Title The Clinical Effectiveness of Non-surgical Adjunctive Therapies Has Not Been Demonstrated When Compared with the Mechanical Debridement Alone Procedure as Initial Therapy for Peri-implantitis
Clinical Question When providing initial treatment to peri-implantitis patients, would non-surgical adjunctive therapies be more beneficial than monotherapy of mechanical debridement in terms of probing depth reduction and clinical attachment gain?
Clinical Bottom Line There is insufficient evidence that specific non-surgical adjunctive therapies for peri-implantitis are more effective than treatment with debridement alone in the reduction of probing depths. According to the meta-analysis of 11 randomized controlled trials, the probing depth reductions of various non-surgical therapies compared to scaling alone are not clinically significant. Heterogeneity of cited studies resulted in large credible intervals. Therefore, it is not certain that any particular initial therapy is superior to debridement alone as the initial intervention for peri-implantitis.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25039292Faggion/2014361 patients in 11 included studiesMeta-Analysis
Key resultsThe authors selected 11 randomized controlled trials and categorized them into 8 non-surgical therapy groups. Bayesian network meta-analysis was performed to compare the mechanical debridement alone as the control group in pocket probing depth reduction with non-surgical adjunctive therapy groups. Compared to the control group, the estimated difference of PPD reductions (95% credible interval) of test groups were 0.490 mm (−0.647 to 1.252) for “Debridement + Local antibiotics,” 0.400 mm (−1.812 to 2.025) for “Debridement + Periochip,” 0.337 mm (−1.594 to 1.792) for “Photodynamic,” 0.330 mm (−0.870 to 1.518) for “Vector system,*” 0.326 mm (−1.592 to 1.976) for “Air-abrasive,” 0.234 mm (−1.812 to 2.025) for “Er:YAG laser monotherapy,” and 0.215 mm (−1.308 to 1.456) for “Debridement + Chlorhexidine gel.” The review concluded that there was insufficient evidence that any specific non-surgical adjunctive therapies for peri-implantitis are more effective than treatment with debridement alone in the reduction of probing depth due to the minimal difference of PPD reduction and very large credible intervals. (*Vector system: carbon tip device with aerosol, particulate spray)
Evidence Search ("peri-implantitis"[MeSH Terms] OR "peri-implantitis"[All Fields] OR ("peri"[All Fields] AND "implantitis"[All Fields]) OR "peri implantitis"[All Fields]) AND (non-surgical[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND Review[ptyp]
Comments on
The Evidence
Validity: Inclusion and exclusion criteria were specified and resulted in the selection of 11 studies. The authors evaluated all RCTs and categorized them as low-grade evidence. Seven out of 11 studies were sponsored by industry companies, increasing the risk of bias. Perspective: Based on this review, mechanical debridement monotherapy will remain as the choice for initial therapy. Providing adjunctive therapies is not justified at this time. They may be used in case of unresponsive peri-implantitis in situations where surgical treatment is not indicated.
Applicability The prevalence of peri-implantitis has been increasing as more patients desire implants over conventional fixed and removable prostheses. Although various non-surgical therapies have been proposed and researched, this evidence indicates that conventional debridement monotherapy should be utilized for initial intervention until the clinically significant superiority of other non-surgical adjunctive treatments is shown. Doing so, we as clinicians can provide evidence-based cost-effective services to our patients.
Specialty (General Dentistry) (Periodontics)
Keywords Network meta-analysis; non-surgical treatment; peri-implantitis
ID# 3107
Date of submission 11/08/2016
E-mail LeeS15@livemail.uthscsa.edu
Author Seung Y. Lee, DDS
Co-author(s) e-mail
Faculty mentor David Lasho, DDS, MSD
Faculty mentor e-mail LASHO@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available