Interventions for replacing missing teeth: treatment of perimplantitis

Area of Science:

• Dental Implantology
• Periodontology
• Evidence-Based Dentistry

Background:

• Maintaining healthy peri-implant tissues is crucial for long-term oral implant success.
• Bacterial plaque accumulation can lead to inflammatory changes, peri-implantitis, and eventual implant failure.
• Existing treatment strategies for peri-implantitis lack clear evidence of superior efficacy.

Purpose of the Study:

• To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants.

Main Methods:

• A comprehensive search of multiple databases (Cochrane, MEDLINE, EMBASE) and handsearching of journals was conducted.
• Randomized controlled trials (RCTs) comparing interventions for peri-implantitis were selected.
• Data extraction and quality assessment were performed independently by two authors; meta-analysis was not feasible due to study heterogeneity.

Main Results:

• Seven RCTs were identified, testing various interventions including local antibiotics, debridement techniques, laser therapy, and systemic antibiotics.
• No significant differences were found between most tested interventions.
• A single RCT showed adjunctive local antibiotics improved probing attachment levels (PAL) and probing pocket depths (PPD) by approximately 0.6 mm over 4 months in severe cases, though this trial had a high risk of bias.

Conclusions:

• There is insufficient reliable evidence to determine the most effective peri-implantitis treatments.
• Simple subgingival mechanical debridement alone appeared effective in some cases, comparable to more complex therapies.
• Further well-designed RCTs are necessary to establish evidence-based treatment guidelines for peri-implantitis.