The use of chemical and pharmaceutical adjunctive therapies in the treatment of peri-implant mucositis (PiM): a narrative review.

OBJECTIVES: Peri-implant mucositis is a reversible inflammatory condition that may progress to peri-implantitis if untreated. Professional mechanical plaque removal (PMPR) is the standard therapy, although complete resolution is not always achieved. This review aimed to evaluate the effectiveness of chemical and pharmacologic adjunctive therapies to PMPR in peri-implant mucositis management. METHOD AND MATERIALS: A literature search was conducted in PubMed and Scopus up to March 2025. Randomized controlled trials including adult patients with peri-implant mucositis, reporting bleeding on probing changes, and with a minimum follow-up of 3 months were included. Nine randomized controlled trials (414 patients) were qualitatively analyzed. RESULTS: PMPR alone resulted in significant reductions in bleeding on probing and probing depth, but complete disease resolution was inconsistent. Adjunctive therapies, including chlorhexidine, local antibiotics, sodium hypochlorite, probiotics, and bioactive agents, showed intra-group improvements. However, additional benefits over PMPR alone were limited and often not statistically significant. Study heterogeneity in diagnostic criteria, outcome definitions, and treatment protocols limited comparability. CONCLUSIONS: PMPR remains the gold standard for peri-implant mucositis treatment. Adjunctive therapies may provide additional clinical benefits in selected cases, but their routine use is not supported by consistent evidence. Standardized randomized controlled trials with long-term follow-up are needed.