Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research.

Purpose: To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.Material and methods: Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched.Results: Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm;p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%;p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%;p = 0.01 and WMD = − 17.35%;p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%;p = 0.01 and WMD = − 1.47 mm;p = 0.01), PD (− 0.51 mm;p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm;p = 0.01), while changes in BOP were not significant (WMD = − 11.11%;p = 0.11).Conclusions: Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.