“Chelation therapy applied to the treatment of oral Peri-implantitis: A hypothesis”

The supporting tissues of dental implants can be affected by peri-implant disease, which encompasses mucositis and peri-implantitis. Mucositis is localized in the soft tissues around dental implants and is reversible. Meanwhile, peri-implantitis is irreversible, presents peri-implant bone loss, and can lead to implant failure. The causes of peri-implantitis are multifactorial, including biofilms, genetics, history of periodontal disease, smoking, obesity, incorrect prosthetic designs, and metal particles and ions. The current strategies for treating peri-implantitis (decontamination of the implant surface, treatment of the infection, regeneration of the lost bone, and modification of risk factors) have obtained inconsistent outcomes, and relapse occurs. In recent years new histological, immunological, and clinical data shows a strong relationship between metallic ions and particles (nano- or micron-sized) and peri-implantitis. In which the metal ions and particles can produce foreign body reactions, diminished cellular response, increased DNA methylation, alteration of the microbiome, and dysbiosis. Therefore, current therapies for oral peri-implantitis do not consider the deposits of metal particles and ions, and this could explain why the peri-implant disease is not entirely under control with conventional treatments. We hypothesize that chelation therapy used to treat oral peri-implantitis could reduce the excess metal ions present in the surrounding peri-implant tissues improving the outcomes of the current treatments against peri-implantitis. Represented by reduced metal ions, lowered inflammatory markers, reduced bone loss and increased implant survival.