Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis
Journal of Prosthetic Dentistry
Published:April 16, 2024DOI:https://doi.org/10.1016/j.prosdent.2024.03.024
Abstract
Statement of problem
Extensive research has been carried out on the various aspects of diagnosing and treating
peri-implantitis. However, clinical guidelines for the management of peri-implantitis
based on high quality evidence are lacking.
Purpose
The purpose of this systematic review with network meta-analysis was to analyze the
current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis
and synthesize clinical guidelines based on high quality evidence.
Material and methods
A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane
Central Register of Controlled Trials from inception until July 2023. The study was
registered with the International Prospective Register of Systematic Reviews (PROSPERO)
(CRD42023451056). A network meta-analysis was performed on data from randomized controlled
trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis.
The interventions were ranked according to their efficacy using surface under the
cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development,
and evaluations (GRADE) approach was used to assess the level of certainty of evidence.
Results
A total of 45 articles were included in the quantitative analysis. The GRADE approach
determined a moderate to high level of certainty of evidence. Among the nonsurgical
interventions, mechanical debridement with adjunctive systemic antibiotics was significant
in improving probing depth at 3 months and beyond 6 months, clinical attachment loss
at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement
with adjunctive topical antibiotics was significant in improving probing depth beyond
6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6
months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive
photodynamic therapy was significant in improving probing depth beyond 6 months, clinical
attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic
bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics
and photodynamic therapy was significant in improving probing depth beyond 6 months.
Among surgical interventions, open flap debridement with implant surface decontamination
and open flap debridement with decontamination and adjunctive photodynamic therapy
were significant in improving probing depth at 3 months.
Conclusions
Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy
results in improved clinical outcomes.
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