Direct answer
Peri-implantitis treatment begins with diagnosis, control of plaque and periodontal disease, professional debridement, and correction of the restoration when needed. Persistent disease commonly requires surgical access to clean the implant surface and manage the bone defect. Resective or regenerative procedures may be used in selected cases. Systemic antibiotics are not a stand-alone cure. A mobile, fractured, severely malpositioned, or untreatable implant may need removal.
Key takeaways
- Peri-implantitis requires evidence of inflammation and progressive supporting bone loss, not bleeding alone.
- Nonsurgical treatment is an essential first phase but often does not fully resolve moderate or advanced peri-implantitis.
- Surgical treatment is selected according to defect configuration, implant surface, position, esthetic zone, and ability to obtain hygiene access.
- No single laser, powder, chemical, or antibiotic has been proven to predictably sterilize every implant surface.
- Long-term supportive care is necessary because recurrence remains possible even after successful treatment.
Evidence and decision snapshot
| Question | Established role | Possible value | Important limitation |
|---|---|---|---|
| Initial control phase | Hygiene instruction, periodontal stabilization, debridement, and prosthesis correction. | Reduces inflammation and prepares the site for definitive care. | Deep defects and inaccessible threads often remain contaminated. |
| Resective surgery | Open access, surface decontamination, bone recontouring, and sometimes implantoplasty. | Can reduce pockets and improve cleansability in nonesthetic sites. | Implantoplasty changes the surface and may not be appropriate for zirconia fixtures. |
| Regenerative surgery | Uses graft and barrier principles in contained defects. | May improve bone fill and clinical parameters in selected anatomy. | Results are variable and radiographic fill is not equivalent to complete re-osseointegration. |
| Implant removal | Eliminates an untreatable, mobile, fractured, or severely malpositioned fixture. | Allows infection control and a new reconstruction plan. | Creates a bone defect and does not guarantee replacement is appropriate. |
Diagnosis before treatment
Peri-implantitis is defined by inflammation around an implant with progressive loss of supporting bone after initial healing. Clinical findings include bleeding or suppuration on probing, increasing probing depths, and radiographic bone loss. Baseline records are ideal. Without them, case definitions use current bone position and clinical findings, but uncertainty should be acknowledged.
The clinician also looks for excess cement, a fractured or loose component, endodontic disease in an adjacent tooth, vertical root fracture, implant fracture, malposition, and sinus or nerve involvement. These conditions can coexist or mimic peri-implantitis and change treatment.
Step one: create a cleanable environment
Current EFP guidance uses a stepwise approach. The first phase includes patient education, individualized home-care instruction, professional supragingival and subgingival biofilm disruption, smoking and diabetes risk management, and treatment of active periodontitis. The restoration may need to be removed or modified so the implant surface can be reached.
Nonsurgical instrumentation can reduce bleeding and probing depth, but complete resolution is less predictable than for mucositis. Deep threaded surfaces, rough implant geometry, circumferential defects, and inaccessible crown contours limit effectiveness. Reassessment determines whether surgery is indicated.
Surgical access and surface decontamination
Open-flap surgery allows direct visualization and removal of granulation tissue. Mechanical instruments, air-polishing, chemical agents, saline, and lasers have been studied. No universally superior decontamination protocol has been established. The method should remove deposits while limiting damage to the implant, surrounding tissue, and restorative connection.
Implantoplasty - smoothing exposed titanium threads - can improve cleansability in selected resective cases, but it removes implant material and creates particles. It should not be automatically applied to ceramic implants because grinding zirconia can introduce defects and alter strength. System-specific material behavior must guide treatment.
Resective versus regenerative treatment
Resective treatment reduces pocket depth and reshapes bone or soft tissue to create access. It may cause recession and visible implant surface, making it less desirable in the esthetic zone. Regenerative treatment is considered for contained intrabony defects where graft stability and wound closure are achievable. Defect morphology strongly influences outcome.
Regenerative studies report improvements in probing and radiographic fill, but complete restoration of the original bone-to-implant interface cannot be assumed. A crown or bridge that remains noncleansable will undermine either approach. In some cases, a combined resective and regenerative procedure is used in different parts of the same defect.
Antibiotics, prognosis, and removal
Systemic or local antimicrobials may be adjuncts in selected surgical cases, but biofilm, calculus, foreign material, and noncleansable anatomy require mechanical source control. Repeated antibiotics without definitive treatment can delay care and contribute to adverse effects and resistance.
Prognosis is poorer with mobility, advanced circumferential loss, severe malposition, fractured fixtures, repeated recurrence, uncontrolled smoking, or inability to maintain hygiene. Removal is not a failure of treatment judgment when retaining the implant would prolong infection or require an unsustainable restoration. After therapy, supportive peri-implant care and serial monitoring are mandatory.
Frequently asked questions
Can peri-implantitis be cured?
Disease can often be controlled and tissues stabilized, but recurrence is possible. The word cure should be used cautiously because long-term maintenance remains necessary.
Will antibiotics alone treat peri-implantitis?
No. They do not remove biofilm, calculus, cement, granulation tissue, or a noncleansable restoration. They may be adjuncts in selected cases.
Can bone grow back around an infected implant?
Selected contained defects may show clinical and radiographic improvement after regenerative treatment, but complete re-osseointegration is not guaranteed.
Are lasers better than conventional treatment?
Lasers may be used as adjuncts, but current evidence does not establish one laser protocol as a universal superior solution.
Can a ceramic implant be treated with implantoplasty?
Routine implantoplasty principles developed for titanium should not be transferred automatically to zirconia. Grinding can damage ceramic and must be evaluated for the exact system.
Questions to discuss with your implant team
- What records prove progressive bone loss and what is the defect pattern?
- Can the prosthesis be removed or redesigned for access and long-term cleaning?
- Why is resective, regenerative, combined treatment, or removal recommended?
- How will the ceramic or titanium surface be decontaminated without unacceptable damage?
- What findings at reassessment would indicate success, recurrence, or need for removal?
What this means for patients
Peri-implantitis is treated stepwise, beginning with plaque control and restoration access and often progressing to surgery. The implant should be retained only when disease can be controlled and the final restoration can be cleaned and maintained.
Selected references
- Herrera D, Berglundh T, Schwarz F, et al. Prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50 Suppl 26:4-76. doi:10.1111/jcpe.13823.
- Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop. J Periodontol. 2018;89 Suppl 1:S313-S318.
- Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol. 2018;45 Suppl 20:S246-S266.
- Jepsen S, Schwarz F, Cordaro L, et al. Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology. J Clin Periodontol. 2019;46 Suppl 21:277-286.
- Koo KT, Khoury F, Keeve PL, et al. Implant surface decontamination by surgical treatment of peri-implantitis: a literature review. Implant Dent. 2019;28(2):173-176.
- Apaza Alccayhuaman KAA, Zandinejad A, Beltrao R, Schick F, Rohr N. ZrO Summit 2025, Group 4. Int J Oral Maxillofac Implants. 2026. doi:10.11607/jomi.11786.