Peri-Implantitis: Non-Surgical Treatment
Curettes and/or ultrasonics. Air polishing is not recommended subgingivally.
Critical distinction from mucositis: Curettes + ultrasonics recommended. Air polishing not recommended subgingivally.
Evidence Guidelines & evidence
- EFP S3 R7.1
In patients with peri-implantitis, we recommend therapy to retain an individually acceptable implant/prosthesis as the first line of treatment. Peri-implantitis therapy starts with a non-surgical step, followed by re-evaluation.
Source ↗ - EFP S3 R7.2
Non-surgical step should include: OH instructions and motivation, risk factor control, prosthesis cleaning/removal/modification, supramarginal and sub-marginal instrumentation, concomitant periodontal therapy as needed.
- EFP S3 R7.4
We recommend performing non-surgical supra- and sub-marginal instrumentation with curettes and/or sonic/ultrasonic devices.
- EFP S3 R7.6
We suggest not to use air polishing for non-surgical sub-marginal peri-implant instrumentation.
1 OH instructions & risk factor control
First step in non-surgical treatment. Individually tailored oral hygiene instructions. Manage modifiable risk factors (smoking, diabetes, poor hygiene, non-adherence). Check for prosthetic overhangs and biofilm-retentive factors; modify prosthesis access where needed (R7.2).
2 Sub-marginal instrumentation
Supra- and sub-marginal instrumentation with curettes and/or sonic/ultrasonic devices (R7.4). Do NOT use air polishing subgingivally (R7.6). Do NOT use lasers (R7.5). Assess BOP, suppuration, increased probing depth and radiographic bone loss beyond remodeling before instrumentation.
EFP Probe Hero 
ColorVue Probe
Implacare TIS Hero 
PWR Piezo Hero 
Gracey Curettes 
Implacare II
3 Concomitant periodontal therapy
If periodontal disease is detected at adjacent natural teeth, treat concurrently (R7.2). Do not leave an untreated periodontal reservoir alongside implant therapy.
Expert perspectives
“Mechanical debridement remains the cornerstone of peri-implantitis management — no adjunctive therapy has consistently demonstrated superiority without it.”
“Clinicians should recognise that non-surgical therapy alone rarely resolves advanced peri-implantitis, but it is the mandatory first step before considering surgery.”
Related resources
- EFP S3 Clinical Practice Guideline (Peri-Implant Diseases)
Full-text clinical guideline (Herrera et al. 2023) — the underlying evidence for the non-surgical protocol
- Peri-implantitis decision aid (patient-facing)
Downloadable leaflet explaining peri-implantitis and treatment options in plain language