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Meta-Analysis
. 2022 Nov;33(11):1069-1086.
doi: 10.1111/clr.13992. Epub 2022 Sep 7.

Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis

Giacomo Baima  1 , Filippo Citterio  1 , Mario Romandini  2 , Federica Romano  1 , Giulia Maria Mariani  1 , Nurcan Buduneli  3 , Mario Aimetti  1
Affiliations
Meta-Analysis

Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis

Giacomo Baima et al. Clin Oral Implants Res. 2022 Nov.

Abstract

Objective: To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?"

Methods: Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses.

Results: Twenty-two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55], p = .26), even if with substantial heterogeneity.

Conclusions: No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).

Keywords: air-powder devices; curettes; decontamination; dental implants; implantoplasty; peri-implant diseases; surgical therapy; titanium brushes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Risk of bias assessment
FIGURE 2
FIGURE 2
Meta‐analyses for the effect of different decontamination protocols tested in 2 or more RCTs. A‐C: effect of the single use of curettes in access flap surgery on PPD reduction, MBL change and treatment success. D‐F: effect of systemic antibiotics (AB) in addition to mechanical decontamination in access flap surgery on PPD reduction, MBL change and treatment success; in parenthesis are reported other eventual chemical decontaminants used in association with AB. G‐I: effect of 0.12% chlorhexidine (CHX) and 0.05% cetylpyridinium chloride (CPC) in addition to mechanical decontamination in resective surgery on PPD reduction, MBL change and treatment success. L: effect of Er:Yag laser in addition to mechanical and/or chemical decontamination in combined surgery on PPD reduction.
FIGURE 3
FIGURE 3
Meta‐analyses for the comparison among different decontamination protocols reported in 2 or more RCTs. A‐B: added effect of systemic antibiotics (AB) over mechanical decontamination in access flap surgery on PPD reduction and treatment success. C: added effect of Er:Yag laser in addition to mechanical and/or chemical decontamination in combined surgery on PPD reduction.
See this image and copyright information in PMC

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