Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Bergen, Norway.
J Clin Periodontol. 2023 Jun;50 Suppl 26:135-145. doi: 10.1111/jcpe.13789. Epub 2023 Feb 28.
To study in humans with peri-implant mucositis the efficacy of (Q1) mechanical/physical instrumentation over oral hygiene instructions alone; (Q2) any single mode of mechanical/physical instrumentation over others; (Q3) combinations of mechanical/physical instrumentation over single modes; and (Q4) repetitions of mechanical/physical instrumentation over single administration.
Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the four PICOS questions were included. A single search strategy encompassing the four questions was applied to four electronic databases. Two review authors independently screened the titles and abstracts, carried out full-text analysis, extracted the data from the published reports and performed the risk of bias assessment through the RoB2 tool of the Cochrane Collaboration. In case of disagreement, a third review author took the final decision. Treatment success (i.e., absence of bleeding on probing [BoP]), BoP extent and BoP severity were considered as the implant-level outcomes of critical importance for the present review.
A total of five papers reporting on five RCTs, involving 364 participants and 383 implants, were included. Overall, treatment success rates after mechanical/physical instrumentation ranged from 30.9% to 34.5% at 3 months and from 8.3% to 16.7% at 6 months. Reduction in BoP extent was 19.4%-28.6% at 3 months, 27.2%-30.5% at 6 months and 31.8%-35.1% at 12 months. Reduction in BoP severity was 0.3-0.5 at 3 months and 0.6-0.8 at 6 months. Q2 was addressed in two RCTs, which reported no differences between glycine powder air-polishing and ultrasonic cleaning, as well as between chitosan rotating brush and titanium curettes. Q3 was addressed by three RCTs, which showed no added effect of glycine powder air-polishing over the use of ultrasonic and of diode laser over ultrasonic/curettes. No RCTs were identified that answered Q1 and Q4.
Several mechanical/physical instrumentation procedures including curettes, ultrasonics, lasers, rotating brushes and air-polishing are documented; however, a beneficial effect over oral hygiene instructions alone or superiority over other procedures could not be demonstrated. Moreover, it remains unclear whether combinations of different procedures or their repetition over time may provide additional benefits. (CRD42022324382).
研究患有种植体周围黏膜炎的患者，（Q1）机械/物理器械治疗与单纯口腔卫生指导相比的疗效；（Q2）任何单一机械/物理器械治疗与其他器械相比的疗效；（Q3）机械/物理器械联合治疗与单一器械治疗相比的疗效；（Q4）机械/物理器械重复治疗与单次治疗相比的疗效。
本研究纳入了符合特定纳入标准的随机临床试验（RCT），旨在回答上述四个 PICOS 问题。采用单一的搜索策略涵盖了四个问题，检索了四个电子数据库。两位综述作者独立筛选标题和摘要，进行全文分析，从已发表的报告中提取数据，并使用 Cochrane 协作的 RoB2 工具进行偏倚风险评估。如果存在分歧，由第三位综述作者做出最终决定。治疗成功率（即探诊时无出血[BoP]）、BoP 程度和 BoP 严重程度被认为是本次综述至关重要的种植体水平结局。
共纳入五篇报告了五项 RCT 的研究，涉及 364 名参与者和 383 个种植体。总体而言，机械/物理器械治疗后的 3 个月时治疗成功率为 30.9%至 34.5%，6 个月时为 8.3%至 16.7%。3 个月时 BoP 程度的减少率为 19.4%至 28.6%，6 个月时为 27.2%至 30.5%，12 个月时为 31.8%至 35.1%。BoP 严重程度的减少率为 3 个月时为 0.3 至 0.5，6 个月时为 0.6 至 0.8。Q2 在两项 RCT 中得到了探讨，这两项 RCT 报告了甘氨酸粉空气抛光和超声洁牙之间以及壳聚糖旋转刷和钛洁治器之间没有差异。Q3 在三项 RCT 中得到了探讨，这些 RCT 表明甘氨酸粉空气抛光联合超声洁牙与单独使用超声洁牙相比，以及二极管激光联合超声洁牙/洁治器与单独使用超声洁牙相比，没有额外的效果。没有 RCT 能够回答 Q1 和 Q4。
记录了多种机械/物理器械治疗方法，包括洁治器、超声、激光、旋转刷和空气抛光；然而，与单纯口腔卫生指导相比，或与其他治疗方法相比，这些治疗方法并没有显示出有益的效果。此外，不同治疗方法的联合或随着时间的推移重复治疗是否可能提供额外的益处，仍不清楚。（CRD42022324382）。
