Factors affecting the efficacy of nonsurgical therapy of peri‐implantitis

OBJECTIVES AND MATERIALS AND METHODS: This article critically reviews the current knowledge on the factors influencing the efficacy of non-surgical therapy (NST) of peri-implantitis, taking also advantage of the know-how from periodontitis management. RESULTS: Despite the limited available literature, it is clear that factors influencing the possibility to access and effectively decontaminate the implant (by the clinician and by the patient) and factors influencing patients' response and their wound healing potential are likely to play a crucial role. In this respect, assessing the appropriateness of implant-supported prostheses and verify their cleanability (and, whenever needed, modify/replace them) becomes of crucial importance. Likewise, promoting smoking cessation, controlling underlying relevant medical conditions (e.g. type 2 diabetes) and improving patient's compliance to meticulous oral hygiene can enhance NST outcomes. CONCLUSIONS: Future studies are needed to better clarify the plethora of factors impacting on NST efficacy and how clinicians can further promote disease resolution by selecting/adapting decontamination protocols, use of adjunctives and motivation strategies. CLINICAL RELEVANCE: Although NST is always the first treatment approach in peri-implantitis management, its efficacy in promoting disease resolution is currently limited, especially in cases presenting advanced pathology and complex peri-implant defect configurations. It is becoming increasingly clear that successful NST does not only entail an effective biofilm removal, but it requires a multi-level approach where the peri-implant tissues are considered in close interrelation with the implant-abutment-prosthesis complex.