Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

Abstract

Aim To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis. Materials and Methods Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Results Evidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5–0.9) for every millimetre in increase of mean PD at baseline. During the follow‐up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Conclusions Access flap and pocket elimination surgery are effective procedures in the management of peri‐implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.

A longitudinal analysis of the impact of nonsurgical and surgical treatment of peri‐implantitis upon clinical parameters and implant stability quotient values. A 2–3‐year follow‐up

“…attachment following the open flap approach were not in agreement with what has been reported in previous studies. Additionally, and in agreement with previous observations, relapse was common (Karlsson et al, 2022).…”

Prevention and treatment of peri‐implant diseases—The EFP S3 level clinical practice guideline

“…For this guideline, a total of 13 SRs were conducted to support the guideline development process (Carra et al, 2023; Cosgarea et al, 2023; de Waal et al, 2023; Dommisch et al, 2023; Donos et al, 2023; Gennai et al, 2023; Karlsson et al, 2023; Liñares et al, 2023; Ramanauskaite et al, 2023; Stiesch et al, 2023; Teughels et al, 2023; Verket et al, 2023; Wilensky et al, 2023). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology .…”

“…Seven RCTs assessed the efficacy of reconstructive surgery (194 patients) compared with access flap surgery. The respective datasets were evaluated in two SRs (Donos et al, 2023; Karlsson et al, 2023). All studies reported on reduction of PD and BOP.…”

“…Thirteen studies ( n = 649 patients), with a follow‐up range from 1 to 5 years (only two studies with a 5‐year follow‐up), were included (Karlsson et al, 2023). One study was an RCT comparing surgical therapy to non‐surgical intervention.…”

Factors influencing outcomes of surgical therapy of peri‐implantitis: A secondary analysis of 1‐year results from a randomized clinical study

“…Surgical therapy of peri‐implantitis is effective in reducing peri‐implant probing and clinical signs of inflammation (Karlsson et al, 2023). Although generally effective, current evidence also suggests that no specific surgical approach is superior in terms of clinical outcomes one year after treatment (Donos et al, 2023).…”