Peri-implantitis surface decontamination: which method?

One of the often cited complications of dental implants, which may lead to loss of the implant in the long term, is peri-implantitis. Peri-implantitis has been defined as an inflammatory lesion of the tissues surrounding the implant subjected to functional loading, with a loss of supporting bone. Two popular physical decontamination methods used to treat/prevent peri-implantitis, are the mechanical removal of biofilm from the implant surface using curettes or decontamination using a Laser. Laser decontamination is based on its thermal effect, which denatures proteins and causes cellular necrosis.

But which method produces better results? A recent study assessed the long-term outcomes (>4 years) following combined surgical resective/regenerative therapy of advanced peri-implantitis lesions using either (i) an Er:YAG laser (ERL) or (ii) plastic curettes + cotton pellets + sterile saline (CPS).

The conclusion:

At 7 years, both ERL and CPS were associated with similar mean bleeding on probing reductions (CPS: 89.99 ± 11.65% versus ERL: 86.66 ± 18.26%) and clinical attachment level gains (CPS: 2.76 ± 1.92 mm versus ERL: 2.06 ± 2.52 mm). Combined surgical resective/regenerative therapy of advanced peri-implantitis was effective on the long-term, but not influenced by the initial method of surface decontamination.1

Read the Full Abstract Here


1. J Clin Periodontol. 2017 Mar;44(3):337-342. Combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination: a 7-year follow-up observation Schwarz F et al.

2 thoughts on “Peri-implantitis surface decontamination: which method?

  1. Greg Kammeyer says:

    Read the 2 case series reports by Stewart Froum et al, in the Int J Perio and Restor Dent.
    He advocates a multi-step process that works quite well.
    4 rounds of Air abrasion with chemical treatments between them
    Citric Acid, CHX,. EDTA.

    Beyond that he uses a growth factor, GBR, and CTG to help restore the defect.

    As I read the literature this is the most consistent protocol when treating a larger (relative to the published literature) sample and a significant number of cases. Happily it also doesn’t require the cost of a laser that may gather dust between cases.

  2. Dennis Flanagan DDS MSc says:

    All the detoxifying agents are bacteriocidal to a portion of the colony. Thus it may be best to use several agents, bleach (dilute), citric acid, tetracycline, CaOH, NaHCO3 spray, EDTA. It may be beneficial to leave the CaOH or minocycline microspheres in the site.

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