DDJ Patient Article · As of March 2026 · Explained Clearly
Which Periimplantitis Therapies Are Evidence-Based Effective and Where Does the Transferability of Individual Approaches End?
Explained clearly based on current scientific studies. This article helps you make informed decisions together with your dentist.
This topic concerns a treatment or measure that your dentist can perform or recommend.
Quick Summary
The most important findings at a glance:
- The results are mixed — there are both positive and critical findings.
- The scientific foundation is solid, but not all questions have been conclusively resolved.
- The article must clarify the decision threshold between the approaches.
- Treating periimplantitis means not just operating — it means maintaining long-term control.
Why is this topic important for you?
You may have heard that there are differing opinions on this topic. That is because science is often more complex than a simple yes-or-no answer might suggest. In this article, we explain what current research actually shows — without jargon and without leaving out important details.
Periimplantitis is treatable, but not every therapy is equally well supported by evidence. The core clinical question is choosing the right approach for the right clinical finding.
Why is this important for you? Because as a patient, you can make better decisions when you understand the background. This article does not replace a conversation with your dentist, but it gives you the knowledge to ask the right questions.
The most important research questions revolve around the following areas: non-surgical vs. surgical, decontamination and surface treatment, long-term success and recurrence risk. For each of these areas, we explain below what the studies show and what that means for your everyday life.
What is better: Non-surgical or surgical?
One of the most common questions patients ask about this topic concerns non-surgical vs. surgical treatment. The answer is not as simple as one might hope — but research now provides clear guidance.
The EFP S3 guideline (West et al. 2024) defines a clear escalation logic: Non-surgical therapy via mechanical biofilm removal is the first treatment step for periimplantitis. The guideline is based on the GRADE-ADOLOPMENT framework and was developed by a representative panel including prosthodontics, implantology, and oral surgery. Mechanical instrumentation alone shows limited effectiveness with advanced defects, which is why surgical escalation is recommended in cases of persistent pockets and progressive bone loss.
Surgical therapy includes resective and regenerative approaches. Resective procedures aim to eliminate the peri-implant defect through bone recontouring and flap surgery. Regenerative procedures using bone substitute materials and membranes are used in suitable defect morphologies. The EFP guideline recommends surgical intervention for patients who do not respond adequately to non-surgical therapy, with defect morphology determining the choice between resective and regenerative approaches.
The threshold between non-surgical and surgical therapy is not uniformly defined. Schwarz et al. (2012) analyzed 75 publications on ligature-induced periimplantitis animal models in a scientific review and identified considerable methodological heterogeneity: the active breakdown period varied on average by 14.3 ± 6.4 weeks, followed by a progression period of 5.5 ± 10.4 weeks, producing a mean bone loss of 40.0 ± 14.0% of implant length. This experimental variability reflects clinical uncertainty in determining the timing of escalation.
The clinical decision between conservative and surgical therapy is further influenced by patient factors: smoking status, periodontal disease (periodontitis) history, systemic conditions, and compliance determine the individual treatment response. The EFP guideline emphasizes that the treatment decision should depend not solely on defect depth, but on a multiparametric risk profile.
Methodologically, it should be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across different study types.
For transferability to the context of German-speaking healthcare, it is additionally relevant that a considerable proportion of the scientific evidence comes from Anglo-American or Scandinavian healthcare systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the overall conclusion.
In practice, the stepwise escalation logic is the most important framework: first non-surgical biofilm removal, re-evaluation after three to six months, and surgical intervention if signs of inflammation and bone loss persist. The choice of surgical procedure is guided by defect morphology.
The clinical challenge is not to set the escalation point too late. Since periimplantitis progresses more rapidly than periodontal disease (periodontitis) and its non-linear progression pattern includes an accelerating phase, re-evaluation after non-surgical therapy should not be delayed.
In everyday practice, this means: the evidence does not provide a one-size-fits-all answer, but a framework for individualized decisions. Patient-specific factors such as general health, compliance, individual risk profiles, and treatment preferences must be incorporated into the decision.
What does this mean for you? The article must clarify the decision threshold between the approaches.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and to ask targeted questions when something is unclear.
Science has intensively studied this topic in recent years. More than 8 scientific publications were evaluated for this article. It is important to understand: not every study carries the same weight. Large, well-controlled studies provide more reliable results than small observational studies. The overall view of these various studies paints the picture we present to you here.
💡 What does this mean for you?
The article must clarify the decision threshold between the approaches. Discuss at your next dental appointment what this means specifically for your situation.
What does "decontamination and surface treatment" mean for me as a patient?
When it comes to decontamination and surface treatment, the research picture is clearer than many people think. Here you will find out what the current studies actually show.
Mechanical decontamination of the implant surface is the core of every periimplantitis therapy. The EFP S3 guideline (West et al. 2024) recommends subgingival instrumentation as the standard procedure. Additional procedures such as laser, photodynamic therapy, and chemical antiseptics are discussed as potential adjuncts but are not recommended as routine measures.
An independent systematic review by Jervøe-Storm et al. (2024) examined adjunctive antimicrobial photodynamic therapy (aPDT) in 50 RCTs with 1,407 participants. In active periodontal disease (periodontitis) therapy, the mean difference in probing depth after six months was 0.52 mm (95% CI 0.31–0.74), bleeding on probing 5.72% (95% CI 1.62–9.81), and clinical attachment level 0.44 mm (95% CI 0.24–0.64) in favor of aPDT — all at very low quality of evidence. The authors rated these differences as clinically not meaningful.
In the supportive phase, Jervøe-Storm et al. (2024) found no relevant differences: the mean difference in probing depth was -0.04 mm (95% CI -0.19–0.10), bleeding on probing 4.98% (95% CI -2.51–12.46). No usable data were available for periimplantitis — the review identified no studies on patients with periimplantitis and only one very small study on peri-implant mucositis without six-month data.
24 studies with 639 participants reported no adverse effects from aPDT (moderate quality of evidence). The authors concluded that due to the very low quality of evidence, it cannot be reliably assessed whether adjunctive aPDT leads to improved clinical outcomes, and that even possible improvements would be too small to be clinically meaningful.
Methodologically, it should be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across different study types.
For transferability to the context of German-speaking healthcare, it is additionally relevant that a considerable proportion of the scientific evidence comes from Anglo-American or Scandinavian healthcare systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the overall conclusion.
In practice, mechanical decontamination should remain central. Adjunctive procedures such as aPDT, laser, or chemical additives can be discussed as complementary options in individual cases but should not be recommended as routine measures, since the level of evidence does not support a meaningful additional benefit.
The cost implications of adjunctive procedures should be communicated: the acquisition of laser or aPDT devices is substantial, while the demonstrated clinical additional benefit is minimal to non-existent.
In everyday practice, this means: the evidence does not provide a one-size-fits-all answer, but a framework for individualized decisions. Patient-specific factors such as general health, compliance, individual risk profiles, and treatment preferences must be incorporated into the decision.
What does this mean for you? Additional procedures should only be recommended with evidence-based justification.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and to ask targeted questions when something is unclear.
How do scientists arrive at these conclusions? They do not evaluate just a single study, but look at many investigations simultaneously. This allows them to determine whether a result was coincidental or whether it is consistently confirmed. In this case, the findings are supported by 8 scientific publications from different countries and research groups.
💡 What does this mean for you?
Additional procedures should only be recommended with evidence-based justification. Discuss at your next dental appointment what this means specifically for your situation.
What does "long-term success and recurrence risk" mean for me as a patient?
One point that often causes uncertainty is long-term success and recurrence risk. But science has made important advances in recent years.
The long-term outcomes of periimplantitis therapy are characterized by a high recurrence rate. The EFP S3 guideline (West et al. 2024) emphasizes that periimplantitis can progress in a non-linear, accelerating pattern after treatment if no supportive peri-implant therapy (dental maintenance care) is provided. The progression rate is typically faster than with periodontal disease (periodontitis).
The cost analysis of the EFP guideline reveals the economic dimension: a Swedish study with 514 patients calculated mean costs over 8.2 years of 878 euros (single-tooth restoration) to 1,210 euros (full-arch restoration). The largest cost component was prevention (741 euros), while implant loss was the most expensive complication (1,508 euros), followed by periimplantitis (1,244 euros). The additional costs of implant maintenance were five times higher than those of tooth maintenance.
A cost-effectiveness analysis modeled the 20-year course of individual implants and showed that omitting annual dental maintenance increased the risk of peri-implant disease. Provision of maintenance care was cost-effective, especially for high-risk patients. For non-surgical treatment, instrumentation alone, air polishing, and the combination of instrumentation with local antiseptics/antibiotics were more cost-effective than Er:YAG laser, Vector system, or photodynamic therapy.
Maintenance compliance is the decisive predictor of long-term success. Patients with a history of severe periodontal disease (periodontitis), poor plaque control, and lack of regular dental maintenance consistently have an elevated risk of periimplantitis recurrence. Smoking and diabetes are additional risk factors, although the evidence for these is less consistent than for lack of maintenance care.
Methodologically, it should be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across different study types.
For transferability to the context of German-speaking healthcare, it is additionally relevant that a considerable proportion of the scientific evidence comes from Anglo-American or Scandinavian healthcare systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the overall conclusion.
The clinical consequence is clear: treating periimplantitis means long-term control. Therapy does not end with the surgical procedure but requires lifelong structured maintenance. The maintenance interval should be risk-adapted — every three to four months for high-risk patients, every six months for stable patients.
Already in treatment planning, the long-term costs of maintenance care should be communicated transparently. Patients who can afford the implant but do not account for maintenance are carrying a structurally elevated risk of complications.
In everyday practice, this means: the evidence does not provide a one-size-fits-all answer, but a framework for individualized decisions. Patient-specific factors such as general health, compliance, individual risk profiles, and treatment preferences must be incorporated into the decision.
What does this mean for you? Treatment success must be considered together with ongoing maintenance compliance.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and to ask targeted questions when something is unclear.
What makes these results reliable? In medical research, the principle is: the more independent studies arrive at the same result, the more reliable the conclusion. The type of study and the number of participants also play an important role. Large controlled studies with many participants provide more reliable results than small surveys.
💡 What does this mean for you?
Treatment success must be considered together with ongoing maintenance compliance. Discuss at your next dental appointment what this means specifically for your situation.
Frequently Asked Questions
Here we answer the questions patients most frequently ask about this topic:
❓ What is better: Non-surgical or surgical?
Non-surgical therapy is useful as a first step, but has limited effectiveness with advanced defects. The article must clarify the decision threshold between the approaches.
❓ What does "decontamination and surface treatment" mean for me as a patient?
Mechanical decontamination is standard. Additional procedures should only be recommended with evidence-based justification.
❓ What does "long-term success and recurrence risk" mean for me as a patient?
Surgical therapy shows better short-term outcomes than purely non-surgical approaches. Treatment success must be considered together with ongoing maintenance compliance.
❓ How reliable are the results?
The scientific foundation is solid, but not all questions have been conclusively resolved.
❓ Should I change my behavior based on this information?
Talk to your dentist before making any changes. This article informs you about the current state of research, but every situation is individual. Your dentist knows your personal health situation best.
❓ Where can I learn more?
The detailed expert version of this article with all study details can be found on Daily Dental Journal. For personal advice, contact your dentist.
❓ What is the most important message of this article?
Periimplantitis therapy is a stepwise process, not a one-time intervention.
❓ Why are there differing opinions on this topic?
The conflict lies between the desire for a clear protocol and the heterogeneous research landscape, which does not support a uniform approach for all clinical findings.
🦷 When should you see your dentist?
Schedule an appointment with your dentist if:
- You are unsure whether a recommended treatment makes sense for you
- You have symptoms or notice changes
- You would like to get a second opinion
- You have questions about the topics described in this article
- Your last dental visit was more than a year ago
Important: This article does not replace a dental visit. It helps you enter the conversation informed.
What you can do yourself
Here are concrete steps you can take as a patient:
The Key Takeaway in One Sentence
Treating periimplantitis means not just operating — it means maintaining long-term control.
Note on Sources
This article is based on the DDJ Expert Article and current scientific evidence. All statements are supported by studies that are fully cited in the expert article.
The content has been prepared for patients by the DDJ editorial team. Medical decisions should always be made in consultation with your dentist.
As of: March 2026 · Language: English · Audience: Patients and interested lay readers