[Composition of Submucosal Microbiota and Non-Surgical Management of Peri-Implant Diseases]

Dental implants are the most acceptable treatment option for the replacement of missing teeth. Despite the high success rate, the presence of implant complications is increasing. Peri-implant mucositis and peri-implantitis are biologic implant complications induced by a dysbiotic shift in the microbiota. The main goal of the treatment of peri-implant diseases is to remove the bacterial biofilm on the implant surface and restore the ecological balance between the host and oral microbiota. For this purpose, both non-surgical and surgical treatments are applied. Non-surgical approaches based on mechanical debridement focus on biofilm control such as disruption/removal of submucosal biofilm and oral hygiene instructions. Mechanical debridement, non-ionizing radiation sources, antiseptics or antibiotics are included in the non-surgical treatment. Mechanical debridement is applied by the help of the curettes (titanium-coated, carbon fiber, Teflon and plastic), ultrasonic tips, various types of brushes and air-flow devices and allows the removal of soft and hard deposits from the implant surface. However, it remains unclear which treatment is the most effective and predictable for the management of peri-implant diseases. This review article aimed to overview, the non-surgical treatment options of peri-implant diseases and their microbial effectiveness. For this purpose, studies evaluating changes in the peri-implant microbiota before and after treatment using 16S ribosomal RNA (rRNA) sequencing were searched in databases (PubMed and Google Scholar).The literature search covered studies published between 2012 and May 2024 and 1202 of the 1209 articles searched were excluded. Seven studies that met the inclusion criteria were examined; these studies included a total of 107 patients with peri-implant mucositis and 182 patients with peri-implantitis for periods ranging from one to 60 months. Six studies evaluated the effectiveness of mechanical debridement alone or combined with other therapies while one study assessed the hyaluronic acid efficacy. Based on the literature review, it can be inferred that non-surgical treatment demonstrates effectiveness in the short term for managing peri-implant mucositis. However, its impact on the treatment of peri-implantitis appears to be considerably limited. Regarding the treatment of peri-implant mucositis, the application of antimicrobial agents (chlorhexidine or delmopinol) in addition to mechanical treatment (manually or ultrasonic devices) shows both clinical and microbiological effectiveness in the short term. After treatment, the microbial profile tends to shift towards a less dysbiotic form. According to the short-term follow-up findings, the effect of using chlorhexidine in addition to mechanical debridement in peri-implantitis therapy is contradictory. However, additional use of antimicrobial photodynamic therapy also appears to provide short-term benefits. The application of hyaluronic acid may decrease the microbial diversity. However, it is crucial to note that these findings are derived from a limited number of studies, emphasizing the need for future research to provide more comprehensive insights.