Peri-implantitis: An Overview of Current Treatment Modalities

Peri-implantitis represents a biologically complex, biofilm-mediated inflammatory condition characterized by progressive loss of supporting bone and soft tissue around dental implants, with a reported prevalence approaching 22%. The pathogenesis of peri-implantitis is multifactorial, involving dysregulated host immune responses, altered peri-implant tissue biology, and persistent microbial biofilm, which collectively hinder the predictability of conventional periodontal therapies. This article provides a comprehensive overview of currently available treatment modalities with an emphasis on implant surface decontamination as a critical determinant of clinical success. Both chemical and mechanical detoxification strategies are reviewed, including saline, citric acid, chlorhexidine, hydrogen peroxide, and hypochlorous acid, as well as air abrasion, implantoplasty, and emerging electrolytic cleaning technologies. While many of these approaches demonstrate the ability to reduce microbial load and clinical inflammation, no single modality has demonstrated consistent superiority, and true re-osseointegration remains difficult to achieve. Electrolytic cleaning has shown promising early evidence for facilitating re-osseointegration in preclinical and limited clinical studies, representing a potential advancement in peri-implantitis management. Clinically, effective treatment requires complete disruption of the biofilm and detoxification of the implant surface, often necessitating surgical intervention when osseous defects are present. This review highlights the advantages, limitations, and biologic implications of each modality, underscoring the need for a multifaceted, case-specific approach. Future research should focus on long-term human outcomes and optimization of combined therapeutic protocols to improve predictability and implant survival.