I see that no one has responded to your question. I am sure that there are others that have more sophisticated approaches to this dilemma, but this is what I have done in the past with good results:

Alter the surface of the implant body via carbide finishing burs following surgical flap. Not as easy as stated, but that is the goal. The finishing burs leave a much better surface than the original surface, but still less than ideal. Polishing is more difficult and more fraught with concern over heating the implant body.

I have used, with copious irrigation, diamond imbedded rubber polishing points such as used for porcelain polishing, 3 grits, and this can make a great difference in the reduction of microenvironments. I shape these as necessary to get in to smaller areas, but polishing to the exact bone/implant margin is not possible yet may not be necessary if detoxified along with the polishing process (see other posts on this). Also, the biologic width that re-establishes itself during healing might seal this small unpolished area, but you can get to that interface with the finishing burs so the surface left will still be better than the original one causing the inflammation via the microenvironments supporting bacterial colonies.

More difficulty exists when the result is angular bony defects against the implant because of the poor access to the implant. Options exist to address this including implant removal, grafting, and re-implanting the site.

This is a difficult situation to address but I have had good success in years past with this approach when it is desirable to save the implant rather than redo it. Combined with periodontal osseous surgical principals success can be achieved, case selection is paramount of course.

Others may have different experiences or suggestions.

Michael

Great responses from above. My short answer is refer to perio they are best at treating this. As an OMFS I work pretty closely with periodontists on these types of issues.