ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In Patients With Peri-Implantitis, Access Flap Surgery May Be More Effective Than Mechanical Debridement In Terms Of Clinical Attachment Gain Although Both Treatments Lead To Improved Clinical Parameters
Clinical Question When treating peri-implantitis, would access flap surgery be more effective than non-surgical therapy in terms of clinical attachment gain?
Clinical Bottom Line In patients with peri-implantitis, surgical therapy seems to be more effective than non-surgical therapy in terms of clinical attachment gain. This is supported by a systematic review, which showed that surgical therapy resulted in more improvements in probing attachment levels and pocket depths. However, this is derived from clinical trials assessing the two treatment modalities separately as there is no direct comparison in form of randomized controlled trials available. A randomized control study showed that two types of non-surgical therapy are also successful in reducing probing depths and increasing clinical attachment. All of the studies are feasible in clinical settings and are applicable to patients with peri-implantitis.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22834392Esposito/2012Patients with peri-implantitis: more than 3 mm of infrabony defects or more than 50% bone lossSystematic Review
Key resultsIn one trial assessing surgical therapy with a 4-year followup, Bio-Oss and resorbable barriers were used to treat peri-implantitis. Patients who had infrabony defects of greater than 3 mm showed a 1.4 mm improvement in probing attachment levels (95% CI 0.24-2.56) and probing pocket depths (95% CI 0.81-1.99). Non-surgical therapy, including manual debridement and use of with local antibiotics in patients who lost 50% or more of the peri-implant bone showed a 0.61 mm improvement in probing attachment levels (94% 0.40-0.82) and a 0.59 mm reduction in probing pocket depths (95% CI 0.39-0.79) over a 4 month period.
#2) 22092831Heitz-Mayfield/201124 patients with moderate to severe peri-implantitisCohort Study
Key resultsAfter being surgically treated with open flap debridement and implant surface decontamination, probing depths significantly improved after 3 months. 19 out of the 36 implants had a mean probing depth of greater than 5 mm before treatment, and only 1 implant had a mean probing depth of greater than 5 mm at 3 months after treatment. After 12 months, all 36 implants had probing depths of less than 5 mm.
#3) 21770995Sahm/201130 patients with initial to moderate peri-implantitisRandomized Control Study
Key resultsAfter 3 months, the group treated with the air-abrasive device had probing depth reductions of 0.8 ± 0.5 mm and clinical attachment gains of 0.7 ± 0.5 mm. The group treated with mechanical debridement had probing depth reductions of 0.8 ± 0.9 mm and clinical attachment gains of 0.8 ± 1.1 mm. After 6 months, the group treated with the air-abrasive device had pocket depth reductions of 0.6 ± 0.6 mm and clinical attachment gains of 0.4 ± 0.7 mm in comparison to the mean baseline values. The group treated with mechanical debridement had pocket depth reductions of 0.5 ± 0.6 mm and clinical attachment gains of 0.5 ± 0.8 mm. The group treated with the air-abrasive device showed more improvement than the mechanical debridement group at both 3 months and 6 months.
Evidence Search "Peri-Implantitis"[Mesh] AND "therapy"[Subheading]
Comments on
The Evidence
The study by Esposito et al. was a systematic review of 9 randomized controlled trials. There was a comprehensive and detailed search for relevant trials, and each study was assessed for validity. A meta-analysis was also conducted. However, the study did not provide evidence that surgical therapy was more effective than manual debridement. The study conducted by Heitz-Mayfield et al. was a cohort study. The patients had similar conditions at the start and there was more than 80% completion rate. The groups were treated the same, and there was adequate follow-up after 3 months, 6 months, and 9 months. Sahm et al. conducted a randomized control study and randomly assigned the patients to one of the two treatments. The groups had similar conditions at the start and were treated the same during their respective treatments. There was adequate follow-up 3 and 6 months after treatment. Overall, the differences in pocket depth improvements between different therapies were not significant.
Applicability The subjects in these studies are representative of patients with peri-implantitis, and the treatments are feasible in a clinical setting.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Peri-implantitis, therapy
ID# 2432
Date of submission: 04/03/2013spacer
E-mail BautistaL@livemail.uthscsa.edu
Author Lorraine Bautista
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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