Little progress has been made in the treatment of peri-implant diseases over the last five years. No revolutionary approach has emerged to ensure predictability, especially for the treatment of peri-implantitis. In the process, we have learned that peri-implant bleeding is highly prevalent, that peri-implant diseases are much more difficult to bring under control than periodontal diseases, and that hygiene around implants should be emphasized even more than around teeth. It has also become evident that when implant-supported prostheses are correctly planned in a prosthetically driven position, the risk of peri-implant diseases is greatly reduced.

Currently, we treat patients with peri-implant diseases according to three possible situations: 

1. Implants with peri-implant mucositis with adequate access for plaque control are sent for submarginal plaque removal and reinforcement of oral hygiene instructions. In the absence of keratinized mucosa and in the presence of brushing discomfort, patients are often required to undergo keratinized soft tissue augmentation.
2. Implants with peri-implantitis and adequate access for plaque control are treated in the same manner as mucositis implants, in addition to open flap debridement. In the presence of intra-osseous defects, reconstructive procedures are often used.
3. Implants with peri-implantitis that are considered unreasonable to treat due to mobility, progressive radiographic bone loss, poor esthetics or no access to proper plaque control, are explanted and replaced.

In summary, we have learned over the last 5 years that the best course of action to manage peri-implant diseases continues to be prevention by providing adequate (i) prothesis design, (ii) proper access for domestic plaque control and (iii) inclusion in a regular maintenance program.