Orientation Before Reading
Critical Axes and Publication Boundaries
- Article Type: Intervention. The topic is organized across five decision axes, not through a global judgment.
- Evidence Basis: Grade A / strong / fully evaluated. 8 studies, of which 4 are supporting (green) and 4 are with reservations (yellow). 0 sources rated as critical.
- Bias Risk: low to moderate. CoI Risk: low. Source Integrity: sound.
- Peri-implantitis therapy is not a single procedure but a management concept. Each axis must be read in isolation.
Clinical Question
What is the evidence-based therapy sequence for peri-implantitis, which adjunctive procedures have proven added value—and what role does structured aftercare play in long-term success?
Executive Summary
The body of literature for this topic is strongly supportive: 8 evaluated sources, including an EFP S3 guideline (2024), a Cochrane Review (2024), and several current systematic reviews and meta-analyses. DDJ reads the strength of conclusion as strong and organizes the evidence not merely as a topic label but along five specific clinical decision axes.
The core messages: Mechanical biofilm removal is the evidence-based first-line approach [1, 2]. Surgical escalation follows persistent disease, guided by defect morphology [1, 2]. Adjunctive photodynamic therapy and lasers do not have consistent added value [3, 4, 5]. Antibiotics remain decisions for individual cases [6, 7]. And without supportive peri-implant therapy (SPT), any primary therapy success is jeopardized [1, 2].
The aggregated bias risk is low to moderate. The visible conclusion ties strong statements to the respective decision axis and avoids global oversimplification.
How DDJ Reads This Topic
Peri-implantitis therapy is not a singular procedure but a sequential management concept. The central tension lies between the evidence-based stepwise concept—first mechanics, then reevaluation, and then potentially surgery—and the marketing of adjunctive technologies that seek to bypass or replace this step-wise concept.
DDJ treats this topic as an intervention article with five axes. Each axis carries its own evidence profile. The article refuses a simple yes or no answer to the question "Is peri-implantitis treatable?" and instead dissects where the evidence supports, where reservations exist, and where actively exaggerated expectations are being sold.
Claim Clusters and Decision Axes
Claim Cluster 1 · ddj0016-c01
Non-Surgical First-Line Therapy
Clinical Axis: Mechanical biofilm removal as the basis of therapy
Why this axis matters: Peri-implantitis begins with bacterial biofilm on the implant surface. Before discussing adjunctive measures or surgery, biofilm control must be established. The EFP S3 guideline from 2024 defines non-surgical mechanical decontamination as the first mandatory treatment step—based on 13 systematic reviews and a consensus process involving 111 delegates. [1]
Evidence Status: Ramanauskaite et al. (2021) show in a systematic review that mechanical debridement consistently leads to reductions in probing depth and bleeding index. [2] The guideline classifies this as a mandatory step, not an optional one.
Where the signal is stable: The recommendation for mechanical decontamination as first-line therapy is based on broad, independently supported evidence. A green guideline source and an independent review converge.
Where the uncertainty begins: The proportion of patients for whom mechanics alone is permanently sufficient cannot be precisely quantified from the existing body of studies. Reevaluation after a defined healing phase is therefore mandatory.
Clinical Consequence: Non-surgical therapy is a prerequisite, not an alternative to escalation. Without mechanical first-line care, there is no evidence-based treatment pathway.
Claim Cluster 2 · ddj0016-c02
Surgical Escalation Based on Defect Morphology
Clinical Axis: When and how is surgery escalated?
Why this axis matters: If inflammation persists and bone loss progresses after non-surgical therapy, surgical intervention is indicated. The EFP guideline explicitly formulates the escalation logic: Defect morphology determines whether a resection or regenerative approach is chosen. [1]
Evidence Status: Ramanauskaite et al. (2021) demonstrate that surgical procedures achieve significantly greater reductions in probing depth than non-surgical therapy alone in advanced defects. [2] The guideline anchors the decision not on the clinician's preference, but on the defect type.
Where the signal is stable: The indication for surgical escalation when non-surgical therapy is insufficient is guideline-based and confirmed by independent reviews.