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International Journal of Implant Dentistry

Table 6 Included studies—nonsurgical treatment of peri-implantitis: alternative measures for biofilm removal

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
Karring et al. [28]   11 patients PD ≥5 mm, BOP + bone loss >1.5 mm and exposed threads 3 months OHI + ultrasonic device with hydroxyapatite fluid polish OHI + mechanical debridement (carbon fibre curettes) Test
   22 implants machined and medium-rough surfaces      BOP: 63.6 (BL) to 36.4 % (3 months, subject level)
        PD: 5.8 (1.1) (BL) to 5.8 (1.2) mm (3 months, subject level)
        Radiographic bone level changes: 0.1 (0.5) mm (3 months, subject level)
        Control
        BOP: 72.7 (BL) to 81.8 % (3 months, subject level)
        PD: 6.2 (1.6) (BL) to 6.3 (2.2) mm (3 months, subject level)
        Radiographic bone level changes: −0.2 (1.2) mm (3 months, subject level)
        Absence of BOP at 7/11 (test) and 2/11 (control) sites
Schwarz et al. [25] RCT, parallel 20 patients PD ≥4 mm, BOP + and pus 6 months OHI + Er:YAG laser device (cone-shaped glass fibre tip) at 12.7 J/cm2 OHI + mechanical debridement (plastic curettes), 0.2 % CHX pocket irrigation and 0.2 % CHX gel Test
   32 implants rough and medium-rough surfaces Radiographic bone loss     BOP: 83.2 (17.2) (BL) to 31.1 (10.1) % (6 months, subject level)
        PD: 5.4 (1.2) (BL) to 4.6 (1.1) mm (6 months, subject level)
        Control
        BOP: 81.3 (19.0) (BL) to 58.3 (16.9) % (6 months, subject level)
        PD: 5.5 (1.5) (BL) to 4.8 (1.4) mm (6 months, subject level)
        BOP scores at 6 months were significantly lower in the test group
Schwarz et al. [24] RCT, parallel 20 patients PD ≥4 mm, BOP + and pus 12 months OHI + Er:YAG laser device (cone-shaped glass fibre tip) at 12.7 J/cm2 OHI + mechanical debridement (plastic curettes), 0.2 % CHX pocket irrigation and 0.2 % CHX gel Test
   40 implants rough and medium-rough surfaces Radiographic bone loss     Moderately deep sites
        BOP: 81.7 (6.7) (BL) to 35.0 (6.3) % (12 months, subject level)
        PD: 4.5 (1.4) (BL) to 4.0 (0.1) mm (12 months, subject level)
        Deep sites
        BOP: 79.9 (4.8) (BL) to 55.0 (6.5) % (12 months, subject level)
        PD: 5.9 (0.1) (BL) to 5.4 (0.1) mm (12 months, subject level)
        Control
        Moderately deep sites
        BOP: 81.6 (5.2) (BL) to 53.3 (7.3) % (12 months, subject level)
        PD: 4.4 (0.2) (BL) to 4.3 (0.1) mm (12 months, subject level)
        Deep sites
        BOP: 88.3 (3.5) (BL) to 66.6 (5.5) % (12 months, subject level)
        PD: 5.9 (0.3) (BL) to 5.5 (0.2) mm (12 months, subject level)
        No significant differences between groups at 12 months
Renvert et al. [31] RCT, parallel 31 patients PD ≥4 mm, BOP + and/or pus 6 months OHI + ultrasonic device with hydroxyapatite fluid polish OHI + mechanical debridement (titanium curettes) Test
   31 implants machined and medium-rough surfaces Bone loss <2.5 mm     BI: 1.7 (0.6) (BL) to 1.2 (0.7) (6 months, subject level)
        PD: 4.3 (0.6) (BL) to 3.9 (0.8) mm (6 months, subject level)
        Control
        BI: 1.7 (0.9) (BL) to 1.4 (1.0) (6 months, subject level)
        PD: 6.2 (1.6) (BL) to 6.3 (2.2) mm (6 months, subject level)
        No significant differences between groups
Renvert et al. [30] RCT, parallel 42 patients PD ≥5 mm, BOP + and/or pus 6 months OHI + air abrasive device, glycine powder OHI + Er:YAG laser device (cone-shaped glass fibre tip, 12.7 J/cm2) Test
   90 implants machined and medium-rough surfaces Bone loss >3 mm     PD changes: 0.9 (0.8) mm (6 months, implant level)
        Radiographic bone level change: −0.3(0.9) mm (6 months, subject level)
        Positive treatment outcome: 47 %
        Control
        PD changes: 0.8 (0.5) mm (6 months, implant level)
        Radiographic bone level change: −0.1(0.8) mm (6 months, subject level)
        Positive treatment outcome: 44 %
        No significant differences between groups
Sahm et al.; John et al. [27, 33] RCT, parallel 32 patients (BL) PD ≥4 mm, BOP + with suppuration 12 months OHI + air abrasive device, glycine powder OHI + mechanical debridement (carbon curettes + 0.1 % CHX) Test
   25 patients (12 months) Bone loss ≤33 %     BOP: 99.0 (4.1) (BL) to 57.8 (30.7) % (12 months, subject level)
   36 implants      PD: 3.7 (1.0) (BL) to 3.2 (1.1) mm (12 months, subject level)
   8 implant systems      Control
        BOP: 94.7 (13.7) (BL) to 78.1 (30.0) % (12 months, subject level)
        PD: 3.9 (1.1) (BL) to 3.5 (1.2) mm (12 months, subject level)
        BOP: significant difference between groups at 3, 6 and 12 months
  1. BI bleeding index, BL baseline, BOP bleeding on probing, CHX chlorhexidine digluconate, OHI oral hygiene instructions, PD probing pocket depth, RCT randomized controlled clinical study
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