The efficacy of bone reconstructive therapies in the management of peri‐implantitis. A systematic review and meta‐analysis

Abstract

Aim To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri‐implantitis‐related bone defects at ≥12‐month follow‐up. Materials and Methods Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question—FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta‐analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. Results Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (−0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri‐implantitis resolution, as defined by different composite outcomes. Conclusions Reconstructive surgery does not offer significant improvements in peri‐implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.

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 .…”

“…Based on RoB 2, two of the five included RCTs were at high risk of bias, some concerns were raised for two studies and one was at low risk of bias. Based on ROBINSI, one CCT was at serious risk of bias, three prospective cohort studies were considered at serious risk of bias and two prospective cohort studies were at critical risk of bias (Donos et al, 2023).…”

“…Studies reporting on SOP showed a significant reduction at 12 months and 5 years post‐surgery. Based on one study (45 patients and 75 implants), included in the network meta‐analysis (4 studies; 160 patients and 190 implants) (Donos et al, 2023), an improved PD reduction was shown when a xenogeneic rather than an autologous graft was applied in combination with a collagen membrane. Implant survival at 12 months ranged from 92% to 100%, but when considering composite outcomes for peri‐implantitis resolution the range reported by the included studies was considerably wider (0%–91% at 12 months).…”

Unraveling the effectiveness of antibiotics for peri‐implantitis treatment: A scoping review

“…Similar to events occurring in periodontitis, these effects are dependent on a striking change in the biofilm profile around the diseased implants, including reduction in levels and proportions of pathogens and the concomitant increase in proportions of host‐compatible species 11–13 . Unfortunately, up to now, there is no “gold standard” treatment that meets the clinical and microbiological requirements for the effective and predictable treatment of peri‐implantitis 14–16 . While nonsurgical therapy has been shown to be successful in treating peri‐implant mucositis, 17 this treatment has shown less favorable results for peri‐implantitis 14,18 …”

“…[11][12][13] Unfortunately, up to now, there is no "gold standard" treatment that meets the clinical and microbiological requirements for the effective and predictable treatment of peri-implantitis. [14][15][16] While nonsurgical therapy has been shown to be successful in treating peri-implant mucositis, 17 this treatment has shown less favorable results for peri-implantitis. 14,18 Certain local and systemic antibiotic protocols have been used as adjuncts to mechanical debridement of the implant surface, with the aim of improving the outcomes of peri-implantitis treatment.…”