Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis.

Frank Schwarz,Andrea Schmucker,Jürgen Becker

doi:10.1186/s40729-015-0023-1

Abstract

In patients with peri-implant mucositis and peri-implantitis, what is the efficacy of nonsurgical (i.e. referring to peri-implant mucositis and peri-implantitis) and surgical (i.e. referring to peri-implantitis) treatments with alternative or adjunctive measures on changing signs of inflammation compared with conventional nonsurgical (i.e. mechanical/ultrasonic debridement) and surgical (i.e. open flap debridement) treatments alone? After electronic database and hand search, a total of 40 publications (reporting on 32 studies) were finally considered for the qualitative and quantitative assessment. The weighted mean changes (WM)/ and WM differences (WMD) were estimated for bleeding on probing scores (BOP) and probing pocket depths (PD) (random effect model). Peri-implant mucositis: WMD in BOP and PD reductions amounted to −8.16 % [SE = 4.61] and −0.15 mm [SE = 0.13], not favouring adjunctive antiseptics/antibiotics (local and systemic) over control measures (p > 0.05). Peri-implantitis (nonsurgical): WMD in BOP scores amounted to −23.12 % [SE = 4.81] and −16.53 % [SE = 4.41], favouring alternative measures (glycine powder air polishing, Er:YAG laser) for plaque removal and adjunctive local antibiotics over control measures (p < 0.001), respectively. Peri-implantitis (surgical): WMD in BOP and PD reductions did not favour alternative over control measures for surface decontamination. WM reductions following open flap surgery (±resective therapy) and adjunctive augmentative therapy amounted to 34.81 and 50.73 % for BOP and 1.75 and 2.20 mm for PD, respectively. While mechanical debridement alone was found to be effective for the management of peri-implant mucositis, alternative/adjunctive measures may improve the efficacy over/of conventional nonsurgical treatments at peri-implantitis sites. Adjunctive resective and/or augmentative measures are promising; however, their beneficial effect on the clinical outcome of surgical treatments needs to be further investigated.

Highlights

Peri-implant mucositis describes an inflammatory lesion that resides in the soft tissues compartment, while at peri-implantitis sites, this lesion has extended and affects the implant supporting bone [1]
Nonsurgical treatment of peri-implant mucositis— adjunctive antiseptics/antibiotics Based on four and four studies, WM differences (WMD) in bleeding on probing scores (BOP) [16, 17, 19, 22] and pocket depths (PD) [17, 19, 20, 22] scores amounted to −8.16 % [SE = 4.61; p > 0.05; 95 % CI (−17.20, 0.88)] and −0.15 mm [SE = 0.13; p > 0.05; 95 % CI (−0.42, 0.11)], not favouring local antiseptic or antibiotic therapy as an adjunct to mechanical debridement (p value for heterogeneity: 0.42, I2 = 0.0 % = low heterogeneity; p value for heterogeneity: 0.45, I2 = 0.0 % = low heterogeneity, respectively) (Fig. 2a, b)
This was true for 8 (7 randomized controlled clinical study (RCT) and 1 CCT) [15,16,17,18,19,20,21,22] and 9 (9 RCTs) [23,24,25,26, 28, 29, 31,32,33] studies reporting on the nonsurgical treatment of periimplant mucositis and peri-implantitis, as well as 5 RCTs [38, 39, 41, 42, 55] reporting on the surgical treatment of peri-implantitis

Summary

Introduction

Peri-implant mucositis describes an inflammatory lesion that resides in the soft tissues compartment, while at peri-implantitis sites, this lesion has extended and affects the implant supporting bone [1]. The 11th European Workshop on Periodontology has pointed to an “estimated weighted mean prevalence of periimplant mucositis and peri-implantitis of 43 and 22 %, respectively” [2]. The presence of some independent systemic/patient-related (i.e. smoking) and local (i.e. residual cement, dimension of the keratinized tissue, surface roughness) risk indicators may increase the probability of the disease occurring [3]. According to the cause-related concept of therapy, professionally administered plaque removal is a key strategy for the prevention and management of periimplant diseases [6]. There is a need to identify the most effective interventions for the treatment of peri-implant diseases

Methods

Results

Discussion

Conclusion