Interventions for replacing missing teeth: treatment of perimplantitis

Area of Science:

• Dental Implantology
• Periodontology
• Regenerative Medicine

Background:

• Maintaining peri-implant tissue health is crucial for dental implant longevity.
• Bacterial plaque can cause inflammation, leading to peri-implantitis and potential implant failure.
• Current treatment strategies for peri-implantitis lack definitive evidence of effectiveness.

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, CENTRAL, MEDLINE, EMBASE) and handsearching was conducted.
• Randomized controlled trials (RCTs) comparing different agents or interventions for peri-implantitis were included.
• Data extraction and quality assessment were performed independently by two reviewers.

Main Results:

• Twelve RCTs were identified, with five excluded. Interventions tested included local antibiotics, debridement techniques, laser therapy, systemic antibiotics, and bone grafting materials.
• Adjunctive local antibiotics to manual debridement showed a statistically significant, though small, improvement in probing attachment levels (PAL) and probing pocket depths (PPD) after 4 months in severe cases.
• Bio-Oss with resorbable barriers demonstrated greater PAL and PPD improvement over 4 years compared to nanocrystalline hydroxyapatite for infrabony defects.

Conclusions:

• Reliable evidence for the most effective peri-implantitis treatments is scarce.
• While some interventions show modest short-term or long-term benefits, simple mechanical debridement appeared sufficient in some trials.
• High recurrence rates and small sample sizes necessitate caution; larger, longer-term RCTs are needed.