Effectiveness of Tetracycline Drugs in the Non Surgical Treatment of Peri-implantitis: A Systematic Review and Meta-analysis

Abstract

Introduction: Peri-implantitis is a significant factor affecting the success rate of oral reconstruction. Hence, it is vital to prevent it. To control peri-implant disease, non surgical treatment is the first line of defense. While peri-implant mucositis can be entirely treated, there are unforeseen repercussions for the treatment of peri-implantitis, according to many studies using non invasive approaches. Aim: To investigate the clinical effects of the tetracycline group of medications in the treatment of non surgical peri-implantitis. Materials and Methods: Electronic bibliographic databases PubMed (MEDLINE), EBSCO, Cochrane database, Clinical trial registry, DOAJ, Google Scholar, and Manual reference searches were performed for articles published January 2010 to August 2021. Total five Randomised Controlled Trials (RCTs) were selected. Three reviewers independently performed the data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting. The risk of bias was assessed with the ROB-2 tool and the quality of evidence was determined with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. A quantitative meta-analysis was performed to compare the reduction in Bleeding On Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Results: In the overall analysis, BOP and PPD, was statistically reduced in the tetracycline drugs compared to the tetracycline groups. When comparing experimental and control groups, the mean reduction in BOP was -9.71 mm, (95% CI: -11.74 to -7.68), The random-effects model showed a statistically significant difference Z=9.40 (p-value<0.00001). The mean PPD was reduced by -1.18 mm in the experimental groups compared to the control groups (95 % CI: -2.35 to -0.02). The CAL gain was -0.98 mm from 3.23 to 1.28 mm in the experimental group which was statistically non significant. The minocycline revealed statistically significant mean difference in BOP (mean difference was -0.72 (95 % CI: -6.84, -3.24 mm but non significant difference reduction in PPD (p-value >0.05). High heterogenicity was reported in all analyses. Conclusion: The non surgical treatment with the tetracycline medication group resulted in a significant clinical reduction in BOP and PPD without a significant change in CAL when compared to other non surgical therapies. The minocycline has resulted in clinical decreases in BOP except PPD. Longterm randomised controlled trials are needed to assess the efficacy of treatments that do not prevent further bone loss, implant survival rates, and oral health-related quality of life standards.