Impact of surface decontamination and systemic antimicrobials for surgical treatment of peri-implantitis: A systematic review and meta-analysis of randomized clinical trials

Abstract

BackgroundEfficient control of infection is essential to achieve desired outcomes in the surgical treatment of peri-implantitis lesions, although methods employed are largely heterogeneous.PurposeTo compare the impact of different decontamination protocols and adjunctive systemic antimicrobials on the outcomes of surgical treatment of peri-implantitis.Materials and methodsRandomized clinical trials (RCTs) on surgical treatment of peri-implantitis were selected through an electronic search on Medline, Embase, Scopus, and Central databases. Only studies comparing two or more anti-infective strategies were included. Following data extraction, two different sets of meta-analyses were performed. Firstly, overall impact of different implant surface decontamination methods was assessed by comparing baseline values with outcomes at 6-12 months. Secondly, pairwise comparisons evaluated the potential benefit of adjunctive systemic antimicrobials over placebo. Results were expressed as weighted mean effect (WME), weighed mean difference (WMD) or risk ratio (RR).ResultsSixteen RCTs were included. No pairwise comparisons were available for different surface decontamination methods. Use of curettes resulted in improved probing depth (PD) (WME = 2.13 mm), but the results in terms of marginal bone levels (MBL) and percentage of disease resolution were unsatisfactory. Moreover, the adjunctive benefit of systemic antimicrobials over placebo was evaluated in two studies, representing a total of 178 implants. Despite not being statistically significant, the meta-analyses identified a higher probability of disease resolution (RR = 1.50) for test procedures. In terms of overall outcome, systemic antimicrobials with open flap debridement resulted in improved MBL (WME = 0.44 mm), reduced PD (WME = 2.46 mm) and 51.4% of disease resolution.ConclusionsThere is not enough evidence to support adjunctive usage of systemic antimicrobials together with the surgical treatment of peri-implantitis. Moreover, higher consistency is required to prove the superiority of a surface decontamination protocol over another (PROSPERO CRD42020182303).SUMMARY BOXWhat is knownPeri-implantitis is a common biological complication occurring at dental implants, and surgery is usually required to obtain thorough peri-implant infection control.No systematic reviews with meta-analysis have assessed surface decontamination protocols for surgical treatment of peri-implantitis, as well as the adjunctive benefit of peri-operative systemic antimicrobials.What this study addsThis study offered the first evidence-based synthesis of randomized clinical trials regarding this relevant topic.Although protocol heterogeneity was high, a combination of mechanical and chemical implant surface decontamination is recommendable.Titanium brushes and local delivery of minocycline showed encouraging results; while the additional benefit of systemic antimicrobials needs to be further determined.