Inconclusive evidence of treatment modalities for peri-implantitis

Data sources Ovid Medline, Embase, EBM Review, Cochrane Central Register of Control Trials and the Cochrane Database of Systematic Reviews.Study selection Randomised controlled trials or prospective cohort studies published in English with ≥10 patients and ≥6 months follow-up (the longest follow-up period was chosen in longitudinal studies which were published more than once). Experimental animal or in vitro studies were excluded.Data extraction and synthesis Data on the primary outcome reduction in bleeding on probing (BOP) in implants treated surgically for peri-implantitis, and secondary outcomes pocket probing depth (PPD) and RBL (radiographic bone-loss) were extracted and meta-analysis conducted. Results Sixteen papers met the inclusion criteria. Four treatment modalities to supplement mechanical debridement were identified: (1) apically repositioned flap, (2) chemical surface decontamination, (3) implantoplasty and (4) bone augmentation. Inconsistent results were evident which were dependent on several treatment-independent factors. No clinical benefits were identified for the additional use of surface decontamination, while limited evidence demonstrated improvement of clinical and radiographic outcomes after implantoplasty. The effect of bone augmentation appeared limited to 'filling' radiographic defects. The meta-analysis was conducted using eight randomised clinical trials and two controlled prospective cohort studies. Meta-analysis demonstrated that implants treated with surface decontamination had SMD of -0.21 (95% CI: -1.70 to 1.27) for periodontal pocket reduction (PPD) reduction. Only one study reported the effect of implantoplasty on PPD, which shows a significant SMD of -3.33 (95% CI: -4.37 to -2.28 mm). Bone augmentation with grafting materials and the additional use of membrane resulted in SMD of 0.15 mm (95% CI: -0.55 to 0.84 mm) and 0.30 mm (95% CI: -0.31 to 0.91 mm), respectively. In terms of RBL changes, the use of surface decontamination methods resulted in SMD of 0.54 mm (95% CI: -0.20 to 1.28 mm). Implants treated with implantoplasty had SMD of -3.38 (95% CI: -.43 to -2.33 mm). The SMD for RBL changes after the use of bone augmentation was -1.05 (95% CI: -1.80 to -0.31 mm). However, the additional use of membrane had SMD of -0.16 (95% CI: -0.56 to 0.24 mm.Conclusions The outcomes of the currently available surgical interventions for peri-implantitis remain unpredictable. There is no reliable evidence to suggest which methods are the most effective. Further randomised controlled studies are needed to identify the best treatment methods.