The protocol includes four treatment modalities:

A = Mechanical Debridement

In this the patients are re-instructed in oral hygiene and motivated to initiate and continue maintenance. Mechanical debridement is done using non metallic curettes, and polishing is done with rubber cup and non abrasive polishing paste.

B = Chemical Plaque control (anti septic cleaning) is performed

a) Chlorhexidine gluconate is used typically as mouthrinses with 0.1 per cent to 0.2 per cent chlorhexidine for 30 seconds using approximately 10 ml.

b) Application of local chlorhexidine gel (0.2 per cent)

c) Local irrigation with chlorhexidine (0.2 per cent) two times a day for 3-4 weeks

C = Systemic or Local Antibiotic Therapy

Systemic treatment Includes:

Ornidazole (1000 mg X 1) or Metronidazole (250 mg X 3) for 10 days OR a combination of Amoxicillin (375 mg X 3 ) and Metronidazole (250 mg X 3) for 10 days.

Local Antibiotic treatment:

Local application of antibiotics using a controlled release device for 10 days.

eg.,Tetracycline fibres and Minocycline Microspheres.

D = Surgical Therapy

Surgical therapy for peri-implantitis should be performed in conjunction with systemic antibiotics and implant surface decontamination. If regenerative treatment is chosen, a barrier membrane technique alone or in combination with autogenous grafts and/ or bone substitutes may be considered. Resective surgery may be considered when the periimplant defect is not suitable for regenerative techniques.