Interventions for replacing missing teeth: treatment of perimplantitis

Area of Science:

• Dental Implantology
• Periodontology
• Biomaterials Science

Background:

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

Purpose of the Study:

• To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included major databases (Cochrane, MEDLINE, EMBASE) and handsearching.
• Data extraction and quality assessment were performed independently by two authors.

Main Results:

• Ten eligible RCTs were identified, comparing various treatments for perimplantitis.
• Adjunctive local antibiotics to debridement showed a 0.61 mm improvement in probing attachment levels (PAL) and 0.59 mm reduction in probing pocket depths (PPD) after 4 months in severe cases.
• Bio-Oss with resorbable barriers showed a borderline significant 0.5 mm gain in PAL and PPD after 6 months compared to nanocrystalline hydroxyapatite.

Conclusions:

• There is limited reliable evidence for the most effective perimplantitis treatments.
• Local antibiotics combined with debridement may offer modest benefits in severe perimplantitis.
• Larger, well-designed RCTs are needed due to small sample sizes and short follow-up periods.