Efficacy of mechanical/physical approaches for implant surface decontamination in non‐surgical submarginal instrumentation of peri‐implantitis. A systematic review

Abstract

Aim To evaluate the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination compared to non‐surgical submarginal instrumentation alone or with placebo decontamination in patients with peri‐implantitis. Materials and Methods Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri‐implantitis and a minimal follow‐up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri‐implant bone level changes, patient‐related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes. Results Out of 239 findings, full‐text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air‐abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser‐treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air‐polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta‐analysis was performed. Conclusions Available evidence on the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient‐reported benefits remain to be demonstrated.

Prevention and treatment of peri‐implant diseases—The EFP S3 level clinical practice guideline

“…For this guideline, a total of 13 SRs were conducted to support the guideline development process (Carra et al, 2023; Cosgarea et al, 2023; de Waal et al, 2023; Dommisch et al, 2023; Donos et al, 2023; Gennai et al, 2023; Karlsson et al, 2023; Liñares et al, 2023; Ramanauskaite et al, 2023; Stiesch et al, 2023; Teughels et al, 2023; Verket et al, 2023; Wilensky et al, 2023). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology .…”

“…Supporting literature (Cosgarea et al, 2023;de Waal et al, 2023;Liñares et al, 2023) and Expert opinion Quality of evidence Moderate-indirect evidence derived from 15 RCTs, with at least 6 months of follow-up (10 with low, 3 with some concerns and 2 with high risk of bias)…”

“…Supporting literature (Cosgarea et al, 2023) Quality of evidence Low-five RCTs (n = 178 patients, n = 225 implants) with a minimum follow-up of 6 months (two studies at high risk and three studies with low risk of bias)…”

“…In the SRs prepared for the present project (Cosgarea et al, 2023; de Waal et al, 2023; Liñares et al, 2023), 15 RCTs with at least 6‐month follow‐up were considered as valid for developing recommendations. For the present recommendation, outcomes from both test and control groups are considered.…”

Peri‐implantitis as the consequence of errors in implant therapy

“…13,89 Provided that implant-supported restorations are cleansable, mechanical biofilm removal at implant and abutment surfaces may be accomplished by the use of hand and mechanical instruments, respectively. 32,90 Although adjunctive treatments to mechanical biofilm removal alone yielded beneficial effects in the management of peri-implant mucositis, complete resolution of mucosal inflammation still remained unpredictable.…”