Subgingival Débridement Appears as Effective as More Complex and Expensive Therapies for Peri-Implantitis

Abstract

Systematic review conclusion. Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis.Critical summary assessment. There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis.Evidence quality rating. Limited. Systematic review conclusion. Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis. Critical summary assessment. There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis. Evidence quality rating. Limited. What are the most effective treatments for peri-implantitis, the progressive marginal bone loss around dental implants induced by bacterial plaque infection? For this systematic review, the authors selected for inclusion randomized controlled trials (RCTs) involving patients with at least one stable implant demonstrating marginal bone loss who were treated for peri-implantitis. The authors included studies in which surgical and nonsurgical procedures aimed at treating peri-implantitis were evaluated. Outcome measures included change in probing pocket depth (PPD) and probing attachment level (PAL), as well as implant failure. The authors conducted an all-language search of several electronic databases (from as early as 1966 through January 2008) and relevant dental journals. They contacted selected authors and dental implant manufacturers to locate unpublished or ongoing RCTs. Two of the authors served as reviewers and independently duplicated the selection of studies for inclusion, evaluation of study quality, and data extraction. The authors identified seven studies (146 patients total) that met their inclusion criteria. In these studies, investigators evaluated the following treatments:use of topical antibiotic (metro-nidazole gel) versus ultrasonic débridement;manual débridement with and without use of topical antibiotic (10 percent doxycycline hyclate gel);different techniques of subgingival débridement;laser versus manual débridement with chlorhexidine (applied either via irrigation or in gel form);apical flap–repositioning surgery with and without implant polishing;augmentation with either nanocrystalline hydroxyapatite or bovine-derived xenograft and resorbable membrane. The only statistically significant differences between treatment outcomes were in two trials judged by the authors to be at high risk of bias. The addition of doxycycline to manual débridement provided an additional 0.6 millimeters' improvement in PAL and PPD in patients demonstrating at least 50 percent bone loss. And although both augmentation procedures improved PAL and PPD, the bovine-derived xenograft/membrane group gained an additional 0.5 mm in PAL and PPD. The majority of studies in which more complex and expensive therapies for treating peri-implantitis were evaluated did not show statistically or clinically significant advantages for these treatments versus simple subgingival débridement. For treatments having similar degrees of effectiveness, there is no information on which have fewer adverse effects or are simpler or less expensive to use. The lack of reliable evidence demonstrating which treatments are most effective for treating peri-implantitis does not mean that treatments used are ineffective. Local antibiotics and bone augmentation may provide additional benefit in treatment of peri-implantitis, but large, well-designed RCTs are needed to address this question adequately.