Overview of Treatment Modalities for Peri-Implantitis (Part 2)

Peri-implantitis is a biofilm-associated inflammatory disease that results in progressive loss of the supporting tissues around dental implants and remains one of the greatest challenges in implant therapy. Successful treatment extends beyond implant surface decontamination and often requires adjunctive therapies to control infection, reduce inflammation, and facilitate regeneration of the lost peri-implant tissues. This second part of this review of peri-implantitis summarizes the current evidence regarding local and systemic antibiotic therapy, laser-assisted treatment, implantoplasty, and regenerative surgical approaches. Local antimicrobial agents may provide modest short-term clinical improvements when used as adjuncts to mechanical debridement, whereas routine systemic antibiotic therapy remains controversial because of limited long-term benefit and concerns regarding antimicrobial stewardship. Laser therapy may enhance implant surface decontamination and soft-tissue healing but has not consistently demonstrated superior long-term clinical outcomes. Implantoplasty may improve surface cleansability and reduce plaque retention but should be used judiciously because of potential titanium particle release and alteration of implant surface characteristics. Regenerative procedures can achieve predictable clinical and radiographic improvements in appropriately selected defects when combined with meticulous implant surface detoxification and effective plaque control, although true re-osseointegration remains difficult to confirm clinically. Overall, no single adjunctive modality has demonstrated consistent superiority, and successful peri-implantitis management requires a comprehensive, patient-specific treatment strategy that integrates biologic principles, surgical therapy, and long-term maintenance.