Peri-implant mucositis:professional plaque removal adjuncts

The prevalence of peri-implant mucositis has been reported to be between 18-65% and professional and patient-administered plaque control are considered important for its management. The aim of this review was to assess the efficacy of professionally administered plaque removal (PAPR) with adjunctive measures on changing signs of inflammation compared with PARP alone?

Methods

Searches were conducted in the PubMed and Web of Knowledge databases supplemented by handsearching of the journals; Clinical Implant Dentistry and Related Research; Clinical Oral Implants Research; International Journal of Oral and Maxillofacial Implants; Journal of Clinical Periodontology; Journal of Periodontology. Prospective randomised controlled (RCT), or non-randomised controlled (CCT) studies (split-mouth or parallel group designs) in humans comparing PAPR (i.e. any type of mechanical debridement) with or without adjunctive measures for biofilm removal, or adjunctive antiseptic/antibiotic therapies in the treatment of peri-implant mucositis were considered. Study quality was assessed using the Cochrane risk of bias tool. The weighted mean difference (WMD) in bleeding on probing- (BOP) (primary outcome), gingival index- (GI) and probing pocket depth- (PD) reductions was estimated using a random effect model.

Results

7 studies involving a total of 140 patients were included
4 studies assessed PAPR with or without adjunctive antiseptic therapy
2 studies assessed PAPR with or without adjunctive antibiotic therapy
1 study assessed PAPR with or without adjunctive measures for biofilm removal
Meta-analysis based on 4 studies WMD in BOP reduction between test and control groups amounted to -8.16% [SD = 4.61; p = 0.07; 95% CI (-17.20, 0.88)] not favouring adjunctive antiseptic or antibiotic (local, systemic) therapy over PAPR alone.
Meta-analysis based on 2 studies the WMD in GI amounted to -0.12 [SD = 0.13; p = 0.34; 95% CI (-0.38, 0.13)] not favouring adjunctive (antiseptics, systemic antibiotics, air abrasive device) over control measures respectively.
Meta-analysis based on 5 studies the WMD in PD reductions amounted to -0.056 mm [SD = 0.10; p = 0.60; 95% CI (-0.27, 0.16)] not favouring adjunctive (antiseptics, systemic antibiotics, air abrasive device) over control measures respectively.

Conclusions

The authors concluded:

Within its limitations, the present systematic review and meta-analysis revealed that adjunctive antiseptic, antibiotic (local and systemic) or mechanical (i.e. air abrasive device) therapy may not improve the efficacy of PAPR in reducing BOP, GI and PD scores at mucositis sites on the short term. Despite clinically important improvements, a complete resolution of clinical signs indicating peri-implant mucositis may not be expected by any of the treatment and maintenance protocols investigated.

Comments

A number of systematic reviews have ben published recently (see links) looking as various aspect of managing peri-implant disease. The majority of included studies have been small and have used different treatment protocols and outcome measures which make combining them difficult. With increasing number of implants being placed there is a need for greater clarity on haw best to maintain peri-implant health so larger higher quality RCTs are needed using commonly agreed outcomes so that we have better evidence for the profession and patients.