Evidence is limited about effective interventions for maintaining healthy peri-implant tissues

Abstract

Data sources Studies were identified through the Cochrane Oral Health Group Specialised Register, the Cochrane Controlled Trials Register, Medline and EMbase, hand searches of dental journals, as well as contact with authors of all identified trials, 55 oral implant manufacturers and from two extensive personal libraries (ME and AJ).Study selection Randomised controlled trials (RCT) of oral implants that compared agents or interventions for maintaining or re-establishing healthy tissues around dental implants.Data extraction and synthesis Data were independently extracted in duplicate by two reviewers (ME and HW). Authors were contacted for details of randomisation and withdrawals, and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed.Results Nine RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion.Conclusions There is only a little reliable evidence for deciding which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is a weak evidence that Listerine (Pfizer) mouthwash used twice a day for 30 s, as an adjunct to routine oral hygiene, is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCT that had short follow-up periods and few subjects. There is no reliable evidence for the most effective regimens for long-term maintenance. For the treatment of failing implants (peri-implantitis) there is no reliable evidence for preferring one therapeutic regimen over another. More RCT should be conducted in this area. In particular, there is a clear need for trials that investigate the most effective approach for the treatment of peri-implantitis and for trials with longer follow-up for maintenance. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).