<p>Peri-implant mucositis is a common inflammatory condition affecting the soft tissues around dental implants, characterized by bleeding on probing (BoP) without bone loss. If left untreated, it can progress to peri-implantitis, potentially leading to implant failure. Non-surgical mechanical and physical therapies, such as ultrasonic debridement, air-abrasive devices, and oscillating chitosan brushes, are frequently used for treatment, but their comparative effectiveness is uncertain. This systematic review of randomized controlled trials (RCTs) assesses the efficacy and safety of these therapies in managing peri-implant mucositis. A comprehensive literature search was conducted across multiple electronic databases from October 2015 to October 2025. Nine RCTs meeting the inclusion criteria were analyzed, focusing on mechanical and physical interventions. Studies included those with follow-up periods of at least three months, reporting on outcomes such as BoP, probing pocket depth (PPD), and soft tissue health. The trials, with sample sizes ranging from 11 to 220 participants, evaluated treatments like air-abrasive devices (glycine/erythritol), ultrasonic debridement, and oscillating chitosan brushes. All therapies showed significant reductions in BoP and PPD, while no single treatment showed short-term superiority. Mechanistic studies indicated improved microbial diversity and reduced pro-inflammatory cytokines. Overall, mechanical and physical therapies, including ultrasonic debridement and air-abrasive systems, are effective for managing peri-implant mucositis. A critical determinant of success for any professional treatment is the establishment and maintenance of excellent patient-administered oral hygiene. Consistent professional care combined with good patient oral hygiene remains essential. Future research should focus on long-term follow-ups and patient-reported outcomes. .</p>