PERI-EDU University Education
Peri-implant health is designed before implant placement and protected throughout function. Prevention, early detection, sequential treatment and structured supportive care form one continuous clinical pathway.
Prevention begins before implant placement
Implant planning should address periodontal stability, plaque control, smoking, glycaemic status, anatomy, tissue phenotype and the patient’s ability to maintain the future restoration.
| Domain | Clinical question | Preventive action |
|---|---|---|
| Periodontal history | Is periodontitis controlled? | Complete therapy and establish stability before implant placement. |
| Plaque control | Can the patient clean the proposed restoration? | Provide individualized instruction and verify performance. |
| Smoking | What is the current exposure? | Offer cessation support and discuss treatment risk. |
| Diabetes | Is glycaemic control adequate? | Coordinate medical care where required. |
| Anatomy | Can the implant be placed within a stable tissue envelope? | Modify the plan, augment tissues or reconsider the restorative option. |
| Maintenance | Can long-term follow-up be provided? | Agree on a supportive-care pathway before treatment. |
Position and prosthetic design determine maintainability
Three-dimensional implant position, bone and soft-tissue dimensions, emergence profile and interproximal access determine whether biofilm can be removed and disease can be detected early.
- Use a restoratively driven implant position supported by an adequate bone envelope.
- Avoid contours and deep margins that obstruct self-care or professional instrumentation.
- Prevent or remove residual submucosal cement.
- Verify component integrity, retention and retrievability.
- Confirm that the patient can demonstrate effective cleaning before finalizing the restoration.
After tissue maturation, record probing depths, bleeding or suppuration, mucosal margin position and an interpretable radiographic baseline.
Supportive peri-implant care is active prevention
| Component | What to assess or deliver | Purpose |
|---|---|---|
| Health update | Smoking, diabetes, medications and symptoms. | Identify changing risk and treatment needs. |
| Clinical examination | Plaque, bleeding/suppuration, probing depths and recession. | Detect inflammation and dimensional change. |
| Radiographic review | Comparable images when findings justify exposure. | Assess supporting bone and technical complications. |
| Self-care review | Observe technique around the actual restoration. | Correct access and performance problems. |
| Professional biofilm removal | Use implant-appropriate instruments. | Reduce microbial challenge while limiting surface damage. |
| Prosthetic review | Cleansability, retention, occlusion and component integrity. | Correct factors sustaining inflammation. |
Recall intervals should reflect previous periodontitis, current inflammation, plaque control, systemic risk, prosthetic complexity and previous peri-implantitis treatment.
Peri-implant mucositis is the prevention checkpoint
Mucositis is treated through improved self-performed plaque control, professional mechanical debridement and correction of local plaque-retentive factors. Treatment should be re-evaluated after approximately two to three months.
- Confirm inflammation without progressive bone loss.
- Adapt oral-hygiene aids to the restoration.
- Provide professional debridement.
- Remove excess cement and correct inaccessible contours.
- Address smoking and metabolic control where relevant.
- Re-evaluate whether peri-implant health has been restored.
Antiseptics, antimicrobials, lasers and other adjuncts do not replace effective mechanical biofilm control and adequate access.
Peri-implantitis treatment is sequential
Initial therapy confirms the diagnosis, reduces inflammation, improves hygiene, controls risk factors and establishes whether surgery or implant removal is required.
| Step | Purpose | Key consideration |
|---|---|---|
| Confirm diagnosis | Separate progressive disease from remodeling and technical complications. | Compare baseline records and exclude mimics. |
| Assess prognosis | Determine whether retention can produce a maintainable result. | Consider position, support, prosthesis and patient risk. |
| Control biofilm | Reduce the microbial burden and improve daily access. | Modify or remove the prosthesis if it blocks treatment. |
| Mechanical instrumentation | Disrupt accessible deposits and biofilm. | Balance efficacy with surface preservation. |
| Risk-factor control | Reduce continued inflammatory pressure. | Address smoking, glycaemia and periodontal infection. |
| Re-evaluation | Determine whether additional intervention is required. | Use predefined clinical endpoints. |
Surgical therapy follows defect anatomy
- Access flap: provides direct visualization and instrumentation.
- Resective therapy: reduces pocket depth and creates maintainable architecture but may increase recession.
- Implantoplasty: may smooth exposed threads in selected areas but is irreversible and generates titanium debris.
- Reconstructive therapy: may provide defect fill in suitable contained defects, although outcomes remain variable.
- Soft-tissue augmentation: can improve tissue stability or comfort but does not replace infection control.
- Explantation: should be considered for hopeless, fractured, severely malpositioned or repeatedly uncontrolled implants.
Radiographic defect fill alone does not establish treatment success. Inflammation, pocket depth, bone stability and long-term maintainability must also be assessed.
Surface decontamination: no universal gold standard
Mechanical, chemical, air-polishing, laser and photodynamic methods have all been investigated. Performance depends on access, surface geometry, treatment parameters and tissue safety. Experimental biofilm removal does not automatically translate into superior clinical outcomes.
Antibiotics should not routinely substitute for access and mechanical biofilm disruption. Their use requires a defined indication and antimicrobial-stewardship assessment.
Treatment endpoints and recurrence prevention
- No suppuration and minimal or absent bleeding on gentle probing.
- Reduction of pocket depth to a clinically maintainable level.
- Stable supporting bone on comparable radiographs.
- Demonstrated patient access for daily plaque control.
- A stable, cleansable prosthesis with intact components.
- Attendance at individualized supportive-care intervals.
Integrated clinical pathway
- Control risk before implant placement.
- Create a correct position and cleansable restoration.
- Establish baseline clinical and radiographic records.
- Treat mucositis promptly.
- Manage peri-implantitis through an initial non-surgical phase.
- Select surgical therapy according to defect and site anatomy.
- Verify clinical endpoints.
- Prevent recurrence through lifelong risk-adjusted supportive care.
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The full PDF expands prevention, maintainable implant design, supportive care, mucositis management, sequential peri-implantitis treatment, surgical selection, surface decontamination and recurrence prevention.
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Selected references
- Herrera D, 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.
- Wang HL, et al. AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report. J Periodontol. 2025.
- Hart I, et al. Effectiveness of mechanical and chemical decontamination methods for implant surfaces affected by peri-implantitis. Clin Exp Dent Res. 2024;10:e839.
- Schwarz F, et al. Peri-implantitis. J Clin Periodontol. 2018;45(Suppl 20):S246-S266.
- Tomasi C, et al. Efficacy of reconstructive surgical therapy at peri-implantitis-related bone defects. J Clin Periodontol. 2019;46(Suppl 21):340-356.
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This material supports clinical reasoning and does not replace individualized diagnosis, implant-system instructions, surgical training or professional judgment.
This work was co-funded by the European Union under grant agreement No. 2024-1-PL01-KA220-HED-000251208. Views and opinions expressed are those of the author(s) only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System (FRSE). Neither the European Union nor FRSE can be held responsible for them.