Cochrane · intervention · CD003069

Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants

Grusovin, MG, Coulthard, P, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2010 · Cochrane Library

Oral Health Implants and prosthodontics4 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 0 · 0%Ungraded 32 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Adults who have dental implants; (1) healthy peri-implant soft tissues at baseline (maintaining); (2) peri-implant mucositis lesions at baseline (recovering: bleeding on marginal probing and/or pockets with bone loss <=2.5 mm)	Adults with dental implants (healthy tissues or peri-implant mucositis); USA (3), Netherlands (2), New Zealand (1), Sweden (3), Israel (1), Portugal (1); 319 patients
Intervention	(1) Interventions for maintaining peri-implant soft tissue health (self / professionally administered); (2) Interventions for recovering peri-implant soft tissue health (self / professionally administered). Active agents: oral hygiene procedures; local or systemic therapeutic agents; other interventions	Powered toothbrushing (n=40); Hyaluronic acid gel (n=30); Amine fluoride/stannous fluoride mouthwash (n=33); Phosphoric etching gel (n=16); Chlorhexidine solution enclosed in implants (n=12); Sonic toothbrushing (n=31); Listerine mouthwash (n=20); Subgingival chlorhexidine irrigation (n=24); Topical minocycline (n=32); Triclosan dentifrice (n=59); Titanium curette debridement (n=31)
Comparison	Placebo; No treatment; Another active intervention	Manual toothbrushing (n=40); Chlorhexidine gel (n=30); Chlorhexidine mouthwash (n=33); Mechanical debridement (n=16); Physiologic solution (n=12); Manual toothbrushing (n=31); Placebo mouthwash (n=20); Chlorhexidine mouthwash (n=24); Chlorhexidine gel (n=32); Sodium fluoride dentifrice (n=59); Ultrasonic device debridement (n=31)
Outcomes	Implant failure; Radiographic marginal bone level changes; Changes in probing attachment level; Changes in probing pocket depth; Marginal bleeding; Plaque; Side effects; Ease of maintenance; Patient satisfaction; Cost; Treatment time	Plaque (n=264); Marginal bleeding (n=74); Changes in probing pocket depth; Probing attachment level (n=20); Implant failure (n=122); Change in taste (n=33); Staining index (n=33); Patient satisfaction (n=64); Ease of maintenance (n=31); Soreness in the gums (n=32); Side effects/pain (n=16)
Study designs	Randomised controlled trials (parallel group, split-mouth and cross-over designs)	8 parallel group; 2 split-mouth; 1 cross-over (all RCTs)
Timing	Not specified	6 weeks to 1 year

Search date: 2010-06-02. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE

Questions and results

Current version only

Powered toothbrushing vs Manual toothbrushing

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB4 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Change in probing pocket depth 6 weeks same question in other reviews	At 6 weeks there was no significant difference in change of probing pocket depths	1 study · 40 participants	Ungraded
Plaque 6 weeks same question in other reviews	MD 0.10 [-0.66, 0.86]	1 study · 40 participants	Ungraded

Sonic toothbrushing vs Manual toothbrushing

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction (liked toothbrush) 6 months same question in other reviews	RR 1.48 [1.03, 2.13]	1 study · 31 participants	Ungraded
Ease of maintenance 6 months same question in other reviews	RR 0.94 [0.79, 1.12]	1 study · 31 participants	Ungraded
Plaque 6 months same question in other reviews	MD -0.14 [-0.47, 0.19]	1 study · 31 participants	Ungraded
Change in probing pocket depth 6 months same question in other reviews	MD 0.08 [-0.64, 0.80]	1 study · 31 participants	Ungraded

Listerine mouthwash vs Placebo mouthwash

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bleeding 3 months same question in other reviews	MD -0.20 [-0.25, -0.15]	1 study · 20 participants	Ungraded
Plaque 3 months same question in other reviews	MD -0.88 [-0.93, -0.83]	1 study · 20 participants	Ungraded
Probing pocket depth 3 months same question in other reviews	MD 0.15 [0.06, 0.24]	1 study · 20 participants	Ungraded
Probing attachment level 3 months same question in other reviews	MD 0.07 [-0.11, 0.25]	1 study · 20 participants	Ungraded

Subgingival chlorhexidine irrigation vs Chlorhexidine mouthwash

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bleeding 3 months same question in other reviews	MD -0.17 [-0.19, -0.15]	1 study · 24 participants	Ungraded
Plaque 3 months same question in other reviews	MD -0.20 [-0.24, -0.16]	1 study · 24 participants	Ungraded

Phosphoric etching (acid) gel vs Mechanical debridement and polishing

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB4 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Cleaning/treatment time 5 months same question in other reviews	Both interventions took a similar time to administer (no statistically significant difference in cleaning time)	1 study · 16 participants	Ungraded
Side effects (pain) 5 months same question in other reviews	Nine out of 16 patients reported slight (7) to moderate (2) pain at the etching gel side compared to none in the debridement group (P < 0.001)	1 study · 16 participants	Ungraded
Change in probing pocket depth 5 months same question in other reviews	MD 0.28 [-1.97, 2.53]	1 study · 16 participants	Ungraded
Plaque 5 months same question in other reviews	MD 0.00 [-0.33, 0.33]	1 study · 16 participants	Ungraded

Hyaluronic acid gel (brushing) vs Chlorhexidine gel (brushing)

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB4 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bleeding 6 months same question in other reviews	MD 0.20 [-0.28, 0.68]	1 study · 30 participants	Ungraded
Plaque 6 months same question in other reviews	MD -0.47 [-1.08, 0.14]	1 study · 30 participants	Ungraded
Change in probing pocket depth 6 months same question in other reviews	MD 0.00 [-0.65, 0.65]	1 study · 30 participants	Ungraded

Amine fluoride/stannous fluoride (AmF/SnF2) mouthwash vs Chlorhexidine mouthwash

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB4 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Staining index 3 months same question in other reviews	MD 0.06 [-0.10, 0.22]	1 study · 33 participants	Ungraded
Implant failure 3 months same question in other reviews	RR 0.28 [0.01, 6.43]	1 study · 33 participants	Ungraded
Change in taste 3 months same question in other reviews	MD -0.55 [-1.02, -0.08]	1 study · 33 participants	Ungraded
Patient satisfaction (desire for future use) 3 months same question in other reviews	MD 2.08 [1.52, 2.64]	1 study · 33 participants	Ungraded

Chlorhexidine solution enclosed in implant inner part vs Physiologic (saline) solution

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 weeks same question in other reviews	MD 0.00 [-0.48, 0.48]	1 study · 12 participants	Ungraded

Mechanical debridement plus topical minocycline vs Mechanical debridement plus chlorhexidine gel

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 12 months same question in other reviews	MD 6.00 [-9.07, 21.07]	1 study · 32 participants	Ungraded
Change in probing pocket depth 12 months same question in other reviews	MD 0.30 [-0.17, 0.77]	1 study · 32 participants	Ungraded
Change in probing pocket depth (worst sites) 12 months same question in other reviews	MD 0.40 [-0.28, 1.08]	1 study · 32 participants	Ungraded
Soreness in the gums 12 months same question in other reviews	RR 5.00 [0.66, 38.15]	1 study · 32 participants	Ungraded

Triclosan dentifrice vs Sodium fluoride dentifrice

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Change in probing pocket depth (>=4 mm) 6 months same question in other reviews	MD 0.30 [-0.06, 0.66]	1 study · 59 participants	Ungraded
Plaque 6 months same question in other reviews	MD -7.50 [-17.52, 2.52]	1 study · 59 participants	Ungraded

Mechanical debridement with titanium curettes vs Mechanical debridement with ultrasonic device

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB4 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 months same question in other reviews	MD 5.00 [-21.21, 31.21]	1 study · 31 participants	Ungraded
Change in probing pocket depth 6 months same question in other reviews	MD -0.40 [-1.14, 0.34]	1 study · 31 participants	Ungraded

Powered toothbrushing vs Manual toothbrushing

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB3 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Change in probing pocket depth 6 weeks	At 6 weeks there was no significant difference in change of probing pocket depths	1 study · 40 participants	Ungraded
Plaque 6 weeks	At 6 weeks there was no significant difference in mean plaque scores (Modified plaque index, Mombelli)	1 study · 40 participants	Ungraded

Sonic toothbrushing vs Manual toothbrushing

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB3 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 months	After 6 months there were no statistically significant differences for plaque	1 study · 31 participants	Ungraded
Ease of maintenance 6 months	After 6 months no statistically significant difference in difficulty in brushing	1 study · 31 participants	Ungraded
Patient satisfaction (liked toothbrush) 6 months	RR 1.48 [1.03, 2.13]	1 study · 31 participants	Ungraded
Change in probing pocket depth 6 months	After 6 months there were no statistically significant differences for changes in probing pocket depth	1 study · 31 participants	Ungraded

Listerine mouthwash vs Placebo mouthwash

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB3 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 3 months	MD -0.88 [-0.93, -0.83]	1 study · 20 participants	Ungraded
Marginal bleeding 3 months	MD -0.20 [-0.25, -0.15]	1 study · 20 participants	Ungraded
Probing pocket depth 3 months	MD 0.15 [0.06, 0.24]	1 study · 20 participants	Ungraded
Probing attachment level 3 months	MD 0.07 [-0.11, 0.25]	1 study · 20 participants	Ungraded

Subgingival chlorhexidine irrigation vs Chlorhexidine mouthwash

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB3 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bleeding 3 months	MD -0.17 [-0.19, -0.15]	1 study · 24 participants	Ungraded
Plaque 3 months	MD -0.20 [-0.24, -0.16]	1 study · 24 participants	Ungraded

Phosphoric etching (acid) gel vs Mechanical debridement and polishing

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB3 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Cleaning/treatment time 5 months	No statistically significant difference between the treatment groups in cleaning time	1 study · 16 participants	Ungraded
Plaque 5 months	At 5 months there was no statistically significant difference between the treatment groups for plaque	1 study · 16 participants	Ungraded
Side effects (pain) 5 months	Nine out of 16 patients reported slight (7) to moderate (2) pain at the etching gel side compared to none in the debridement group (P < 0.001)	1 study · 16 participants	Ungraded
Change in probing pocket depth 5 months	At 5 months there was no statistically significant difference between the treatment groups for change in probing pocket depth	1 study · 16 participants	Ungraded

Hyaluronic acid gel (brushing) vs Chlorhexidine gel (brushing)

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB3 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Change in probing pocket depth 6 months	After 6 months no difference in changes in probing pocket depths	1 study · 30 participants	Ungraded
Marginal bleeding 6 months	No difference in marginal bleeding at 6 months (statistically significant less bleeding with hyaluronic in first 2 months of healing, not at 6 months)	1 study · 30 participants	Ungraded
Plaque 6 months	After 6 months no differences in plaque were found (Modified plaque index, Mombelli)	1 study · 30 participants	Ungraded

Amine fluoride/stannous fluoride (AmF/SnF2) mouthwash vs Chlorhexidine mouthwash

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB3 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Change in taste 3 months	MD -0.55 [-1.02, -0.08]	1 study · 33 participants	Ungraded
Patient satisfaction (desire for future use) 3 months	MD 2.08 [1.52, 2.64]	1 study · 33 participants	Ungraded
Implant failure 3 months	No statistical differences in implant failures were found at 3 months	1 study · 33 participants	Ungraded
Staining index 3 months	No statistical difference in tooth staining was found at 3 months	1 study · 33 participants	Ungraded

Chlorhexidine solution enclosed in implant inner part vs Physiologic (saline) solution

Population: Adults with dental implants and healthy peri-implant soft tissues at baseline

CD003069.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 weeks	No statistically significant difference in plaque was found between treatments at 6 weeks	1 study · 12 participants	Ungraded

Mechanical debridement plus topical minocycline vs Mechanical debridement plus chlorhexidine gel

Population: Adults with dental implants and peri-implant mucositis at baseline

CD003069.PUB3 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Soreness in the gums 12 months	At 10 days no statistical differences in soreness of the gums were reported	1 study · 32 participants	Ungraded
Change in probing pocket depth 12 months	At 1 year there was no statistical difference in change of probing pockets depth	1 study · 32 participants	Ungraded
Plaque 12 months	At 1 year there was no statistical difference in plaque levels	1 study · 32 participants	Ungraded

Powered toothbrushing vs Manual toothbrushing

Population: People with dental implants

CD003069.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 weeks	MD 0.1 [-0.66, 0.86]	1 study · 36 participants	Ungraded

Sonic toothbrushing vs Manual toothbrushing

Population: People with dental implants

CD003069.PUB2 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Ease of maintenance 24 weeks	RR 1.07 [0.94, 1.21]	1 study · 31 participants	Ungraded
Change in probing pocket depth 24 weeks	At 24 weeks there were no statistically significant differences for probing pocket depth	1 study · 31 participants	Ungraded
Plaque 24 weeks	At 24 weeks there were no statistically significant differences for plaque	1 study · 31 participants	Ungraded

Listerine mouthwash vs Placebo mouthwash

Population: People with dental implants

CD003069.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Probing pocket depth 3 months	MD 0.15 [0.06, 0.24]	1 study · 20 participants	Ungraded
Marginal bleeding 3 months	MD -0.20 [-0.25, -0.15]	1 study · 20 participants	Ungraded
Probing attachment level 3 months	MD 0.07 [-0.11, 0.25]	1 study · 20 participants	Ungraded
Plaque 3 months	MD -0.88 [-0.93, -0.83]	1 study · 20 participants	Ungraded

Subgingival chlorhexidine irrigation vs Chlorhexidine mouthwash

Population: People with dental implants

CD003069.PUB2 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 3 months	MD -0.20 [-0.24, -0.16]	1 study · 24 participants	Ungraded
Marginal bleeding 3 months	MD -0.17 [-0.19, -0.15]	1 study · 24 participants	Ungraded

Phosphoric etching (acid) gel vs Mechanical debridement and polishing

Population: People with dental implants

CD003069.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Change in probing pocket depth 5 months	At 5 months there was no evidence of a difference between the treatment groups for probing pocket depth	1 study · 16 participants	Ungraded
Plaque 5 months	At 5 months there was no evidence of a difference between the treatment groups for plaque	1 study · 16 participants	Ungraded
Cleaning/treatment time 5 months	There was no statistically significant difference between the two techniques in cleaning time	1 study · 16 participants	Ungraded
Side effects (pain) 5 months	Nine out of 16 patients reported slight (7) to moderate (2) pain at the etching gel side compared to none in the debridement group (P<0.001)	1 study · 16 participants	Ungraded

Powered toothbrushing vs Manual toothbrushing

Population: People with dental implants

CD003069 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Plaque 6 weeks	MD 0.1 [-0.66, 0.86]	1 study · 36 participants	Ungraded

Sonic toothbrushing vs Manual toothbrushing

Population: People with dental implants

CD003069 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 12 weeks	At 12 weeks there were no statistically significant differences for plaque	1 study · 31 participants	Ungraded
Change in probing pocket depth 12 weeks	At 12 weeks there were no statistically significant differences for probing pocket depth	1 study · 31 participants	Ungraded
Ease of maintenance 12 weeks	RR 2.82 [0.12, 64.39]	1 study · 31 participants	Ungraded

Listerine mouthwash vs Placebo mouthwash

Population: People with dental implants

CD003069 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Probing pocket depth 3 months	MD 0.15 [0.06, 0.24]	1 study · 20 participants	Ungraded
Probing attachment level 3 months	MD 0.07 [-0.11, 0.25]	1 study · 20 participants	Ungraded
Marginal bleeding 3 months	MD -0.20 [-0.25, -0.15]	1 study · 20 participants	Ungraded
Plaque 3 months	MD -0.88 [-0.93, -0.83]	1 study · 20 participants	Ungraded

Subgingival chlorhexidine irrigation vs Chlorhexidine mouthwash

Population: People with dental implants

CD003069 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bleeding 3 months	MD -0.17 [-0.19, -0.15]	1 study · 24 participants	Ungraded
Plaque 3 months	MD -0.20 [-0.24, -0.16]	1 study · 24 participants	Ungraded

Phosphoric etching (acid) gel vs Mechanical debridement and polishing

Population: People with dental implants

CD003069 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Plaque 5 months	At 5 months there was no evidence of a difference between the treatment groups for plaque	1 study · 16 participants	Ungraded
Change in probing pocket depth 5 months	At 5 months there was no evidence of a difference between the treatment groups for probing pocket depth	1 study · 16 participants	Ungraded
Cleaning/treatment time 5 months	There was no statistically significant difference between the two techniques in cleaning time	1 study · 16 participants	Ungraded
Side effects (pain) 5 months	Nine out of 16 patients reported slight (7) to moderate (2) pain at the side subjected to etching gel treatment compared to none in the debridement group (P<0.001)	1 study · 16 participants	Ungraded

Interventions to treat peri-implantitis (failing implants) vs Another therapeutic regimen or control

Population: People with failing dental implants (peri-implantitis)

CD003069 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No trial assessed the effectiveness of treatments for peri-implantitis	0 studies	No studies