How should peri-implant mucositis be treated?

Peri-implant mucositis should be treated primarily with nonsurgical mechanical debridement, which alone produces meaningful reductions in bleeding on probing (BOP), probing pocket depth, and plaque indices ^[1][2]. Several mechanical/physical approaches are documented - curettes, ultrasonic scalers, air-polishing, lasers, and rotating brushes - but none has been shown to be superior to the others ^[3]. Treatment success rates (defined as absence of BOP) after mechanical/physical instrumentation range from roughly 30-35% at 3 months and fall to 8-17% at 6 months, meaning complete resolution is uncommon and should not be expected in all patients ^[3][2].

Oral hygiene instructions (OHI) alone can achieve resolution in a meaningful proportion of compliant patients (around 39% at 3 months at patient level), but adding mechanical instrumentation to OHI improves success rates substantially (56% at patient level, 67% at implant level), making the combination preferable ^[4]. Patient compliance is a strong positive predictor of success, while a history of periodontitis, posterior implant location, heavy smoking, and the presence of periodontal pathogens such as Porphyromonas gingivalis and Tannerella forsythia negatively influence outcomes ^[5][4].

The routine adjunctive use of chlorhexidine (CHX) is debated. Two meta-analyses found that CHX does not significantly improve probing depth reduction compared to mechanical debridement alone ^[1][6]; however, one placebo-controlled RCT found that combining nonsurgical instrumentation with CHX mouthwash, subgingival irrigation, and tongue brushing produced significantly greater BOP and plaque index reduction at 6 months compared to placebo ^[5]. Similarly, laser therapy as an adjunct to nonsurgical treatment may offer modest short-term BOP reduction but provides minimal benefit in probing depth or attachment level ^[7]. Overall, the current evidence supports mechanical debridement as the core treatment, with adjuncts yielding only minor additional improvements ^[2].