Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial

Wagner, Tassiane Panta; Pires, Paula Rodrigues; Rios, Fernando Silva; Oliveira, J.; Costa, Ricardo dos Santos Araújo; Cunha, Kelly F.; Silveira, Heraldo Luís Dias da; Pimentel, Suzana Peres; Casati, Márcio Zaffalon; Rösing, Cassiano Kuchenbecker; Haas, Alex Nogueira

doi:10.1007/s00784-021-03874-z

Cited by 16 publications

(18 citation statements)

References 38 publications

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“…While some of the included trials chose the site with the deepest probing depth to represent the implant as a whole (Carcuac et al, 2016; Englezos et al, 2018; Heitz‐Mayfield et al, 2018), others used mean values of either four or six sites per implant (de Waal et al, 2013; K. Jepsen et al, 2016). The importance of this distinction may be illustrated by the findings presented by Wagner et al (2021). The authors kindly provided additional data, which illustrated that the use of mean rather than maximum values may result in significant differences (>2 mm).…”

Section: Discussionmentioning

confidence: 90%

“…Eleven of the relevant studies were designed as RCTs. From five studies (K. Jepsen et al, 2016; Renvert et al, 2018, 2021; Wagner et al, 2021; Derks, Ortiz‐Vigón, et al, 2022), single (control) arms were included in the present analysis, while for an additional six RCTs (de Waal et al, 2013, 2015; Carcuac et al, 2016, 2017, 2020; Hallström et al, 2017; Albaker et al, 2018; Hentenaar et al, 2022) multiple arms within the same trial could be considered. The remaining two studies were designed as prospective case series (Heitz‐Mayfield et al, 2012, 2018; Englezos et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

Karlsson

Trullenque‐Eriksson

Tomasi

et al. 2022

J Clinic Periodontology

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Aim To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis. Materials and Methods Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Results Evidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5–0.9) for every millimetre in increase of mean PD at baseline. During the follow‐up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Conclusions Access flap and pocket elimination surgery are effective procedures in the management of peri‐implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.

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Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

Karlsson

Trullenque‐Eriksson

Tomasi

et al. 2022

J Clinic Periodontology

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“…A recent randomized clinical trial by Wagner et al [19] compared surgical and nonsurgical debridement with a 12-month period of observation, evidencing no statistical differences between the two groups; the authors concluded that non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.…”

Section: Discussionmentioning

confidence: 99%

Peri-Implantitis Management: Surgical versus Non-Surgical Approach Using Photodynamic Therapy Combined with Hydrogen Peroxide (OHLLT—Oxygen High Level Laser Therapy): A Retrospective Controlled Study

et al. 2021

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Peri-implantitis management could be performed either with a surgical or non-surgical approach to the implant surfaces. Various treatment options have been proposed in the literature, such as antiseptic and antibiotic therapies, chemical agents, curettes, ultrasonic, air abrasive, rotary titanium brushes and laser treatments; in particular, photodynamic therapy combined with hydrogen peroxide (OHLLT) has proved to be efficient in the removal of bacterial biofilm from implant surfaces. The aim of our study is to compare OHLLT performed with a surgical approach to a non-surgical approach. We selected a cluster of 227 implants affected by peri-implantitis: 139 implants were treated with a non-surgical approach and 88 implants with a surgical approach. Bone loss pre-operative and post-operative (with a follow-up of five years) have been registered. The collected data were entered on the Statistical Package for Social Sciences (SPSS) version 11.5. The results indicate a statistically significant difference between the two groups, with a mean bone loss after treatment of 2.3 mm for OHLLT with a surgical approach and 3.8 mm for OHLLT with a non-surgical approach; according to the Kolmogorov–Smirnov test, the overall data followed a normal distribution (value of the Kolmogorov–Smirnov test statistic = 0.0891; p = 0.35794). Thus, a surgical approach in the case of peri-implantitis seems to be more effective, probably due to the possibility of a deeper sanitization of implant surfaces, hardly reachable with only non-surgical approach.

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“…For peri-implantitis with alveolar bone loss around the fixture, clinicians should assume that implant fixture surface is heavily contaminated and should use conventional automated and hand scaler to ensure effective removal of dental plaque or biofilm around the contaminated implant fixture (Figure 5) (84). Non-surgical mechanical debridement alone usually provides 20-50% reduction in bleeding on probing and in some cases pocket reduction (≤1 mm) in periimplantitis (74,(85)(86)(87)(88)(89). Thus, in advanced cases, complete resolution of the disease is unlikely and many need adjunctive treatment to improve the magnitude of improvement (74).…”

Section: Non-surgical Peri-implant Therapymentioning

confidence: 99%

Peri-implant disease: early diagnosis and non-surgical treatment—a narrative literature review

Kwon¹,

Yen²,

Levin³

2022

Front Oral Maxillofac Med

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The purpose of this narrative review is to help clinicians understand the main etiologic factor, commonly identified contributing factors, early diagnostic science, and non-surgical therapeutic modalities of peri-implant diseases.Background: Peri-implant diseases (i.e., peri-implant mucositis and peri-implantitis) are common biological complications of dental implant therapy, which may result in the failure of dental implants.Understanding the etiologic and contributing factors is the key to identify implants that are potentially at risk for peri-implant diseases. Furthermore, early diagnosis allows clinicians to execute initial non-surgical therapy in a timely manner, thus, potentially avoiding premature implant failure.Methods: Literature search was conducted using specific keywords related to diagnosis and non-surgical management of peri-implant diseases. Relevant literature between January 1st, 1993 and April 30th, 2021 were carefully selected and included in this narrative review.Conclusions: Patients with potential contributing factors for peri-implant diseases should be monitored carefully for early signs of peri-implant diseases. These factors include smoking habit, active or past history of periodontal diseases, unfavorable restorative conditions (i.e., excessive cements, excessive occlusion, limited access for plaque removal), lack of regular maintenance therapy, diabetes, and lack of keratinized tissue. Bleeding on probing appeared to be the most reliable early sign of peri-implant diseases. Initial non-surgical treatment should be delivered based on the principles of cause related therapy, specifically targeting the major etiologic factor for peri-implant diseases, dental plaque. During this phase, in addition to professional mechanical debridement, patient's active participation in removing dental plaque through home oral care is indispensible to achieve successful outcome. Any contributing factor should be eliminated or minimized. In cases with advanced peri-implantitis, a surgical therapy is often necessary. After successfully resolving peri-implant diseases, a regular maintenance therapy should be provided which allows continuous monitoring of patients and their implants.

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Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial

Cited by 16 publications

References 38 publications

Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

Peri-Implantitis Management: Surgical versus Non-Surgical Approach Using Photodynamic Therapy Combined with Hydrogen Peroxide (OHLLT—Oxygen High Level Laser Therapy): A Retrospective Controlled Study

Peri-implant disease: early diagnosis and non-surgical treatment—a narrative literature review

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