Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy.
Department of General Surgery and Surgical-Medical Specialties, University of Catania (Italy), Catania, Italy.
BMC Oral Health. 2023 Jun 9;23(1):375. doi: 10.1186/s12903-023-03058-z.
The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis.
The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction.
Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction.
Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.
本系统评价（SR）旨在评估不同辅助方法/疗法在种植体周围炎非手术治疗（NST）中的临床疗效。
本研究方案已在 PROSPERO 数据库中注册（CRD42022339709），并按照 PRISMA 声明进行设计。电子和手工检索以确定比较单独进行种植体周围炎非手术治疗与 NST 加任何辅助方法/治疗的随机临床试验（RCT）。主要结局为探诊袋深度（PPD）减少。
共纳入 16 项 RCT。1189 个种植体中仅丢失 2 个，随访时间为 3 至 12 个月。研究中 PPD 减少范围为 0.17 至 3.1 毫米，而缺损缓解率为 5.3%至 57.1%。全身使用抗菌药物与更高的 PPD 减少（1.56 毫米；[95%置信区间 0.24 至 2.89]；p=0.02）相关，但存在高度异质性，与单独的 NST 相比，治疗成功率（OR=3.23；[95%置信区间 1.17 至 8.94]；p=0.02）更高。局部使用抗菌药物和激光辅助治疗在减少 PPD 和探诊出血（BoP）方面没有差异。
单独或联合使用辅助方法的非手术治疗可能会减少 PPD 和 BoP，但无法完全预测袋的完全缓解。在可能的辅助方法中，只有全身使用抗生素似乎提供了额外的益处，但应谨慎使用。
