Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Abstract

Purpose To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.

An Umbrella Review on Low-Abrasive Air Powder Water Jet Technology in Periodontitis and Peri-Implantitis Patients

“…Four systematic reviews analyzed the use of APWJT during active peri-implant therapy [7,39,41,45]. All of the included studies used glycine as an air polishing powder.…”

“…When APWJT was used as an alternative to conventional methods in the treatment of peri-implant mucositis, it was concluded that both treatment methods resulted in comparable clinical outcomes [7,39,41]. Just one study performed a meta-analysis that resulted in contradictory results, showing an additional benefit of APWJT regarding PPD reduction in the treatment of peri-implant mucositis [39].…”

“…APWJT used as an adjunct in the treatment of peri-implant mucositis was investigated in three reviews [7,39,41]. All of them reported from the same two clinical studies [46,47].…”

Adjuvant use of multispecies probiotic in the treatment of peri‐implant mucositis: A randomized controlled trial

“…Even though clinical parameters can be improved by mechanical debridement (MD), sites with deeper pockets and BOP are still observed after the treatment (Heitz‐Mayfield et al, 2011). Ancillary methods, including the use of mouthwash, application of local antiseptic gel, use of antimicrobial photodynamic therapy, systemic antibiotics, and air abrasion device, have not provided additional benefits when compared with conventional mechanical treatment (Ciancio et al, 1995; Porras et al, 2002; Lindhe & Meyle, 2008; Thone‐Muhling et al, 2010; Heitz‐Mayfield et al, 2011; Hallström et al, 2012; Jepsen et al, 2015; Albaker et al, 2018; Barootchi et al, 2020; Liu et al, 2020; Ramanauskaite et al, 2021).…”

Peri-Implantitis: Application of a Protocol for the Regeneration of Deep Osseous Defects. A Retrospective Case Series

“…Many treatment options have been proposed during the years in areas affected by peri-implantitis [ 14 ]. It is widely accepted that mild cases should be treated non-surgically; this approach is also recommended as the initial phase for severe cases.…”