Das Wichtigste in Kürze
- Peri-implantitis is not fully reversible — early treatment is the most important factor for implant preservation.
- Therapy stages: 1. Non-surgical therapy → 2. Re-evaluation after 6 weeks → 3. Surgery if persistent.
- Mucositis (without bone loss): nearly 100% reversible through professional cleaning.
- Reconstructive surgery shows significantly fewer implant losses after 3 years (1%) vs. non-reconstructive (8%).
- Complete bone fill is achieved in only ~10% of cases; partial fill in ~86%.
- Recall every 3–6 months after treatment is mandatory — without follow-up, relapse risk increases sharply.
Peri-implantitis affects approximately 22% of all implant patients and is the most common cause of implant failure. But what happens once the diagnosis is made? This article explains the therapy stages according to the EFP S3 Clinical Practice Guideline 2023 (Herrera et al., Journal of Clinical Periodontology), what patients can expect during treatment — and what research says about long-term outcomes.
Mucositis ≠ Peri-implantitis
The distinction is crucial for treatment. Peri-implant mucositis: inflammation only in soft tissue, no bone loss — fully reversible. Peri-implantitis: inflammation + radiologically detectable bone loss — not fully reversible, but treatable.
Therapy Stages: What Is Done When
Non-Surgical Therapy (Phase 1)
Professional mechanical cleaning of the implant surface (curettes, ultrasound, air-polishing with glycine powder). Adjuvant: chlorhexidine mouthwash, local antiseptics if needed. Goal: biofilm elimination and inflammation reduction. For mucositis this is often sufficient — for peri-implantitis, access to the contaminated surface is limited.
Re-evaluation after 6–8 weeks: Re-evaluation after 6–8 weeks: if bleeding on probing, pocket deepening, or bone loss persists → surgical therapy.
Surgical Therapy (Phase 2) — if persistent
Open flap debridement (OFD): gum is reflected, implant surface directly accessible. Decontamination with mechanical and chemical methods. Then depending on defect morphology: resective (bone recontouring, implantoplasty) or reconstructive (guided bone regeneration with bone substitute material + membrane, for vertical defects ≥ 3 mm).
Explantation (Last Resort)
When surgical therapy fails, bone loss cannot be stopped, or the implant becomes mobile. After complete healing (3–6 months) and bone augmentation, re-implantation is possible — but with lower success rates than primary implantation.
What Research Says About Treatment Outcomes
| Therapy | Resolution | Implant loss (3 yr) | Bone gain |
|---|---|---|---|
| Mucositis: Professional cleaning | ~100% reversible | < 1% | None needed |
| Non-surgical (peri-implantitis) | 50–60% | 2–5% | No measurable gain |
| Surgical resective (OFD) | 60–75% | 2% (after 1 yr) | Minimal |
| Surgical reconstructive (GBR) | 65–80% | 1% (after 3 yr) | Ø +1.7 mm, complete fill ~10% |
Conclusion: Act Early, Follow Up Consistently
Peri-implantitis is treatable — but not fully reversible. The EFP S3 CPG 2023 is clear: early diagnosis and consistent therapy are the decisive factors for implant preservation. Patients who seek treatment at the first signs (bleeding gums, redness, pocket deepening) have significantly better outcomes. And after treatment: recall every 3–6 months is not a recommendation — it is a prerequisite.
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