Efficacy of adjunctive measures in peri-implant mucositis. A systematic review and meta-analysis

To answer the following PICO question: In systemically healthy humans with peri-implant mucositis, what is the efficacy of patient-performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow-up?

Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated.

Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (n_studies  = 16; n_patients  = 650; WMD = 14.25%; 95% CI [9.06-19.45]; p < .001; I²  = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (n_s  = 5; n_p  = 229; WMD = 22.72%; 95% CI [19.40-26.04]; p < 0.001; I²  = 94.8%), followed by probiotics (n_s  = 6; n_p  = 260; WMD = 12.11%; 95% CI [3.20-21.03]; p = .008; I²  = 93.3%) and systemic antibiotics (n_s  = 3; n_p  = 101; WMD = 5.97%; 95% CI [1.34-10.59]; p = .012; I²  = 58.1%). Disease resolution was scarcely reported (n = 6).

Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient-performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved.