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Meta-Analysis
. 2012 Jan 18;1(1):CD004970.
doi: 10.1002/14651858.CD004970.pub5.

Interventions for replacing missing teeth: treatment of peri-implantitis

Marco Esposito  1 , Maria Gabriella Grusovin, Helen V Worthington
Affiliations
Meta-Analysis

Interventions for replacing missing teeth: treatment of peri-implantitis

Marco Esposito et al. Cochrane Database Syst Rev. .

Abstract

Background: One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (peri-implantitis) and ultimately to implant failure. Different treatment strategies for peri-implantitis have been suggested, however it is unclear which are the most effective.

Objectives: To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants.

Search methods: We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 June 2011.

Selection criteria: All RCTs comparing agents or interventions for treating peri-implantitis around dental implants.

Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

Main results: Fifteen eligible trials were identified, but six were excluded. The following interventions were compared in the nine included studies: different non-surgical interventions (five trials); adjunctive treatments to non-surgical interventions (one trial); different surgical interventions (two trials); adjunctive treatments to surgical interventions (one trial). Follow-up ranged from 3 months to 4 years. No study was judged to be at low risk of bias.Statistically significant differences were observed in two small single trials judged to be at unclear or high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm (95% confidence interval (CI) 0.40 to 0.82) and reduced probing pockets depths (PPD) of 0.59 mm (95% CI 0.39 to 0.79). After 4 years, patients with peri-implant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 1.4 mm more PAL (95% CI 0.24 to 2.56) and 1.4 mm PPD (95% CI 0.81 to 1.99) than patients treated with a nanocrystalline hydroxyapatite.

Authors' conclusions: There is no reliable evidence suggesting which could be the most effective interventions for treating peri-implantitis. This is not to say that currently used interventions are not effective.A single small trial at unclear risk of bias showed the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of peri-implantitis. Another small single trial at high risk of bias showed that after 4 years, improved PAL and PPD of about 1.4 mm were obtained when using Bio-Oss with resorbable barriers compared to a nanocrystalline hydroxyapatite in peri-implant infrabony defects. There is no evidence from four trials that the more complex and expensive therapies were more beneficial than the control therapies which basically consisted of simple subgingival mechanical debridement. Follow-up longer than 1 year suggested recurrence of peri-implantitis in up to 100% of the treated cases for some of the tested interventions. As this can be a chronic disease, re-treatment may be necessary. Larger well-designed RCTs with follow-up longer than 1 year are needed.

PubMed Disclaimer

Conflict of interest statement

From April 2011 Marco Esposito became a full‐time free‐lance consultant in dentistry specialising in implantology. Therefore he receives funding for conducting clinical trials and presenting the results of trials/Cochrane reviews at international dental meetings. This funding comes from universities, companies (in alphabetical order: Apollonia e Fama Implant, Biomax, Biomet 3i, Bioteck, Bone System, Branemark Integration, CMS Dental, Dentsply‐Friadent, Geistlich Pharma, Geass, Keystone Dental, MegaGen Implant, Mozo‐Grau, Nano Bridging molecules, Nobel Biocare, Ricerfarma, Saint Jude Medical, Southern Implants, Supercharched production, Techoss Dental Thommen Medical, Tutogen Medical, Zimmer Dental, Z‐Systems), scientific societies, publishing companies, and private dentists. This list of companies was provided by Marco on Friday 4th November 2011 and the funders will change all the time.

This is to certify that: a) Marco does not own stock in companies that produce products included in the reviews; b) he does not have patents on any of the products included in the reviews; c) his salary will not be affected by company sales of any of the products included in the reviews.

Marco’s authorship has been authorised by The Cochrane Collaboration Funding Arbiter (reference 071111/057: Oral Health Group).

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Metronidazole gel versus ultrasonic debridement (3 months), Outcome 1 Change in probing pocket depth.
2.1
2.1. Analysis
Comparison 2 Doxycycline gel versus manual debridement (4 months), Outcome 1 Change in attachment levels.
2.2
2.2. Analysis
Comparison 2 Doxycycline gel versus manual debridement (4 months), Outcome 2 Change in probing pocket depth.
3.1
3.1. Analysis
Comparison 3 Er:YAG laser versus manual debridement and chlorhexidine irrigation/gel (6 months), Outcome 1 Complications.
3.2
3.2. Analysis
Comparison 3 Er:YAG laser versus manual debridement and chlorhexidine irrigation/gel (6 months), Outcome 2 Recurrence of perimplantitis.
3.3
3.3. Analysis
Comparison 3 Er:YAG laser versus manual debridement and chlorhexidine irrigation/gel (6 months), Outcome 3 Change in attachment levels.
3.4
3.4. Analysis
Comparison 3 Er:YAG laser versus manual debridement and chlorhexidine irrigation/gel (6 months), Outcome 4 Change in probing pocket depth.
3.5
3.5. Analysis
Comparison 3 Er:YAG laser versus manual debridement and chlorhexidine irrigation/gel (6 months), Outcome 5 Change in recession.
4.1
4.1. Analysis
Comparison 4 Nanocrystalline hydroxyapatite versus bovine‐derived xenograft and resorbable membrane (4 years), Outcome 1 Recurrence of perimplantitis.
4.2
4.2. Analysis
Comparison 4 Nanocrystalline hydroxyapatite versus bovine‐derived xenograft and resorbable membrane (4 years), Outcome 2 Change in attachment levels.
4.3
4.3. Analysis
Comparison 4 Nanocrystalline hydroxyapatite versus bovine‐derived xenograft and resorbable membrane (4 years), Outcome 3 Change in probing pocket depths.
4.4
4.4. Analysis
Comparison 4 Nanocrystalline hydroxyapatite versus bovine‐derived xenograft and resorbable membrane (4 years), Outcome 4 Change in recessions.
5.1
5.1. Analysis
Comparison 5 Adjunctive implant surface smoothening to systemic antibiotics + resective surgery + 2 different local antibiotics (6 months), Outcome 1 Implant failure.
6.1
6.1. Analysis
Comparison 6 Er:YAG laser versus plastic curettes and saline solution for surface debridement before bone augmentation (6 months), Outcome 1 Complications.
6.2
6.2. Analysis
Comparison 6 Er:YAG laser versus plastic curettes and saline solution for surface debridement before bone augmentation (6 months), Outcome 2 Change in attachment levels.
6.3
6.3. Analysis
Comparison 6 Er:YAG laser versus plastic curettes and saline solution for surface debridement before bone augmentation (6 months), Outcome 3 Change in probing pocket depths.
6.4
6.4. Analysis
Comparison 6 Er:YAG laser versus plastic curettes and saline solution for surface debridement before bone augmentation (6 months), Outcome 4 Change in recession.
7.1
7.1. Analysis
Comparison 7 Er:YAG laser versus air‐abrasive device, Outcome 1 Change in probing pocket depth.
7.2
7.2. Analysis
Comparison 7 Er:YAG laser versus air‐abrasive device, Outcome 2 Radiographic changes in bone levels.
7.3
7.3. Analysis
Comparison 7 Er:YAG laser versus air‐abrasive device, Outcome 3 Recurrence of peri‐implantitis.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Büchter 2004 {published and unpublished data}
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Bach 2000 {published data only}
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