Dental Education Guide

Maintenance

Peri-Implantitis Treatment: What Actually Works

An evidence-based summary of non-surgical, surgical, and regenerative approaches to peri-implantitis — and what 'success' looks like at one and five years.

Reading time
10–12 min
Medically reviewed
Reviewed by a licensed dentist
Last updated
2026-06-01

Written by

Dental Education Guide Editorial Team

Editorial team

Medically reviewed by

Medical Review Board (External Clinical Advisors)

Medical review

Editorial review

Evidence Review Lead

Editorial review

Last reviewed:
2026-06-01
Last updated:
2026-06-01
Reading time:
10–12 min
Version:
1.0

Overview

Peri-implantitis is plaque-associated inflammation of peri-implant tissues with progressive loss of supporting bone[1]. It affects a substantial minority of implants over time — pooled prevalence figures around 20% at the patient level[2] — and treating it earlier produces dramatically better outcomes than treating it late.

How peri-implantitis is diagnosed

  • Bleeding and/or suppuration on probing.
  • Increased probing depth compared to baseline.
  • Radiographic bone loss beyond initial crestal remodelling.

Step 1: Non-surgical therapy

Mechanical debridement using titanium / PEEK curettes, ultrasonics with implant-safe tips, glycine air-polishing, or erbium laser; combined with reinforcement of home plaque control and (where appropriate) local antiseptics. Antibiotics alone are not effective. Non-surgical therapy resolves mucositis reliably but only stabilises a minority of true peri-implantitis cases by itself.

Step 2: Surgical therapy

When non-surgical therapy fails to stabilise the lesion, surgical access is needed. Two broad approaches: resective (gum and bone reshaped to eliminate the pocket — used where aesthetics are not critical) and regenerative (bone graft and membrane to rebuild lost bone — most successful in contained, intrabony defects). Both are usually combined with thorough implant surface decontamination and, where indicated, implantoplasty (mechanical smoothing of exposed threads).

What 'success' looks like

The EFP 2023 guideline defines treatment success as no bleeding on probing, no suppuration, no further bone loss, and probing depths ≤ 5 mm[3]. Achieving this outcome depends heavily on the defect morphology, the patient's systemic and behavioural risk factors, and ongoing supportive peri-implant therapy every 3 months.

When the implant must come out

  • Mobility of the implant body.
  • Greater than ~50% bone loss with progression after treatment.
  • Recurrent suppuration despite proper surgical care.
  • Strategic prosthetic considerations (loss of value vs. risk of further complications).

Frequently asked questions

Scientific references

  1. 1. Berglundh T, Armitage G, Araujo MG, et al. (2018). Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 45 Suppl 20:S286-S291. View source
  2. 2. Derks J, Tomasi C. (2015). Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 42 Suppl 16:S158-71. View source
  3. 3. Herrera D, Berglundh T, Schwarz F, et al. (EFP Workshop). (2023). Prevention and treatment of peri-implant diseases — The EFP S3 level clinical practice guideline. J Clin Periodontol. 50 Suppl 26:4-76. View source