The purpose of this paper was to systematically evaluate the effectiveness of non-surgical therapy for the treatment of peri-implant diseases including both, mucositis and peri-implantitis lesions.
An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2011 to 2016. Human studies reporting non-surgical treatment of peri-implant mucositis and peri-implantitis with more than 10 implants and at least 6 months follow up published in English language were evaluated. A systematic review was performed to evaluate the effectiveness of the different methods of decontamination employed in the included investigations. Risk of bias assessment was elaborated for included investigations.
Twenty-five articles were identified of which 14 were further evaluated and included in the analysis. Due to significant heterogeneity in between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. Included investigations reported the used of different methods for implant decontamination, including self-performed cleaning techniques, and professionally delivered treatment such as laser, photodynamic therapy, supra-/sub-mucosal mechanical debridement, and air-abrasive devices. Follow-up periods ranged from 6 to 60 months.
Non-surgical treatment for peri-implant mucositis seems to be effective while modest and not-predictable outcomes are expected for peri-implantitis lesions. Limitations include different peri-implant diseases definitions, treatment approaches, as well as different implant designs/surfaces and defect characteristics.
During the last decades the definition of peri-implantitis has suffered several modifications with the development in the understanding of dental implantology and its biological implications. Recently, as described by the American Academy of Periodontology [
With regard to the treatment of the peri-implant diseases, a variety of different approaches have been proposed including but not limited to: non-surgical therapy; surgical management by means of access flap debridement, lasers disinfection, implantoplasty, resective procedures, as well as regenerative approaches [
Non-surgical therapy for peri-implant diseases has traditionally been considered effective for mucositis. However, results for peri-implantitis lesions were found not to be effective [
Due to the increasing prevalence of both peri-implant mucositis and peri-implantitis, there is an urgent need to understand its aetiology and the multiples variables affecting it development and progression leading to the generation of more predictable treatment approached. Hence, the aim of the present review was to systematically evaluate the effectiveness of current (last 5 years) methodologies for the non-surgical treatment of peri-implant diseases.
The methods as well as inclusion/exclusion criteria employed for the present review were determined in advance. This protocol was registered in an international prospective register of systematic reviews ‘PROSPERO’ with the following registration number: CRD42016037631. The current systematic review was performed by two independent reviewers following the PRISMA guidelines for identification, screening, eligibility, and inclusion [
The following focus question was developed according to the population, intervention, comparison, and outcome (PICO) study design: In patient suffering from peri-implant mucositis or peri-implantitis, what is the effectiveness of non-surgical therapy by means of different techniques and/or approaches for clinical and radiographically resolution of disease, including bleeding on probing (BOP), probing pocket depth (PPD), and radiographic bone (RB) level changes.
The search strategy consisted in the examination of several databases as well as manual screening. The electronic search was performed in several databases, including MEDLINE (PubMed), and EMBASE databases for articles from 2011 up to April 2016 with limitation to English language. Additionally, a manual search of periodontics/implantology-related journals, including “Clinical Oral Implant Research”, “Journal of Dental Research”, “Journal of Clinical Periodontology”, “Journal of Periodontology”, “Clinical Implant Dentistry and Related Research”, and “The International Journal of Periodontics & Restorative Dentistry”, from 2011 up to April 2016 was also performed to ensure a thorough screening process. Furthermore, references of all articles reviewed in full text were further screened.
Both PubMed and EMBASE databases were screened through advances searchers. For the PubMed library, combinations of controlled terms (MeSH and EMTREE) and keywords were used whenever possible. Into the addition, other terms not indexed as MeSH and filters were applied. As such, the key terms used were: (((((((((((((“non-surgical”) OR “dental prophylaxis” [MeSH Terms]) OR “dental scaling” [MeSH Terms]) OR “scaling, subgingival” [MeSH Terms]) OR “dental polishing” [MeSH Terms]) OR “diode lasers” [MeSH Terms]) OR “yag laser, erbium” [MeSH Terms]) OR “antibiotic prophylaxis” [MeSH Terms]) OR “agents, local anti infective” [MeSH Terms]) AND “periimplantitis” [MeSH Terms]) OR “peri-implant mucositis”) OR “peri-implant maintenance”) OR “implant infection”) OR “peri-implant infection” AND (“last 5 years” [PDat] AND “Humans” [Mesh]). On the other hand, for EMBASE for following terms were employed: “non-surgical” OR “scaling” OR “laser/exp” OR “laser” OR “subgingival curettage/exp” OR “subgingival curettage” AND (“periimplantitis/exp” OR “periimplantitis”) OR “peri-implant mucositis”.
Titles and abstracts derived from the search were independently screened by two reviewers (FSLA and SHY) based on the inclusion criteria. Both reviewers compared decisions and their eligibility for this review was confirmed after discussion. Full articles were obtained for all the investigations deemed eligible for inclusion in this paper and further evaluated by both reviewers. If needed, a third party was consulted when consensus could not be reached.
The present review included only human studies published in the English language. Letters, editorials, reviews and meta-analysis, PhD thesis, as well as abstracts were not evaluated.
The present investigation included cases series, prospective, as well randomized controlled trials (RCTs) published between 2011 and April of 2016 that reported on non-surgical treatment for peri-implant mucositis and peri-implantitis. Case report, retrospective, as well as studies with less than 10 implants or less than 6 months follow up were excluded.
Individuals included in the studies should have had at least one osseointegrated screw-type dental implant that presented with signs of peri-implant mucositis or peri-implantitis and received non-surgical treatment. Nonetheless, included investigations presented with different definitions for the diseases evaluated.
Articles were included in this systematic review if they met the following inclusion criteria:
Investigated non-surgical treatment outcomes for peri-implant mucositis and peri-implantitis in patients with at least one osseointegrated solid screw-type implant;
All human prospective studies, as well as clinical trials, cohort studies, case-control, and case series studies;
At least 10 implants;
At least 6 months follow-up;
Clinical and/or radiographic changes reported. Treatment outcomes reporting changes in PPDs and/or BOP and/or RB changes.
On the contrary, the following articles were excluded:
Care reports, retrospective investigations,
Less than 10 implants;
Less than 6 months of follow-up;
Surgical treatment for peri-implantitis;
Human trials with missing information or unclear data.
Initial literature search was conducted in several databases including MEDLINE (PubMed) and EMBASE from 2011 to 2016. All articles titles were screened in order to eliminate non-qualifying studies. Next, screening of abstract was performed followed by elimination of non-qualifying investigations. Finally, full text evaluation of each article was performed in order to confirm the eligibility based on the inclusion and exclusion criteria. References of full text evaluated investigations were also performed. In addition, a manual search in periodontics/implantology-related journals, including “Clinical Oral Implant Research”, “Journal of Dental Research”, “Journal of Clinical Periodontology”, “Journal of Periodontology”, “Clinical Implant Dentistry and Related Research”, and “The International Journal of Periodontics & Restorative Dentistry”, from 2011 up to 2016, was also performed to ensure a thorough screening process.
Data were extracted from the included studies independently by two reviewers (FSLA and ESHY). If any disagreement occurred, a third reviewer was consulted (HLW).
The quality of all selected RCTs was assessed using The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials [
Random sequence generation;
Allocation concealment;
Blinding of participants and personnel;
Blinding of outcome assessment;
Incomplete outcome data;
Selective reporting;
Other bias.
The potential risk of bias was categorized as “low”, “unclear” or “high” depending on the quality and detailed explanation of provided information about all abovementioned parameters. All assessments were completed by a single examiner (SHY). The Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of nonrandomized included studies [
Significant heterogeneity between publications in terms of diseases definitions, study designs, patient and defect related characteristics, as well as measured outcomes, among others, prevented the quantitative synthesis of the included studies and consequently a meta-analysis could not be completed. Instead, a qualitative descriptive analysis of the reported outcomes was performed and systematically reviewed in forms of tables.
Initial screening of electronic databases yielded a total of 2837 articles. Additionally, 21 more articles were found through manual screening. After removal of duplicated studies, a total of 2625 titles and abstract were evaluated. Overall, a total of 26 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full text of these articles was obtained and thoroughly evaluated. Of these, 14 studies fulfilled the inclusion criteria and were subsequently included in the systematic review (
PRISMA flowchart of the screening process in the different databases.
Characteristics of the included articles
Study |
Year of |
Type of |
Groups |
Treatment provided |
N |
N |
Follow-up |
Diagnosis |
Treatment outcomes |
Microbiological |
Conclusions | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Self- |
Professionally- |
Mucositis/ |
PDs |
Radiographic |
BOP |
Exudate changes | PI or MPI (SD) changes |
CAL |
Recession |
||||||||||
Arisan et al. [20] | 2015 | RCT | Control | OHI | MD | 5 | 24 | 6 | Peri-implantitis |
4.38 (0.42) |
2.35 (0.56) |
100 to 100% | NA | 91.7 to 41.7% | NA | NA |
No changes in microbiota |
Laser does not provide any additional benefit when compared to SRP alone. | |
Test | OHI |
MD + diode laser 810 nm |
5 | 24 |
4.71 (0.67) |
2.13 (0.47) |
100 to 95.8% | NA | 91.7 to 54.2% | NA | NA | ||||||||
Bassetti et al. [21] | 2014 | RCT | Control |
Instructions |
MD + Airpolishing |
20 | 20 | 12 | Peri-implantitis |
4.39 (0.77) |
NA |
Sites: |
NA |
0.21 (0.27) |
2.72 (0.72) |
1.68 (1.04) |
|
Similar results clinically and microbiologically for both.
|
|
Test |
MD + Airpolishing + PDT |
20 | 20 |
4.19 (0.55) |
NA |
Sites: |
NA |
0.13 (0.21) |
2.66 (0.73) |
1.53 (0.91) |
No statistically significant difference with the exception for |
||||||||
Esposito et al. [22] | 2013 | RCT | Control |
In surgery group: CHX mouthwash 0.12% for 1 min twice a day for 2 weeks.
|
Bone loss between 3 - 5 mm: |
No adjunct treatment | 40 | 100 | 12 | Peri-implantitis |
6.45 (2.15) |
4.9 (2.07) |
Bleeding scores: |
NA |
Mean plaque scores: |
NA | NA | NA | Adjunctive use of LAD therapy with mechanical debridement did not improve any clinical outcomes when compared to mechanical cleaning alone up to 1 year after treatment. |
Test | LAD (FotoSan 630 instrument) | 40 | 101 |
6.23 (1.62) |
4.5 (1.75) |
Bleeding scores: |
NA |
Mean plaque scores: |
NA | NA | NA | ||||||||
Hallstrom et al. [23] | 2012 | RCT | Control | OHI |
MD with titanium curettes |
21 | NA | 6 | Mucositis |
4.6 (0.9) |
NA |
Full mouth |
NA |
Mean PI at implant %: |
NA | NA | No significant differences in bacterial count. Statistical analysis by intent to treat failed to identify within group differences comparing baseline data with all other time points. |
No short-term differences between groups. The clinical improvements observed at 6 months may be attributed to improvements in oral hygiene.
|
|
Test |
MD with titanium curettes |
22 | NA |
4.4 (1) |
NA |
Full mouth |
NA |
Mean PI at implant %: |
NA | NA |
ABX = antibiotics treatment; BOP = bleeding on probing; CAL = clinical attachment level; CHX = chlorhexidine digluconate; DE = debridement; LAD = light-activated disinfection; LD = local delivery; MBL = marginal bone level; MD = mechanical debridement; MPI = modified plaque index; NA = not available; OHI = oral hygiene instructions; PD = probing depth; PDT = photodynamic therapy; PI = plaque index; PR = prospective study; RB = radiographic bone; RCT = randomized controlled trials; SD = standard deviation.
Characteristics of the included articles
Study |
Year of |
Type of |
Groups |
Treatment provided |
N |
N |
Follow-up |
Diagnosis |
Treatment outcomes |
Microbiological |
Conclusions | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Self- |
Professionally- |
Mucositis/ |
PDs reduction |
Radiographic |
BOP changes |
Exudate changes | PI or MPI (SD) changes |
CAL |
Recession |
|||||||||
John et al. [24] | 2015 | RCT | AAD | OHI on 2 to 4 appointments | Submucosal AAD employed with amino acid glycine powder (Air-Flow® Perio Powder, EMS) | 12 | 18 | 12 | Peri-implantitis |
3.7 (1) |
NA |
99 (4.1) |
NA |
1.2 (1.1) |
5.2 (1.9) |
1.5 (1.4) |
NA | Both treatments resulted in comparable but limited CAL gains at 12 months. AAD was associated with significantly higher BOP decrease than MDA. |
MD (carbon curettes |
OHI on 2 to 4 appointments | MD was performed using carbon curets followed by pocket irrigation with a 0.1 % CHX solution and submucosal application of 1 % CHX gel | 13 | 18 |
3.9 (1.1) |
NA |
94.7 (13.7) |
NA |
1.2 (1) |
5 (1.5) |
1 (1.1) |
NA | ||||||
Machtei et al. [25] | 2012 | Double-blind RCT | Control |
OHI |
Surface MD+ biodegradable crosslinked gelatin matrix chip (placebo) | 30 | 37 | 6 | Peri-implantitis |
7.21 |
NA | 100 to 42.5% | NA | NA |
7.63 (0.3) |
NA | NA | Substantial reduction in PD, gain in CAL and reduction in BOP in sites with peri-implantitis. |
Test |
OHI |
Surface MD+ matrix containing 2.5 mg CHX chips | 30 | 40 |
7.60 |
NA | 100 to 59% | NA | NA |
7.88 (0.2) |
NA | NA | ||||||
Persson et al. [26] | 2011 | RCT | Er:YAG laser | OHI and patients received a sonic toothbrush | (Er:YAG) laser: 100 mJ/pulse and 10 Hz (12.7 J/cm2) | 21 | 55 | 6 | Peri-implantitis | PD reductions: 0.9 (0.8) | Statistical analyses failed to demonstrate differences in bone-level changes between baseline and 6 months | Statistical analyses also failed to demonstrate differences in the BOP at 6 weeks after treatment | NA | NA | NA | NA | Both treatments failed to reduce bacterial counts at 6 months. |
At 1 month, |
AAD subgingival |
OHI patients received a sonic toothbrush |
AAD subgingival |
21 | 45 | PD reductions: 0.8 (0.5) | Statistical analyses failed to demonstrate differences in bone-level changes between baseline and 6 months | Statistical analyses also failed to demonstrate differences in the BOP at 6 weeks after treatment | NA | NA | NA | NA | |||||||
Riben-Grundstrom et al. [27] | 2015 | RCT |
Glycine |
OHI | Glycine powder air-polishing was performed at baseline, 3 and 6 months. Supragingival DE was provided at month 9 and 12. | 18 | NA | 12 | Mucositis | NA | NA | 43.9 (7.3) to 12.1 (3.8) |
No differences were |
Implant 25.5 (6.8) to |
NA |
No differences were |
NA | Non-surgical treatment with a glycine powder air-polishing or ultrasonic device is effective in reducing inflammation and number of peri-implant pockets subject to patient compliance |
Ultrasonic group | OHI | Cleaning with ultrasonic was performed at baseline, 3 and 7 months. Supragingival MD was provided at month 9 and 12. | 18 | NA | NA | NA | 53.7 (7.9) to 18.6 (6.4) |
No differences were |
Implant 24.1 (6.6) to |
NA |
No differences were |
NA | ||||||
Swierkot et al. [28] | 2013 | RCT | Sonic toothbrush group |
Brush 2 min twice daily with |
NA | 35 |
Mean count: |
12 | No peri-implantitis, 22% mucositis |
3.4 (0.88) |
NA | 0.22 (0.3) to 0.27 (0.26) | NA |
0.86 (0.73)to |
4.64 (1.63) to |
1.23 (1.33) to |
After 12 months, both groups exhibited a small increase in total bacterial load at implants and teeth. |
No difference between sonic and manual tooth brushing for plaque reduction at implants and teeth. Sonic and manual toothbrushes maintained clinical, microbiological and immunological parameters over a period of 12 months at implants and teeth with no signs of soft tissue damage or technical complications. |
Manual toothbrush group | Brush 2 min twice daily with toothpaste, modified Bass technique | NA | 36 |
Mean count: |
No peri-implantitis, |
3.13 (0.75) |
NA | 0.19 (0.28) to 0.28 (0.38) | NA |
0.56 (0.52) to |
4.41 (1.65) to |
1.28 (1.26) to |
AAD = air-abrasive device; BOP = bleeding on probing; CAL = clinical attachment level; CHX = chlorhexidine digluconate; DE = debridement; LD = local delivery; MBL = marginal bone level; MD = mechanical debridement; MPI = modified plaque index; NA = not available; OHI = oral hygiene instructions; PD = probing depth; PI = plaque index; RB = radiographic bone; RCT = randomized controlled trials; SD = standard deviation.
Characteristics of the included articles
Study |
Year of |
Type of |
Groups |
Treatment provided |
N |
N |
Follow-up |
Diagnosis |
Treatment outcomes |
Microbiological |
Conclusions | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Self- |
Professionally- |
Mucositis/ |
PDs reduction |
Radiographic |
BOP changes |
Exudate |
PI or MPI (SD) |
CAL |
Recession |
|||||||||
Gomes et al. [29] | 2015 | Single-arm cohort | Test |
Multi-tufted TB, dental floss and/or interdental TB.
|
Weekly supragingival/ |
14 | 59 | 13 | Mucositis |
3.62 (0.31) |
NA |
Sites: |
NA |
18.98 (5.89) |
NA | NA | NA | The supragingival-supramucosal biofilm control benefited both teeth and implants |
Corbella et al. [30] | 2011 | Non-controlled prospective study | Mucositis | CHX 0.2% mouthwash twice a day for 10 days, interdental brushes | Powered and manual devices MD | 61 | 244 | 60 | Mucositis |
2.2 (0.87) |
NA |
Sites: |
NA |
Sites/6 and 58 months |
NA | NA | NA | Systematic hygienic protocol is effective in keeping low the incidence of peri-implant mucositis as well as in controlling plaque accumulation and clinical attachment loss. |
Peri-implantitis | CHX 0.2% mouthwash, interdental brushes |
Powered and manual devices |
Peri-implantiti | |||||||||||||||
Costa et al. [31] | 2012 | Prospective study | Control | No | No | 41 | 183 | 60 | Mucositis |
16.7% sites |
41.5% implants show BL |
Sites: |
NA |
1.6 (0.6) |
% sites > 3 mm |
NA | NA | The absence of preventive maintenance in individuals with pre-existing peri-implant mucositis was associated with a high incidence of peri-implantitis. |
Test | OHI |
At least 5 SC, |
39 | 157 |
5.9% sites |
17.9% implants show BL |
Sites: |
NA |
1.4 (0.6) |
% sites > 3 mm |
NA | NA | ||||||
Deppe et al. [32] | 2013 | Prospective study | Moderate bone loss | OHI, plaque control with use of CHX solution (0.3%) |
Calculus removal |
16 | 10 | 6 | Peri-implantitis |
3.3 (0.8) |
3.9 (0.8) |
Sulcus bleeding index: |
NA | NA |
3.8 (1.3) |
0.5 (0.5) |
NA | Non-surgical PDT could stop bone resorption in moderate peri-implant defects but not in severe defects. marginal tissue recession was not significantly different in both groups. |
Severe bone lost | 8 |
5.8 (0.8) |
6.8 (0.8) |
Sulcus bleeding index: |
NA | NA |
6.7 (0.9) |
0.9 (1.2) |
NA | |||||||||
Schwarz et al. [33] | 2015 | Prospective case series | MD + local antiseptic (MD + CHX) | OHI |
Supragingival calculus removal and supramucosal/gingival professional implant/ |
17 | 24 | 6 | Mucositis |
3.4 (0.5) |
NA |
46.3 (23.5) |
NA |
0.7 (0.6) |
NA | NA | NA | Non-surgical treatment of either peri-implant mucositis using MD + CHX or peri-implantitis using laser therapy at zirconia implants was associated with significant short-term clinical improvements. A complete disease resolution, however, was not achieved in the majority of the patients. |
Er:YAG laser therapy | OHI |
Supragingival calculus removal |
17 | 21 | Peri-implantitis |
5.5 (0.5) |
NA |
45 (18.5) |
NA |
0.6 (0.3) |
NA | NA | NA |
ABX = antibiotics treatment; BOP = bleeding on probing; CAL = clinical attachment level; CHX = chlorhexidine digluconate; LD = local delivery; MBL = marginal bone level; MD = mechanical debridement; MPI = modified plaque index; NA = not available; PD = probing depth; PDT = photodynamic therapy; PI = plaque index; RB = radiographic bone; SD = standard deviation; Sx = surgery; TB = tooth brush.
Characteristics of the included articles: description of affected sites, implant characteristics, prosthetic factors)
Study | Groups |
Description of affected sites |
Implant characteristics |
Prosthetic factors |
Additional |
||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PDs, |
RB loss (SD), |
BOP | Exudate |
CAL (SD), |
Recession (SD), |
Systems |
Time |
Surface |
Screwed/ |
Internal/ |
Splinted/ |
Restoration |
|||
Arisan et al. [20] | Control | 4 to 6 | < 3 mm MBL | Yes | And/or suppuration | NA | NA | Multiple | 19.4 months |
Rough (acid etching |
Cemented | NA | NA | Fixed metal-ceramic prostheses | Suprastructures removed for measurements |
Test | 4 to 6 | < 3 mm MBL | Yes | And/or suppuration | NA | NA | 19.4 months |
Rough (acid etching |
Cemented | NA | NA | ||||
Bassetti et al. [21] | Control: LDD | 4 to 6 | 0.5 to 2 | Yes | NA | 2.72 (0.72) | 1.68 (1.04) | Straumann tissue level | 7.2 (2.6 - 15) years | SLA | Screwed | NA | NA | NA | NA |
Test: PDT | 4 to 6 | 0.5 to 2 | 2.66 (0.73) | 1.53 (0.91) | 7.3 (4 - 14.8) years | ||||||||||
Esposito et al. [22] | Control | Deepest pocket only: 6.45 | Mean 4.73 (2.11) | Yes | Pus exudation and/or soft tissue swelling and/or soft tissue redness | NA | NA | NA | 6.13 years | NA | NA | NA | NA | NA | In some of the Sx treated cases, unsupported threads were removed and polished based on the clinician's decision |
Test | Deepest pocket only: 6.23 | Mean 4.4 (1.58) | 5.65 years | ||||||||||||
Hallstrom et al. [23] | Control | ≥ 4 | < 2mm bone loss | Yes |
And/or |
NA | NA | Multiple | 10.9 years | NA |
Cemented: 52.6%; |
NA | NA | NA | NA |
Test | 10 years |
Cemented: 59.1%; |
|||||||||||||
John et al. [24] | AAD | ≥ 4 |
Loss of |
Yes | Yes | 5.2 (1.9) | 1.5 (1.4) | Multiple | NA |
Machined surface, |
Screwed | NA |
Single tooth |
NA | Without overhangings or margins |
MD (carbon curettes |
5 (1.5) | 1 (1.1) | |||||||||||||
Machtei et al. [25] | Control | 6 to 10 | ≥ 2 | Yes | NA | 7.63 (0.3) | NA | NA | NA | Exclude Titanium Plasma-sprayed or hydroxylapatite coated implants | NA | NA | NA | NA | NA |
Test | 7.88 (0.2) | ||||||||||||||
Persson et al. [26] | Er:YAG laser | ≥ 5 | ≥ 2 | Yes |
And/or |
NA | NA | NA | NA |
Machined surfaces |
NA | NA | NA | NA | Superstructures were removed to enhance assessments of PD and BOP and to improve the ability to collect bacterial samples. |
AAD subgingival polishing | ≥ 6 | ||||||||||||||
Riben-Grundstrom et al. [27] | Glycine powder air-polishing | ≥ 4 | ≤ 2 | Yes |
And/or |
NA | NA | Multiple | NA | NA | NA | NA | NA | NA | NA |
Ultrasonic debridement | |||||||||||||||
Swierkot et al. [28] | Sonic toothbrush group | ≥ 5 | < 1 |
Yes/ |
NA | 4.64 | 1.24 | Nobel Replace Straight Groovy | At least 12 months | Rough | Screwed | NA | NA | Single implant or fixed prosthesis | NA |
Manual toothbrush group | ≥ 6 | 4.41 | 1.28 | At least 13 months | |||||||||||
Gomes et al. [29] | Test | 2.23 (0.09) | NA | Yes | NA | NA | NA | Nobel Biocare | 5.7 (2.5) years | NA | NA | NA | NA | NA | NA |
Corbella et al. [30] | Mucositis | NA | NA | Bleeding index ≥ 2 | NA | NA | NA | NA | NA | NA | NA | NA | NA | Immediately loaded full-arch rehabilitation | NA |
Peri-implantitis | > 4 | ||||||||||||||
Costa et al. [31] | Control | > 5 | No | Yes | Yes | NA | NA | Multiple | 80.5 months | NA | NA | NA | NA |
Single crowns and/ |
NA |
Test | 77.4 months | ||||||||||||||
Deppe et al. [32] | Moderate bone loss | < 5 | 3.9 (0.8) | Yes | NA | 3.8 (1.3) | 0.5 (0.5) | NA | NA | NA | NA | NA | NA | NA | All restorations were left in situ |
Severe bone lost | 5 to 8 | 6.8 (0.8) | 6.7 (0.9) | 0.9 (1.2) | |||||||||||
Schwarz et al. [33] |
MD + local antiseptic |
NA | No | Yes | No | NA | NA | Zirconia implants (ZV4, Zircon Vision GmbH, Wolfratshausen, Germany) | NA |
Modified (roughness: |
Screwed | NA | NA | NA | NA |
Er:YAG laser therapy | ≥ 6 | Changes in RB level |
And/or |
Modified (roughness: |
AAD = air-abrasive device; BOP = bleeding on probing; CAL = clinical attachment level; CHX = chlorhexidine digluconate; LD = local delivery; MBL = marginal bone level; MD = mechanical debridement; NA = not available; PD = probing depth; PDT = photodynamic therapy; RB = radiographic bone; SD = standard deviation; SLA = sandblasted and acid-etched implant.
The reasons for exclusion are summarized in
Excluded articles with reasons for exclusion
Study |
Year of |
Reasons for exclusion |
---|---|---|
Mettraux et al. [6] | 2015 | Retrospective study |
Heitz-Mayfield et al. [10] | 2011 | Short follow-up |
Ji et al. [11] | 2014 | Short follow-up |
McKenna et al. [12] | 2013 | Short follow-up |
Mussano et al. [13] | 2013 | Short follow-up |
Lerario et al. [14] | 2016 | Retrospective study |
Parma-Benfenati et al. [15] | 2013 | Review |
Renvert et al. [16] | 2011 | Same sample as Persson et al. [26] |
Sahm et al. [17] | 2011 | Same sample as John et al. [24] |
Schär et al. [18] | 2013 | Same sample as Bassetti et al. [21] |
Sreenivasan et al. [19] | 2011 | Unclear and incomplete data |
The characteristics of the 14 included articles are summarized in
Most articles reported the subject numbers as well as the implants evaluated in the studies, however 3 articles failed to report the numbers of the implants that were evaluated in the studies [
Regarding the description of the diseased sites, most studies provided information on PPD and BOP of the affected implants, however, 2 articles did not present PPD for the implants affected by mucositis [
Most of the studies included oral hygiene instructions of using interdental brushes or other required techniques indicated in the protocol before initiating different treatment modalities [
PPD was reported as direct or the percentage change except one article [
The results of risk of bias assessment for included RCTs were summarized in
Risk of bias assessment of the included studies
Study |
Random |
Allocation |
Blinding of |
Blinding of |
Incomplete |
Selective |
Other |
---|---|---|---|---|---|---|---|
Arisan et al. [20] | + | - | - | ? | + | + | ? |
Bassetti et al. [21] | + | - | - | + | + | + | ? |
Esposito et al. [22] | + | - | - | + | + | + | + |
Hallström et al. [23] | + | + | - | - | + | + | + |
John et al. [24] | + | - | - | + | + | - | ? |
Machtei et al. [25] | + | + | + | + | + | + | ? |
Persson et al. [26] | + | - | - | ? | + | + | ? |
Riben-Grundstrom et al. [27] | + | + | - | + | + | - | ? |
Swierkot et al. [28] | + | - | - | + | + | + | + |
+ = low risk; ? = unclear risk; - = high risk.
Dental implants have become the gold standard when aiming at reconstruction of the missing dentition. Decades of investigation have proven dental implants to be reliable alternative providing function and aesthetics with long-term success. However, with the increasing number of fixtures being installed yearly, there has also been a significant increase in the number of patients suffering from peri-implant diseases. According to a recent systematic review peri-implant mucositis and peri-implantitis have a prevalence ranging from 19 to 65% and from 1 to 47%, respectively. On the other hand, mean prevalence for peri-implant mucosistis and peri-implantitis are 43% and 22%, respectively [
While initially thought as a periodontitis like lesion surrounding a dental implant, peri-implantitis has recently been related to multiple other variables. In fact, there are a great variety of factors that have been related with marginal bone loss (MBL) and/or peri-implantitis that often differ with the ones associated with periodontitis. To name a few: surgical trauma, infection, plaque and poor oral hygiene, alcohol and tobacco consumption, as well as biological bone remodelling [
Regardless of the aetiology of the peri-implant diseases, multiple investigations are being conducted trying to elucidate the most effective treatment approach. However, while the determination of the most effective treatment seems a challenging duty and over the years conflicting results have been shown, the importance of prevention for prompt intervention seems to be in agreement by researchers. Today, the prevention as well as early detection of peri-implant mucositis remains as key components in successful dental implantology. These statements are supported by the effectiveness in treatment of mucositis while treatment of peri-implantitis remains unpredictable. Consequently, current evidence shows that peri-implant mucositis can be successfully treated by non-surgical therapy. Locally delivered antibiotics, lasers, mechanical sub- and supra- gingival SRP, as well as air-polishing, among others can be used for the non-surgical treatment of peri-implant mucositis. In addition, repeated treatment of diseased sites seems to be effective.
Substantial improvements are to be made in research regarding treatment of peri-implantitis and peri-implant mucositis. It is of paramount importance the identification of both local and systemic factors affecting the incidence and severity of such conditions for the proper management. Now a day, most of the investigations have failed to provide proper documentation with regard to implant system and position, which have been demonstrated to be significant contributing factors influencing the clinical outcome of different treatment modalities. Moreover, depending on the presence and severity of these local and systemic factors, in many instances, the treatment of choice should be explanation of the fixture.
Within the limitation of the present investigations, the major drawback is the multitude of different definitions regarding peri-implant mucositis and peri-implantitis that were employed in the included investigations. Also, multiple different treatment approaches, different implant designs as well as surface characteristics, and wide variation in terms of follow-up periods may have played a role in the treatment outcomes.
Multitude of different treatment approaches is available for the non-surgical treatment of peri-implant diseases. While significant variations exist in term of treatment outcomes, the non-surgical treatment seems to effective for peri-implant mucositis. Self-performed hygiene techniques are effective improving clinical parameters and maintaining a low incidence of developing peri-implant mucositis. Professional-performed mechanical debridement is effective in reducing inflammation and pocket depths.
The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper. This paper was partially supported by the University of Michigan Periodontal Graduate Student Research Fund.