Efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. A systematic review and meta‐analysis

Abstract

Objectives The present systematic review aimed at evaluating the efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. Methods Studies reporting on outcomes of reconstructive surgery at peri‐implantitis‐related bone defects at 12 months were identified through an electronic search. Following data extraction, two different sets of meta‐analyses were performed. Primarily, controlled studies were used to evaluate the potential benefit of reconstructive surgical therapy over controls. Secondly, overall outcome of reconstructive surgical therapy was assessed by comparing baseline values with outcomes at 12 months. Results were expressed as weighted mean differences (WMD) or risk ratios (RR). Heterogeneity was described by I2 and prediction intervals. Results The potential benefit of reconstructive techniques over control procedures was evaluated in three studies, representing a total of 116 implants. Altogether, 16 studies reported on the outcome of reconstructive measures at 12 months after surgery. The meta‐analyses identified a larger improvement in marginal bone levels (MBL, WMD = 1.7 mm) and in defect fill (WMD = 57%) for test procedures, but found no differences for clinical measures (reduction of probing depth (PD) and bleeding on probing (BOP). Changes of clinical attachment and soft tissue levels were not considered. In terms of overall outcome, therapy resulted in improved MBL (WMD = 2.0 mm) and CAL (WMD = 1.8 mm), in recession (WMD = 0.7 mm), in reduced PD (WMD = 2.8 mm) and in reduced BOP (Implants: RR = 0.4/Sites: RR = 0.2). None of the included studies addressed patient‐reported outcome measures. Conclusions The available evidence on reconstructive therapy at peri‐implantitis‐related defects is limited by (a) the low number of controlled studies, (b) the lack of controlled studies for commonly used procedures, (c) the heterogeneity between studies and (d) the choice of outcome measures. A high variability for predicted outcomes at 12 months was noted. The interpretation of the demonstrated larger MBL gain for test procedures is difficult as graft material may not be distinguishable from newly formed bone. Potential aesthetic and patient‐reported advantages remain to be demonstrated.

Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration

“…This systematic review addressed the foussed question of what is the benefit of using a reconstructive technique as adjunct to surgical therapy of peri‐implantitis (Tomasi et al ).…”

“…The group discussions and consensus were based on four systematic reviews focusing on lateral bone augmentation staged with implant placement (Naenni, Lim, Papageorgiou, & Hämmerle, ), vertical bone augmentation (Urban, Montero, Monje, & Sanz‐Sanchez, ), reconstructive treatment of peri‐implantitis associated defects (Tomasi, Regidor, Ortiz‐Vigon, & Derks, ), and lateral window sinus grafting procedures (Raghoebar, Onclin, Boven, Vissink, & Meijer, ).…”

Successful Management of Peri‐Implantitis Using a Titanium Brush and a Doxycycline‐Saline Slurry for Surface Detoxification With Guided Bone Regeneration: A 5‐Year Follow‐Up

“…3d), the results of regenerative therapy around these sites has been mixed in the literature. A systematic review and meta-analysis 9 found significantly more radiographic bone fill at regeneration sites, but showed no significant difference in probing depths or BOP. They also reported that it was difficult to distinguish graft from new bone formation because of the graft mineral content.…”

“…A recent systematic review and meta-analysis 9 reported on the results of three controlled studies comparing reconstructive therapy (e.g., bone grafting, guided bone regeneration or biologic agents/growth factors) of peri-implant lesions versus open flap debridement in 116 implants. Significant improvement in mean radiographic bone defect fill (1.7 mm [0.3 to 3.1 mm 95% confidence interval]) was found in favor of reconstructive therapy, but found no significant reduction in pocket depths or bleeding on probing (BOP).…”

Neues regeneratives Konzept für die Behandlung von Periimplantitis mit Verwendung von Hyaluronsäure als (Wund-)Heilungsbeschleuniger (Clean and Seal)

“…In einem kürzlich publizierten systematischen Review wurde die Effizienz von regenerativen Verfahren zur Verbesserung des periimplantären Gewebeangebots untersucht [15].…”