be reduced by controlling bacterial biofilm, regularly monitoring the implant and managing risk factors. Treatment for peri-implantitis should be followed by a personalised maintenance programme.

To protect the implant, the following are recommended:

• daily oral hygiene, tailored to the implant restoration;
• the use of interdental cleaning aids recommended by the dentist;
• regular professional cleanings;
• clinical and radiological check-ups at set intervals;
• giving up smoking;
• management of diabetes and other systemic conditions;
• monitoring and treating periodontitis;
• consulting a dentist if bleeding, inflammation, discharge or discomfort occurs around the implant.

Peri-implantitis may recur if biofilm builds up again. The frequency of check-ups is determined on a case-by-case basis, depending on the patient’s medical history, the condition of the peri-implant tissues and the risk of recurrence. 

Surgical treatment may be necessary when inflammation and bone loss cannot be controlled using non-surgical methods. The procedure allows direct access to the surface of the implant to remove inflamed tissue and bacterial biofilm.

Your dentist may recommend surgical treatment if:

• there are peri-implant pockets;
• bone loss continues to progress;
• the implant surface cannot be properly cleaned using non-surgical methods;
• biofilm is present in hard-to-reach areas between the threads;
• the shape of the bone defect allows for a regenerative procedure;
• the implant is stable and can be retained.

Depending on the clinical situation, the procedure may serve to provide access and decontamination, to remodel tissues, or to promote bone regeneration. If the implant is mobile or bone loss is too advanced, its removal may be the recommended option. 

An implant affected by peri-implantitis can be preserved if it is stable, the bone loss can be treated, and its surface can be properly decontaminated. Early diagnosis and intervention increase the chances of preserving the implant.

The decision depends on:

• the extent and type of bone loss;
• the stability and position of the implant;
• the extent of the affected surface;
• the condition of the peri-implant tissues;
• the ability to control bacterial biofilm;
• smoking, diabetes and a history of periodontitis;
• adherence to the hygiene and monitoring programme.

If the implant is loose, bone loss is very advanced or decontamination cannot deliver a predictable outcome, the dentist may recommend its removal and the establishment of a new treatment plan. 

A dental implant should be examined by a dentist if there is any bleeding, inflammation, discharge, an unpleasant taste, gum recession or discomfort around it. Peri-implantitis can develop without causing pain, which is why regular check-ups are important for the early detection of inflammation and bone loss. 

Please book an appointment if you notice:

• bleeding whilst brushing or when touching your gums;
• red, swollen or receding gums around the implant;
• discharge or a persistent unpleasant taste;
• pain or discomfort when chewing;
• exposure of the implant threads;
• loose implant or prosthetic restoration.

These symptoms alone do not confirm a diagnosis of peri-implantitis. The dentist will carry out a clinical and radiological assessment of the implant to identify the problem and determine whether it can be preserved. For information on causes and symptoms, read the article on peri-implantitis and dental implant infection. 

Treatment for peri-implantitis begins with a clinical and radiological assessment of the implant, the peri-implant tissues and the bone level. Based on the diagnosis, the dentist determines whether the implant can be preserved and which cleaning and decontamination methods are appropriate.

The treatment plan may include non-surgical or surgical procedures, the adjunctive use of antibiotics in certain situations, decontamination of the implant surface and bone regeneration, where clinical conditions permit.

Have you noticed any bleeding, inflammation or discomfort around a dental implant?