Cochrane · intervention · CD004970
Interventions for replacing missing teeth: treatment of peri‐implantitis
Esposito, M, Grusovin, MG, Worthington, HV · Cochrane Database of Systematic Reviews · 2012 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
39
current version
GRADE rated
0
No studies
1
Included studies
9
as reported
No studies 1 · 2.6%Ungraded 38 · 97.4%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 | People who have at least one dental implant affected by peri-implantitis | Adults with peri-implantitis; Germany, China, Denmark, Sweden, Italy (n=9) |
| Intervention | Any non-surgical or surgical procedure including local or systemic therapeutic agents aimed at recovery of peri-implant oral health | Metronidazole gel (n=1); Adjunctive doxycycline gel, Atridox (n=1); Vector / air-abrasive device (n=1); Er:YAG laser (n=4); Implant surface smoothening after resective surgery (n=1); Nanocrystalline hydroxyapatite, Ostim (n=1) |
| Comparison | Any alternative non-surgical or surgical procedure or therapeutic agent | Ultrasonic debridement (n=1); Manual debridement (n=4); Carbon fibre curettes (n=1); Manual debridement plus chlorhexidine irrigation/gel (n=2); No smoothening after systemic antibiotics, resective surgery and local antibiotics (n=1); Bovine xenograft (Bio-Oss) plus resorbable barrier (n=1); Plastic curettes plus saline solution (n=1) |
| Outcomes | Implant failure; Radiographic marginal bone level change; Complications and side effects; Recurrence of peri-implantitis; Probing attachment level change (PAL); Probing pocket depth change (PPD); Marginal soft tissue recession change (REC); Aesthetics evaluated by patients; Aesthetics evaluated by dentists; Cost | Implant failure (n=9); Radiographic marginal bone levels (n=3); Probing attachment levels (n=6); Probing pocket depths (n=9); Gingival recessions (n=5); Complications and side effects (n=8); Recurrence of peri-implantitis (n=9) |
| Study designs | RCT (parallel group and split-mouth designs) | All parallel group design except one split-mouth (Karring 2005) |
| Timing | Not specified | Three months (n=1); Four months (n=1); Six months (n=4); One year (n=1); Two years (n=1); Four years (n=1) |
Search date: 2011-06. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID
Questions and results
Current version onlyMetronidazole gel 25% (local antibiotic) vs Ultrasonic debridement
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence of peri-implantitis 12 weeks | No recurrence of peri-implantitis occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Complications and side effects 12 weeks | No implant failures, complications or recurrence of peri-implantitis occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Change in probing pocket depth 12 weeks | After 12 weeks there was no statistically significant difference in PPD changes. | 1 study · 27 participants | Ungraded |
Implant failure 12 weeks | No implant failures occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Adjunctive local antibiotic (8.5% doxycycline hyclate, Atridox) added to manual debridement vs Manual debridement with chlorhexidine (no antibiotic)
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence of peri-implantitis 4 months (18 weeks) | No recurrence of peri-implantitis occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing attachment level (PAL) 4 months (18 weeks) | MD 0.61 [0.40, 0.82] | 1 study · 28 participants | Ungraded |
Implant failure 4 months (18 weeks) | No implant failures occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Complications and side effects 4 months (18 weeks) | No complications occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing pocket depth (PPD) 4 months (18 weeks) | MD 0.59 [0.39, 0.79] | 1 study · 28 participants | Ungraded |
Air-abrasive / Vector system debridement vs Manual debridement (carbon fibre curettes)
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence of peri-implantitis 6 months | No recurrence of peri-implantitis occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Change in probing pocket depth 6 months | No statistically significant difference for PPD; data not usable. | 1 study · 11 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Radiographic marginal bone level 6 months | No statistically significant difference for marginal bone levels; data not usable. | 1 study · 11 participants | Ungraded |
Er:YAG laser debridement vs Manual debridement plus chlorhexidine irrigation/gel
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in gingival recession (REC) 6 months | No statistically significant differences for change in recession. | 1 study · 20 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups (both trials). | 2 studies · 40 participants | Ungraded |
Change in probing attachment level (PAL) 6 months | No statistically significant differences for change in PAL. | 1 study · 20 participants | Ungraded |
Complications and side effects 6 months | Complications: risk ratio (totals not selected); one laser patient had a buccal keratinised mucosa perforation. | 1 study · 20 participants | Ungraded |
Recurrence of peri-implantitis 6 months | RR 0.25 [0.03, 2.06] | 2 studies · 40 participants | Ungraded |
Change in probing pocket depth (PPD) 6 months | No statistically significant differences for change in PPD. | 1 study · 20 participants | Ungraded |
Implant surface smoothening added to systemic antibiotics + resective surgery + local antibiotics vs No implant surface smoothening (same surgical protocol)
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 2 years | RR 0.3 [0.01, 6.47] | 1 study · 17 participants | Ungraded |
Complications and side effects 2 years | No complications occurred in any of the groups. | 1 study · 17 participants | Ungraded |
Nanocrystalline hydroxyapatite (Ostim) vs Bovine-derived xenograft (Bio-Oss) plus resorbable barrier
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 6 months | No complication occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Change in probing pocket depth (PPD) 4 years | MD -1.4 [-1.99, -0.81] | 1 study · 22 participants | Ungraded |
Implant failure 6 months | No implant failure occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Change in probing attachment level (PAL) 4 years | MD -1.4 [-2.56, -0.24] | 1 study · 22 participants | Ungraded |
Change in gingival recession (REC) 4 years | MD -0.10 [-0.51, 0.31] | 1 study · 22 participants | Ungraded |
Recurrence of peri-implantitis 4 years | RR 2.0 [0.21, 18.98] | 1 study · 22 participants | Ungraded |
Er:YAG laser surface debridement before bone augmentation vs Plastic curettes plus saline solution before bone augmentation
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 6 months | All patients experienced flap exposure during healing, not associated with infective complications; one patient had a slight pigmentation of the peri-implant soft tissues. | 1 study · 30 participants | Ungraded |
Implant failure 6 months | Six months after treatment there were no implant failures. | 1 study · 30 participants | Ungraded |
Change in soft tissue recession (REC) 6 months | Six months after treatment there were no statistically significant differences for soft tissue recessions. | 1 study · 30 participants | Ungraded |
Change in probing pocket depth (PPD reduction) 6 months | Six months after treatment there were no statistically significant differences for PPD reduction. | 1 study · 30 participants | Ungraded |
Change in probing attachment level (PAL gain) 6 months | Six months after treatment there were no statistically significant differences for PAL gain. | 1 study · 30 participants | Ungraded |
Er:YAG laser vs Air-abrasive device (Perio-Flow)
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence of peri-implantitis 6 months | After 6 months no statistically significant difference for peri-implantitis recurrence; 11% of implants (five air-abrasive, six laser) had pus on probing. | 1 study · 42 participants | Ungraded |
Change in probing pocket depth 6 months | After 6 months no statistically significant difference between Er:YAG laser and air-abrasive device for PPD. | 1 study · 42 participants | Ungraded |
Complications and side effects 6 months | After 6 months there were no complications. | 1 study · 42 participants | Ungraded |
Implant failure 6 months | After 6 months there were no drop-outs, implant failures or complications. | 1 study · 42 participants | Ungraded |
Radiographic marginal bone level change 6 months | After 6 months no statistically significant difference for peri-implant marginal bone levels. | 1 study · 42 participants | Ungraded |
Non-surgical interventions vs Surgical interventions
Population: People with at least one dental implant affected by peri-implantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Non-surgical versus surgical interventions: no trials. | 0 studies | No studies |
Metronidazole gel 25% (local antibiotic) vs Ultrasonic debridement
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 12 weeks | No implant failures occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Recurrence of perimplantitis 12 weeks | No recurrence of perimplantitis occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Change in probing pocket depth 12 weeks | After 12 weeks there was no statistically significant difference in PPD changes. | 1 study · 27 participants | Ungraded |
Complications and side effects 12 weeks | No implant failures, complications or recurrence of perimplantitis occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Adjunctive local antibiotic (8.5% doxycycline hyclate, Atridox) added to manual debridement vs Manual debridement with chlorhexidine (no antibiotic)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 4 months (18 weeks) | No complications occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing pocket depth (PPD) 4 months (18 weeks) | MD 0.59 [0.39, 0.79] | 1 study · 28 participants | Ungraded |
Recurrence of perimplantitis 4 months (18 weeks) | No recurrence of perimplantitis occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Implant failure 4 months (18 weeks) | No implant failures occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing attachment level (PAL) 4 months (18 weeks) | MD 0.61 [0.40, 0.82] | 1 study · 28 participants | Ungraded |
Air-abrasive / Vector system debridement vs Manual debridement (carbon fibre curettes)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic marginal bone level 6 months | No statistically significant difference for marginal bone levels; data not usable. | 1 study · 11 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Recurrence of perimplantitis 6 months | No recurrence of perimplantitis occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Change in probing pocket depth 6 months | No statistically significant difference for PPD; data not usable. | 1 study · 11 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Er:YAG laser debridement vs Manual debridement plus chlorhexidine irrigation/gel
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in gingival recession (REC) 6 months | No statistically significant differences for change in recession. | 1 study · 20 participants | Ungraded |
Change in probing attachment level (PAL) 6 months | No statistically significant differences for change in PAL. | 1 study · 20 participants | Ungraded |
Complications and side effects 6 months | Complications: risk ratio (totals not selected); one laser patient had a buccal keratinised mucosa perforation. | 1 study · 20 participants | Ungraded |
Recurrence of perimplantitis 6 months | RR 0.25 [0.03, 2.06] | 2 studies · 40 participants | Ungraded |
Change in probing pocket depth (PPD) 6 months | No statistically significant differences for change in PPD. | 1 study · 20 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups (both trials). | 2 studies · 40 participants | Ungraded |
Implant surface smoothening added to systemic antibiotics + resective surgery + local antibiotics vs No implant surface smoothening (same surgical protocol)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 2 years | No complications occurred in any of the groups. | 1 study · 17 participants | Ungraded |
Implant failure 2 years | After 2 years no statistically significant difference for implant failures; two implants failed in one control patient, none in the test group. | 1 study · 17 participants | Ungraded |
Nanocrystalline hydroxyapatite (Ostim) vs Bovine-derived xenograft (Bio-Oss) plus resorbable barrier
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in gingival recession (REC) 4 years | MD -0.10 [-0.51, 0.31] | 1 study · 22 participants | Ungraded |
Change in probing pocket depth (PPD) 4 years | MD -1.4 [-1.99, -0.81] | 1 study · 22 participants | Ungraded |
Implant failure 6 months | No implant failure occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Recurrence of perimplantitis 4 years | RR 2.0 [0.21, 18.98] | 1 study · 22 participants | Ungraded |
Complications and side effects 6 months | No complication occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Change in probing attachment level (PAL) 4 years | MD -1.4 [-2.56, -0.24] | 1 study · 22 participants | Ungraded |
Metronidazole gel 25% (local antibiotic) vs Ultrasonic debridement
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 12 weeks | No implant failures occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Change in probing pocket depth 12 weeks | After 12 weeks there was no statistically significant difference in PPD changes. | 1 study · 27 participants | Ungraded |
Complications and side effects 12 weeks | No implant failures or complications occurred in any of the groups. | 1 study · 27 participants | Ungraded |
Adjunctive local antibiotic (8.5% doxycycline hyclate, Atridox) added to manual debridement vs Manual debridement with chlorhexidine (no antibiotic)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 4 months (18 weeks) | No complications occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing pocket depth (PPD) 4 months (18 weeks) | MD 0.59 [0.39, 0.79] | 1 study · 28 participants | Ungraded |
Implant failure 4 months (18 weeks) | No implant failures occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing attachment level (PAL) 4 months (18 weeks) | MD 0.61 [0.40, 0.82] | 1 study · 28 participants | Ungraded |
Air-abrasive / Vector system debridement vs Manual debridement (carbon fibre curettes)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Change in probing pocket depth 6 months | No statistically significant difference for PPD; data not usable. | 1 study · 11 participants | Ungraded |
Radiographic marginal bone level 6 months | No statistically significant difference for marginal bone levels; data not usable. | 1 study · 11 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Er:YAG laser debridement vs Manual debridement plus chlorhexidine irrigation/gel
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 6 months | After 6 months there were no statistically significant differences for change in PPD. | 1 study · 20 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups (both trials). | 2 studies · 40 participants | Ungraded |
Change in gingival recession (REC) 6 months | After 6 months there were no statistically significant differences for change in recession. | 1 study · 20 participants | Ungraded |
Change in probing attachment level (PAL) 6 months | After 6 months there were no statistically significant differences for change in PAL. | 1 study · 20 participants | Ungraded |
Complications and side effects 6 months | RR 0.43 [0.07, 2.66] | 2 studies · 40 participants | Ungraded |
Implant surface smoothening added to systemic antibiotics + resective surgery + local antibiotics vs No implant surface smoothening (same surgical protocol)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 2 years | After 2 years no statistically significant difference for implant failures; two implants failed in one control patient, none in the test group. | 1 study · 17 participants | Ungraded |
Complications and side effects 2 years | No complications occurred in any of the groups. | 1 study · 17 participants | Ungraded |
Nanocrystalline hydroxyapatite (Ostim) vs Bovine-derived xenograft (Bio-Oss) plus resorbable barrier
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 6 months | MD -0.50 [-0.88, -0.12] | 1 study · 22 participants | Ungraded |
Change in gingival recession (REC) 6 months | No statistically significant differences for change in REC at 6 months (0.3 mm in both groups). | 1 study · 22 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Change in probing attachment level (PAL) 6 months | MD -0.50 [-1.00, 0.00] | 1 study · 22 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 22 participants | Ungraded |
Metronidazole gel 25% (local antibiotic) vs Ultrasonic debridement
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 12 weeks | Implant failure was evaluated in four other trials but not in this comparison. | 0 studies | No studies |
Complications and side effects 12 weeks | No complications occurred. | 1 study · 27 participants | Ungraded |
Change in probing pocket depth 12 weeks | After 12 weeks there was no statistically significant difference in PPD. | 1 study · 27 participants | Ungraded |
Adjunctive local antibiotic (8.5% doxycycline hyclate, Atridox) added to manual debridement vs Manual debridement with chlorhexidine (no antibiotic)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 4 months (18 weeks) | MD 0.59 [0.39, 0.79] | 1 study · 28 participants | Ungraded |
Complications and side effects 4 months (18 weeks) | No complications occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Change in probing attachment level (PAL) 4 months (18 weeks) | MD 0.61 [0.40, 0.82] | 1 study · 28 participants | Ungraded |
Implant failure 4 months (18 weeks) | No implant failures occurred in any of the groups. | 1 study · 28 participants | Ungraded |
Air-abrasive / Vector system debridement vs Manual debridement (carbon fibre curettes)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth 6 months | After 6 months no statistically significant difference for PPD; data could not be used (within-patient standard deviations not reported). | 1 study · 11 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Radiographic marginal bone level 6 months | After 6 months no statistically significant difference for marginal bone levels; data could not be used (within-patient standard deviations not reported for the split-mouth study). | 1 study · 11 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 11 participants | Ungraded |
Er:YAG laser debridement vs Manual debridement plus chlorhexidine irrigation/gel
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 6 months | After 6 months there was no statistically significant difference for change in PPD. | 1 study · 20 participants | Ungraded |
Change in probing attachment level (PAL) 6 months | After 6 months there was no statistically significant difference for change in PAL. | 1 study · 20 participants | Ungraded |
Change in gingival recession (REC) 6 months | After 6 months there was no statistically significant difference for change in recession. | 1 study · 20 participants | Ungraded |
Implant failure 6 months | No implant failures occurred in any of the groups. | 1 study · 20 participants | Ungraded |
Complications and side effects 6 months | No complications occurred in any of the groups. | 1 study · 20 participants | Ungraded |
Implant surface smoothening added to systemic antibiotics + resective surgery + local antibiotics vs No implant surface smoothening (same surgical protocol)
Population: People with at least one dental implant affected by perimplantitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 2 years | No complications occurred in any of the groups. | 1 study · 17 participants | Ungraded |
Implant failure 2 years | After 2 years no statistically significant difference for implant failures; two implants failed in one patient of the control group and none in the test group. | 1 study · 17 participants | Ungraded |
Metronidazole gel 25% (local antibiotic) vs Ultrasonic debridement
Population: People with at least one oral implant affected by perimplantitis (plaque-induced marginal bone loss with clinical signs of infection)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications and side effects 12 weeks | No side effects occurred. | 1 study · 27 participants | Ungraded |
Probing attachment level (PAL) 12 weeks | No study used probing attachment levels as an outcome measure. | 0 studies | No studies |
Cost 12 weeks | No study recorded treatment costs as an outcome measure. | 0 studies | No studies |
Implant failure 12 weeks | No study used implant failure as an outcome measure. | 0 studies | No studies |
Radiographic marginal bone level 12 weeks | No study used radiographic marginal bone levels as an outcome measure. | 0 studies | No studies |
Probing pocket depth (cross-sectional at 12 weeks) 12 weeks | MD 0.10 [-0.59, 0.79] | 1 study · 27 participants | Ungraded |