Effectiveness of nonsurgical therapy of peri-implant mucositis: A systematic review

This systematic review intends to respond to the question: "How do clinical parameters change in implants affected by peri-implant mucositis following different non-surgical treatment approaches or no treatment in patients monitored for a minimum of six months?"

A search for randomized clinical trials (RCTs) or prospective controlled clinical studies (NRCT) in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, and Web of Science was performed between May 2015 and April 2025. After a two-step screening, data extraction and risk of bias (RoB) assessment were performed. A network meta-analysis (NMA), incorporating multi-arm RCTs, was planned.

Twenty-one studies (19 RCTs; 2 NRCTs; 1068 patients) were included. The treatments comprised curettes, (ultra)sonic scalers, air-polishing, laser, antimicrobials, probiotics, and antibiotics, alone or in combination. Patient-related systemic and local factors and operator-related factors were sporadically reported and analyzed. To various extents all treatments resulted in a reduction in BOP. When reported, peri-implant mucositis resolution was achieved in a subset of patients, ranging from 9% to 100% (only in one study group). Microbiological and immunological data and patient-reported outcomes (PROs) were sparsely and heterogeneously reported. Only one-third of the studies presented low RoB. Due to limited data available and heterogeneity in treatment protocols and outcomes among the included studies, a NMA could not be performed.

Within the limitations of this review, different nonsurgical treatment protocols, including mechanical debridement alone, all improved clinical parameters, whereas adjuncts yielded only minor improvements after 6 months. Standardized outcome sets and routine PROs are needed to improve comparability and decision-making in future studies.