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International Journal of Implant Dentistry

Table 11 Included studies—surgical treatment of peri-implantitis: adjunctive augmentative therapy

From: Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Publication Design Population Case definition Period Test Control Mean (SD) outcome
Schwarz et al. [48, 51, 54] RCT, parallel 20 patients PD >6 mm, BOP + and/or pus 4 years nonsubmerged healing OHI + initial nonsurgical therapy OHI + initial nonsurgical therapy Test
   21 implants machined and medium-rough surfaces Intrabony defect >3 mm   Open flap surgery + mechanical debridement (plastic curettes) + nanocrystalline hydroxyapatite paste Open flap surgery + mechanical debridement (plastic curettes) + bovine-derived xenograft + native collagen barrier membrane BOP reduction: 32 % (4 years, subject level)
        PD reduction: 2.5 (0.9) mm (4 years, subject level)
        Control
        BOP reduction: 51 % (4 years, subject level)
        PD reduction: 1.1 (0.3) mm (4 years, subject level)
        BOP and PD reductions sign. higher at control sites
Deppe et al. [40] CCT, parallel 32 patients PD ≥5 mm, BOP + progressive vertical bone loss 5 years Group 2 OHI + open flapa surgery + air polishing + carbon dioxide laser (cw mode, 2.5 W, 12 × 5 s) decontamination + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane Group 4 OHI + open flapb surgery + air polishing + beta tricalcium phosphate + cortical bone chips harvested from the retromoar area (50:50) + nonresorbable synthetic barrier membrane Test
   73 implants machined, rough- and medium-rough surfaces      SBI: 0.5 (0.8) (BL) to 2.1 (1.4) (48 months, implant level)
        PD: 4.8 (1.4) (BL) to 2.5 (1.1) mm (48 months, implant level)
        Control
        SBI: 1.2 (0.6) (BL) to 1.9 (1.0) (48 months, implant level)
        PD: 5.7 (1.4) (BL) to 2.5 (1.4) mm (48 months, implant level)
        Comparable outcomes in both groups
Roos-Jansaker et al. [45–47] CCT, parallel 25 patients BOP + and/or pus 5 years transmucosal healing systemic antibiotic medication (amoxicillin + metronidazole for 10 days) Removal of the suprastructure Removal of the suprastructure Test
   45 implants machined and medium-rough surfaces Bone loss ≥3 threads one- to four-wall defects   Open flap surgery + debridement + decontamination using hydrogen peroxide 3 % algae derived xenograft + resorbable synthetic barrier membrane Open flap surgery + debridement + decontamination using hydrogen peroxide 3 % algae derived xenograft + PD reduction: 3.0 (2.4) mm (5 years, implant level)
        Radiographic defect fill: 0.1 (0.5) mm (5 years, implant level)
        Control
        PD reduction: 3.3 (2.0) mm (5 years, implant level)
        Radiographic defect fill: 0.1 (0.5) mm (5 years, implant level)
        Comparable defect fill and BOP reductions in both groups
Schwarz et al. [53] CCT, parallel 27 patients PD >6 mm, BOP + and/or pus 12 months nonsubmerged healing Circumferential-type (Ie) defects OHI + initial nonsurgical therapy Buccal dehiscence-type defects with a semicircular (Ib) or circular component (Ic) Test Ib
   27 implants machined and medium-rough surfaces Intrabony defect >3 mm   Open flap surgery + mechanical debridement (carbon curettes) + decontamination (cotton pellets soaked in saline) OHI + initial nonsurgical therapy Open flap surgery + Mechanical debridement (carbon curettes) + decontamination (cotton pellets soaked in saline) BOP reduction: 38.9 (16.6) % (12 months, subject level)
    Supracrestal component ≤1 mm   Bovine-derived xenograft + native collagen barrier membrane Bovine-derived xenograft + native collagen barrier membrane PD reduction: 1.6 (0.9) mm (12 months, subject level)
        Test Ic
        BOP reduction: 25.9 (14.7) % (12 months, subject level)
        PD reduction: 1.6 (0.7) mm (12 months, subject level)
        Control Ie
        BOP reduction: 61.1 (16.7) % (12 months, subject level)
        PD reduction: 2.7 (0.7) mm (12 months, subject level)
        Sign. difference in BOP reductions between Ic and Ie
Rocuzzo et al. [44] CCT, parallel 26 patients PD ≥6 mm 12 months nonsubmerged healing simultaneous connective tissue graft at sites lacking keratinized mucosa systemic antibiotic medication (amoxicillin + clavulanic acid for 6 days) SLA surfaced implants TPS surfaced implants Test
   26 implants rough and medium-rough surfaces Crater-like (intrabony) defects   OHI OHI BOP reduction: 60.4 % (12 months, subject level)
      Open flap surgery + mechanical debridement (plastic curettes) + decontamination (24 % EDTA and 1 % CHX gel) + bovine-derived xenograft Open flap surgery + mechanical debridement (plastic curettes) + decontamination (24 % EDTA and 1 % CHX gel) + bovine-derived xenograft PD reduction: 3.4 (1.7) mm (12 months, subject level)
        Radiographic defect fill: 1.9 (1.3) mm (12 months, subject level)
        Control
        BOP reduction: 33.9 % (12 months, subject level)
        PD reduction: 2.1 (1.2) mm (12 months, subject level)
        Radiographic defect fill: 1.6 (0.7) mm (12 months, subject level)
        BOP and PD reductions sign. higher in the test group
Schwarz et al. [49, 50, 52] RCT, parallel 17 patients PD >6 mm, BOP + and/or pus 4 years nonsubmerged healing OHI + initial nonsurgical therapy OHI + initial nonsurgical therapy Test
   17 implants machined and medium-rough surfaces Intrabony defect >3 mm   Open flap surgery + debridement + decontamination using an Er:YAG laser device (cone-shaped glass fibre tip) at 11.4 J/cm2 implantoplasty at bucally and supracrestally exposed implant parts Open flap surgery + Mechanical debridement (plastic curettes) + decontamination (cotton pellets soaked in saline) implantoplasty at bucally and supracrestally exposed implant parts BOP reduction: 71.6 (24.9) % (4 years, subject level)
    Supracrestal component >1 mm   Bovine-derived xenograft + native collagen barrier membrane at intrabony components Bovine-derived xenograft + native collagen barrier membrane at intrabony components PD reduction: 1.3 (1.8) mm (4 years, subject level)
        Control
        BOP reduction: 85.2 (16.4) % (4 years, subject level)
        PD reduction: 1.2 (1.9) mm (4 years, subject level)
        BOP and PD reductions comparable in both groups
Aghanzadeh et al. [43] RCT, parallel 45 patients PD ≥2 mm, BOP + and pus 12 months nonsubmerged healing systemic antibiotic medication (Azithromycin for 4 days) Open flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3 % cortical bone chips harvested from the mandibular ramus + resorbable synthetic barrier membrane Open flap surgery + mechanical debridement (titanium instruments) + decontamination using hydrogen peroxide 3 % bovine-derived xenograft + resorbable synthetic barrier membrane Test
   75 implants medium-rough surfaces Bone loss ≥2 mm     BOP reduction: 44.8 (6.3) % (12 months, implant level)
    Angular defects ≥3 mm in depth     PD reduction: 2.0 (0.3) mm (12 months, implant level)
        Radiographic bone level gain: 0.2 (0.3) mm (12 months, implant level)
        Control
        BOP reduction: 50.4 (5.3 %) (12 months, implant level)
        PD reduction: 3.1 (0.2)mm (12 months, implant level)
        Radiographic bone level gain: 0.8 (0.4) mm (12 months, implant level)
        PD reductions and bone level gains were significantly higher at control sites
Wohlfahrt et al. [55, 58] RCT, parallel 33 patients PD ≥5 mm, BOP + intrabony defects ≥4 mm 12 months submerged healing for 6 months Open flap surgery + mechanical debridement (titanium curettes) + conditioning using 24 % ethylenediaminetetraacetic acid gel (2 min) + augmentation of intrabony defect components using porous titanium granules Open flap surgery + mechanical debridement (titanium currettes) + conditioning using 24 % ethylenediaminetetraacetic acid gel (2 min) Test
   33 implants medium-rough surfaces      BOP reduction: 0.38 (2.1) % (12 months, implant level)
        PD reduction: 1.7 (1.7) mm (12 months, implant level)
        Radiographic defect fill: 57.0 (45.1) % (12 months, implant level)
        Control
        BOP reduction: 0.56 (2.9) % (12 months, implant level)
        PD reduction: 2.0 (2.3) mm (12 months, implant level)
        Radiographic defect fill: −14.8 (83.4) % (12 months, implant level) no sign. reductions in BOP scores in both groups comparable reductions in MMP-8 and bone level markers
  1. BL baseline, BOP bleeding on probing, CCT non-randomized controlled clinical study, CHX chlorhexidine dugluconate, MMP-8 matrixmetalloproteinase-8, PD probing pocket depth, RCT randomized controlled clinical study, SBI sulcus bleeding index, SLA sand blasted and acid etched, TPS titanium plasma flamed
  2. aSubgroup analysis of n = 11 implants
  3. bSubgroup analysis of n = 13 implants
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