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Treatment Algorithm · Sample Module

Managing the ailing & failing implant

A chairside decision pathway for peri-implant mucositis and peri-implantitis — diagnosis, stepwise intervention, and the threshold for explantation. Built on the 2017 World Workshop case definitions and the 2023 EFP S3 clinical practice guideline.

Use: Point-of-care reference Scope: Diagnosis → non-surgical → surgical → removal Evidence: S3-level guideline
01 — Diagnosis
Case definitions at a glance

Establish the diagnosis before intervening. The distinction between mucositis (reversible, soft-tissue only) and peri-implantitis (progressive bone loss) determines the entire treatment pathway.

Peri-implant health
  • No bleeding on probing / suppuration
  • No increase in probing depth vs. baseline
  • No bone loss beyond initial remodeling
  • Action: routine supportive care
Peri-implant mucositis
  • BOP and/or suppuration present
  • ± increased probing depth from inflammation
  • No bone loss beyond initial remodeling
  • Action: reversible — non-surgical control
Peri-implantitis
  • BOP / suppuration plus progressive bone loss
  • No prior radiographs: PD ≥ 6 mm + BL ≥ 3 mm
  • Increasing PD vs. prosthesis-delivery baseline
  • Action: staged intervention (below)
02 — Decision Pathway
Interactive treatment selector

Work top-down. Select the scenario that matches your patient to reveal the recommended protocol. Always treat reversible disease first and reassess before escalating.

Tap a node to see the recommended next step. Re-evaluate 6–8 weeks after each phase before escalating.

Step 1 — What is the diagnosis?

MUCOSITIS
Inflammation, no bone loss
BOP/suppuration present; bone stable.
EARLY PERI-IMPLANTITIS
Bone loss, PD ≤ 6 mm, accessible
Progressive loss but limited depth/defect.
ADVANCED, RESPONSIVE
PD > 6 mm / deep defect, implant stable
Persists after non-surgical phase; restorable.
FAILING IMPLANT
Mobility / > 50% bone loss / unrestorable
Loss of osseointegration or non-salvageable.
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03 — Protocol
Stepwise management of peri-implantitis

A cumulative approach mirroring the EFP S3 guideline. Each phase builds on the prior one; surgery is reserved for sites that do not resolve non-surgically.

1
Cause-related (pre-therapeutic) phase
Reinforce oral hygiene, correct plaque-retentive prosthetic factors (overcontoured/over-cemented restorations, residual cement), treat active periodontitis, and address smoking and glycemic control. Remove the restoration if access is inadequate.
2
Non-surgical mechanical debridement
Submucosal instrumentation with implant-appropriate instruments (titanium/PEEK curettes, air-polishing with glycine/erythritol powder, ultrasonics with soft tips). Adjuncts (local antiseptics, lasers) show limited additive benefit. Re-evaluate at 6–8 weeks.
3
Surgical access & decontamination
If inflammation persists: open-flap debridement with thorough implant-surface decontamination. Choose resective (apically positioned flap ± implantoplasty for supracrestal/horizontal defects) vs. reconstructive based on defect morphology.
4
Reconstructive therapy (selected defects)
For contained intrabony defects (≥ 3 walls), consider bone substitute ± barrier membrane. Evidence supports radiographic defect fill but predictability depends on defect geometry and decontamination quality.
5
Supportive peri-implant care (SPIC)
Lifelong recall at risk-based intervals (3–6 months): probing, BOP, radiographic monitoring, professional debridement. The single strongest predictor of long-term stability after treatment.
04 — Removal Threshold
When to explant vs. salvage

No single criterion is absolute; weigh the full picture. The presence of any "remove" indicator below shifts the balance strongly toward explantation.

FindingSalvage favoredRemoval favored
Implant mobility Stable clinically immobile Mobile = lost osseointegration
Bone loss < 50% of implant length > 50% or approaching apex
Defect morphology Contained, accessible Circumferential, non-contained
Position / restorability Prosthetically valuable, correctable Malpositioned, unrestorable
Response to therapy Improving after staged care Progressive loss despite treatment
Symptoms / infection Controlled Recurrent suppuration, pain, fistula
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Treatment decisions remain the responsibility of the treating clinician. Verify drug doses, devices, and protocols against current manufacturer instructions and local guidelines.
  1. Berglundh T, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop. J Periodontol. 2018;89(Suppl 1):S313–S318.
  2. Renvert S, et al. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S304–S312.
  3. 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.
  4. Schwarz F, et al. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–S290.

Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0