Efficacy of adjunctive measures in peri-implant mucositis. A systematic review and meta-analysis.

Abstract

To answer the following PICO question: In systemically healthy humans with peri-implant mucositis, what is the efficacy of patient-performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow-up? Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated. Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies =16; npatients =650; WMD=14.25%; 95% CI [9.06-19.45]; p < .001; I2 = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns =5; np =229; WMD=22.72%; 95% CI [19.40-26.04]; p < 0.001; I2 = 94.8%), followed by probiotics (ns =6; np =260; WMD=12.11%; 95% CI [3.20-21.03]; p=.008; I2 = 93.3%) and systemic antibiotics (ns =3; np =101; WMD=5.97%; 95% CI [1.34-10.59]; p=.012; I2 = 58.1%). Disease resolution was scarcely reported (n=6). Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient-performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved.