Efficacy of professionally administered chemical agents as an adjunctive treatment to sub‐marginal instrumentation during the therapy of peri‐implant mucositis

Abstract

Aim To evaluate the efficacy of professionally administered chemical agents as an adjunctive treatment to sub‐marginal instrumentation (SMI) in the therapy of peri‐implant mucositis. Materials and Methods The primary outcome criteria were reduction in bleeding on probing (BOP), whereas resolution of disease, elimination of suppuration, including suppuration on probing, reduction of peri‐implant probing pocket depth, reduction of plaque, and patient‐reported outcome measures were considered as secondary outcome parameters. A literature search was performed on three electronic databases (01/1980 to 05/2022) focused on clinical studies with at least 3 months of follow‐up, and meta‐analyses were performed when appropriate. Results From a total of 139 publications, 40 articles were identified for full‐text reading, and 5 randomized controlled clinical trials (RCTs) on antimicrobial photodynamic therapy (aPDT), 1 RCT on chlorhexidine (CHX), and 1 RCT on sodium hypochlorite (NaOCl) were included. Three studies had a low risk of bias and four had a mid‐level (some concerns) risk of bias. The application of aPDT, 0.95% NaOCl, or 0.12% CHX as an adjunctive treatment to SMI showed no difference in changes in BOP and PD compared with SMI alone (p > .05). Conclusions Within the limitations of this review and based on a low level of evidence from seven RCTs, it is concluded that the professional adjunctive topical application of aPDT, 0.95% NaOCl, and 0.12% CHX may not be effective to improve changes for BOP and PD when compared with SMI alone.

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

“…In patients with peri-implant mucositis, we suggest not to use locally administered agents (antiseptics, 'postbiotics', desiccant gel) as adjuncts to PMPR Supporting literature (Dommisch et al, 2023) and (Butera et al, 2022;Lombardo et al, 2019;Sahrmann et al, 2019) are products of the metabolic activity of the micro-organism, which, by exerting an antioxidant action, lead to a positive effect on the host (Zolkiewicz et al, 2020); in contrast with probiotics, they do not include live microorganisms.…”

“…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 .…”

“…No study could be identified when considering the inclusion criteria outlined in the SR (Dommisch et al, 2023). However, one RCT ( n = 32) evaluated the adjunctive effect of minocycline microspheres in the treatment of peri‐implant mucositis/incipient peri‐implantitis (bone loss less or equal to three threads).…”

“…For the additional application of aPDT adjunctive to sub‐marginal instrumentation, no benefit was identified in the meta‐analysis (Dommisch et al, 2023). Potential harm of aPDT adjunctive to sub‐marginal instrumentation has not been studied to date.…”

“…For aPDT, the identified RCTs included male patients only, and from these five RCTs four focused on patients with habitual tobacco intake (cigarette smokers, smoke‐less tobacco chewers and vaping individuals). The analysis of data revealed high heterogeneity among the studies (Dommisch et al, 2023). This inconsistency among the studies may be explained by the heterogeneity of reported outcome parameters as well as regarding the variation of tobacco intake habits, even though only male patients were evaluated.…”