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

Ausra Ramanauskaite,Frank Schwarz,Tobias Fretwurst

doi:10.1186/s40729-021-00388-x

Abstract

PurposeTo evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.Material and methodsProspective 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.ResultsPeri-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).ConclusionsAlternative 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.

Highlights

Peri-implant diseases were defined during the 2017 World Workshop as biofilm‐associated pathological conditions affecting osseointegrated dental implants, and they were further classified into peri-implant mucositis and peri-implantitis [1,2,3]
The use of investigated adjunctive and alternative measures were not found to be superior in resolving peri-implant mucositis, supporting recent consensus statements suggesting that non-surgical mechanical instrumentation in conjunction with oral hygiene reinforcement is a standard-of-care intervention for the management of peri-implant mucositis [4, 12, 100]
Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing Bleeding on probing (BOP) values following non-surgical peri-implantitis treatment

Summary

Introduction

Peri-implant diseases were defined during the 2017 World Workshop as biofilm‐associated pathological conditions affecting osseointegrated dental implants, and they were further classified into peri-implant mucositis and peri-implantitis [1,2,3]. Peri-implant mucositis is characterized by inflammation in the soft tissue compartment, whereas peri-implantitis features loss of Ramanauskaite et al Int J Implant Dent (2021) 7:112 the implant-supporting bone [1,2,3]. The onset of peri-implantitis was shown to occur early on, and its progression was characterized by a nonlinear, accelerating pattern that, in the absence of therapy, may lead to implant loss [5]. There is evidence from experimental clinical studies that peri-implant mucositis is a reversible condition if adequate bacterial plaque control is implemented [10, 11]. Non-surgical therapy in conjunction with oral hygiene reinforcement is considered a standard care treatment for managing peri-implant mucositis [1, 12]. At peri-implantitis sites, in contrast, non-surgical mechanical treatment alone or with adjunctive (i.e., local antibiotics, antimicrobial photodynamic therapy—aPDT) or alternative measures (e.g., air abrasive devices, erbium-doped yttrium aluminum garnet— Er:YAG laser monotherapy), has demonstrated only limited efficacy in obtaining disease resolution, indicating the necessity of surgical therapy in a majority of the cases [12, 13]

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Results

Discussion

Conclusion