Bruno Martins*1; Rogerio M. Castilho2; Gustavo V. O. Fernandes1

1Universidade Católica Portuguesa, Viseu, Portugal; 2Periodontics, University of Michigan, Ann Harbor, United States

Background: Despite the high predictability and survival rate involving dental implants, which have achieved averages of 97% and 91% after 10 and 20 years, respectively, there is a risk for biological complications, as peri-implantitis. This inflammatory disease affects directly the osseointegrated implants and it has been considered the most common reason for implant failure. Its prevalence is around 20% up to 14 years and there is a general concern related to its incidence.

Aim/Hypothesis: All the background has been conducted to another important matter: the efficiency of the available and current protocols for peri-implantitis treatment. Thus, this study evaluated the literature on the treatment of peri-implantitis, in order to find the superior available treatment option.

Material and Methods: This systematic review was registered in Prospero (CRD420212367759) and was based on the Cochrane Handbook for Systematic Reviews of Interventions and Prisma Guidelines. The focus question was “could patients, who developed peri-implantitis (P), be treated with success only with non-surgical interventions (I), or achieve better results with surgical and adjunctive therapies (C), culminating in a higher survival/success rate of implants, in short- and long-term follow-ups (O)?” As inclusion criteria were considered human studies, only systematic reviews that enrolled randomized controlled trials, only in the English language published from January 2014 to January 2021. As exclusion was considered studies which approached only mucositis, only abstracts or e-poster without full-text. Then, PubMed, Web of Science, Cochrane Library were searched to find systematic reviews on peri-implantitis treatment. AMSTAR 2 tool was used to evaluate the methodology of each SR included in this study.

Results: Nine systematic reviews were gathered for full-text review. All the included Systematic Reviews were assessed with the AMSTAR 2 tool, and four of them were considered with high quality, three with moderate quality, one with low quality, and one of critically low quality, due to non-existent risk of bias assessment by the authors. Six out of the nine had randomized controlled trials investigating non-surgical techniques, and eight out of the nine had approached surgical techniques. In total, 98 primary studies were included among the 9 systematic reviews, 59 of them being unique. Non-surgical treatments and adjunctive measures were manual debridement with chlorhexidine/saline/hydrogen peroxide, ultrasound debridement, air abrasive systems with glycine powder, systemic or local antibiotics, antiseptics, and the usage of laser systems. Whereas surgical treatments consisted of flap elevation, treatment and detoxification of the implant surface, regenerative or resective treatment.

Conclusion and Clinical implications: Non-surgical interventions appear to offer some level of clinical improvement, especially on bleeding on probing, but they are likely not enough to fully treat peri-implantitis. Surgical interventions seem to be more effective in improving overall clinical parameters, especially probing in-depth, bleeding on probing, and marginal bone level. No specific surgical technique or biomaterial seems to have a clear advantage over others. Surgical outcome predictability is still also a concern.

Disclosure of Interest: None Declared.

Keywords: clinical studies/trials, peri-implantitis, systematic Review