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Table 1 Included studies reporting on peri-implant mucositis treatment

From: Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical 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 Supportive therapy/comments
Alternative measures for biofilm removal
Ji et al. (2014) RCT, parallel 24 patients
Test: 12; mean age: 46.2 years; 50% female
Control: 12; mean age: 41.3 years: 67% female
8 patients – diagnosed with periodontitis
33 implants (test: 17, control: 16)
Molar/premolar sites
1 implant system (ITI Straumann, Standard Implant, SLA surface)
PD ≥ 4 mm, BOP + no radiographic
bone loss compared with baseline (i.e
immediately after prosthesis insertion)
3 months OHI + mechanical debridement (ultrasonic
scaler with carbon fiber tips) + air abrasive device, glycine powder (sites with PD ≥ 4 mm)
OHI + mechanical
debridement (ultrasonic scaler with carbon fiber tips)
Subject level
BI
Test baseline: 1.4 (0.57); 3 months: 1.1 (0.58); p = 0.150
Implant level (at sites PD ≥ 4 mm): baseline: 1.7 (0.93); 3 months: 1.1 (0.98); p = 0.002
Control subject level:
Baseline:1.5 (0.65); 3 months: 1.0 (0.85); p = 0.058
Implant level (at sites PD ≥ 4 mm): baseline: 1.7 (1.0); 3 months: 0.9 (1.1); 3-months; p < 0.001
Between-group comparison: subject level: p = 0.764; implant level: p = 0.361
PD
Test baseline: 3.6 (0.47) mm; 3 months: 3.2 (0.48); p = 0.017
Implant level (at sites PD ≥ 4 mm): baseline: 4.6 (0.50); 3 months: 3.7 (0.95); p < 0.001
Control subject level:
Baseline: 3.5 (0.50); 3 months: 3.1 (0.38); p = 0.012
Implant level (at sites PD ≥ 4 mm): baseline: 4.5 (0.55); 3 months: 3.1 (0.38); 3-months; p = 0.012
Between-group comparison: subject level: p = 0.587; implant level: p = 0.831
During follow-up visits, oral hygiene instructions were reinforced (at 1- and 3-months)
Adjunctive air abrasive device with glycine powder appeared to have a limited beneficial effect as compared with mechanical debridement alone
De Siena et al. (2014) CCT, parallel 30 patients (15 per group)
Test: 9 female; 6 male; mean age: 64.8 (12.5) years; mean cigarettes per day: 5.5 (2.6);
Control: 9 female, 6 male; mean age: 63.3(9.3) years; mean cigarettes per day: 4.3(2.3);
None of the patients were diagnosed with periodontitis
BOP or spontaneous bleeding with
local swelling + 
PD ≤ 3.5 mm + 
bone loss ≤ 3.0 mm
6 months OHI + mechanical debridement Teflon
curettes, polishing + air abrasive devic with,
glycine powder
OHI + mechanical
debridement Teflon
curettes, polishing
Implant level
BI
Test: 13 patients did not present bleeding at 6 months;
Control: 9 patients did not present bleeding at 6 months
PD
Test baseline: 3.0 (0.4) mm; 6 months: 2.4 (0.5) mm; p < 0.05;
Control baseline: 2.9 (0.4) mm; 6 months: 3.0 (0.6) mm; p > 0.05
OHI were provided at baseline and repeated in each follow-up visit 3 and 6 months after intervention
Test group showed a significant reduction in PD values
Riben-Grundstrim et al. (2015) RCT,
parallel
37 patients
Test:17; mean age: 64.4 (range: 25–85) years;
Control:18; mean age: 64.3 (range: 25–86) years;
5 patients – current smokers (test: 1; control: 4)
37 implants
3 implant systems (Astra Tech, Nobel Biocare, Straumann)
PD ≥ 4 mm, BOP + with or without
SUPP
 + bone loss ≤ 2 mm from implant
shoulder
12 months OHI + air abrasive device with glycine powder
Repeated treatment at 3 and 6 months
OHI + mechanical
debridement (ultrasonic
scaler with plastic coated
tips)
Repeated treatment at 3 and 6 months
Subject level
BOP
Test baseline: 43.9 (7.3)%; 12 months: 12.1 (3.8)%; p < 0.05
Control baseline: 53.7 (7.9)%; 12 months: 18.6 (6.4)%; p < 0.05
No significant difference between the groups
Number of diseased sites
(PD ≥ 4 mm
with BOP/
SUPP)
Test baseline: 38%; 12 months: 8%
Control baseline: 52%; 12 months: 17%
Supragingival maintenance care was provided at months 9 and 12
Both treatment approaches were effective in treating peri-implant mucositis
Wohlfahrt et al. (2018) RCT, split-mouth desing 11 patients
Age: NR
Periodontal/smoking status: NR
24 implants (test: 12, control: 12)
3 implant brands (Astra, Nobel Mark III, Straumann)
BOP + at least on esite PD ≥ 4 mm + no perceptible bone loss 6 months Chitosan brush (BioClean Labrida) with oscillating hand piece for 3 min + saline irrigation Mechanical debridement (titanium curettes) for 3 min + saline irrigation Implant level
mBOP
Test baseline: 1.54 (0.78), 6 months: 0.70 (0.70);
Control baseline: 1.35 (0.85); 6 months: 0.74 (0.80); no significant difference between groups
PD
Test baseline: 4.27 (1.36) mm; 6 months: 4.09 (1.68) mm
Control baseline: 4.29 (1.50) mm; 6 months: 3.95 (1.27) mm; no significant difference between groups
Reduced signs of inflammation were seen in both groups
Adjunctive diode laser/aPDT therapy
Javed et al. (2017) RCT,
parallel
54 male patients
Test: 28 patients, mean age: 50.6 (0.8) years
Control: 26 patients, mean age: 52.5 (0.5) years
Nr of implants—NR
All patients smokers
PD ≥ 4 mm at least at 30% sites 3 months Mechanical debridement (plastic curettes) + aPDT (photosensitizer: phenothiazine chloride (HELBO)) application for 2 min + light exposure (diode laser 660 nm 10 s.) Mechanical debridement (plastic curettes) Subject level
BOP
Test baseline: 10.2 (1.2)%, 3 months: 8.8 (0.2)%, p < 0.001;
Control baseline: 8.6 (0.8)%, 3 months: 6.9 (0.2)%, p < 0.001. Between group comparison: p > 0.001. No significant difference between the groups
PD
Test baseline: 7.4 (0.3) mm, 3 months: 1.5 (0.3) mm, p < 0.001;
Control baseline: 6.6 (NR) mm, 3 months: 3.8 (0.4) mm, p < 0.001. Between-group comparison: p < 0.001
In smokers, aPDT was more effective in the treatment of peri-implant mucositis compared to mechanical debridement alone
Al Rifaiy et al. (2018) RCT 38 male patients
Test: 20 patients; mean age: 33.6(3.8) years; 28 implants
Control: 18 patients; mean age: 35.4(2.1) years; 27 implants
All patients reported on vaping e-cigarettes
BOP + no bone loss > 2 mm (7th EWON) 3 months OHI + mechanical debridement + aPDT(photosensitizer: 0.005% Methylene blue) application for 10 s. + diode laser irradiation (670 nm) at 150 milliwatts for 1 min OHI + mechanical debridement Subject level
BOP
Test baseline: 14.6 (3.1)%, 3 months: 11.7 (0.5)%; p < 0.001;
Control baseline: 9.2 (1.0)%, 3 months: 7.9 (0.2)%; p < 0.001. No significant difference between the groups
PD
Test baseline: 4.3 (0.8) mm; 3 months: 2.1 (0.3) mm; p < 0.001;
Control baseline:, 4.5 (0.9) mm; 3 months: 2.2 (0.5) mm; p < 0.001; Significantly higher reduction in the test group (p < 0.001)
aPDT was more effective compared to mechanical debridement alone
Aimetti et al. (2019) RCT, parallel 220 patients
Test: 110 patients; mean age: 58.1(10.1) years; 78 female; light smokers: 14 patients; history of periodontitis: 54 patients
Control: 110 patients; mean age: 56.8 (10.2) years; 71 female; light smokers: 20 patients; history of periodontitis: 45 patients
220 implants: 110 test, 110 control
PD ≥ 4 mm + BOP ± SUPP + no radiographic bone loss beyond bone remodeling or (in the absence of baseline radiographic data) < 2 mm 3 months OHI + diode laser application (980-nm, 2.5 W 30 s. + irrigation with 3% H2O2 10 s.(repeated 3 times) + debridement manual and ultrasonic (titanium-coated Gracey or carbon fiber curretes) + biostimulation 60 s. at 0.7 W OHI + debridement manual and ultrasonic (titanium-coated Gracey or carbon fiber curretes) Subject level
BOP
Test baseline: 48.3 (26.9)%, 3 months: 23.3 (23.5), p < 0.05
Control baseline: 46.2 (25.6)%, 3 months: 26.8 (23.0)%, p < 0.05. Between-group comparison: p > 0.05
PD
Test baseline: 3.5 (0.7) mm, 3 months: 2.9 (0.6), p < 0.05
Control baseline: 3.4 (0.9) mm, 3 months: 3.0 (0.7) mm, p < 0.05. Between-group comparison: p > 0.05
Reinforcement of OHI 1- and 3-months after the treatment and professional implant cleaning and polishing
The adjunctive use of diode laser did not yield any statistical significant clinical benefit as compared to mechanical treatment alone
Mariani et al. 2020 [follow-up study of Aimetti et al. (2019)]   73 patients
Tests: 28; mean age: 59.2 (9.3) years; female: 24; history of periodontitis: 12 patients
Control: 35; mean age: 62.1(6.8) years; female: 23; history of periodontitis: 13 patients
  12 months    Subject level
Test baseline: 63.6 (24.2)%, 12 months: 25.8 (24.1); p < 0.001
Control baseline: 59.5 (25.0)%, 12 months: 27.6 (25.5)%, p < 0.001 Between-group comparison: p > 0.05
PD
Test baseline: 3.6 (0.7) mm, 12 months: 3.1 (0.7), p < 0.001
Control baseline: 3.8 (0.6) mm, 12 months: 3.3 (0.6) mm, p < 0.001. Between-group comparison: p > 0.05
During recalls (3, 6, 12 months after treatment) OHI reinforcement and professional implant cleaning and polishing
The adjunctive use of diode laser showed no statistically significant additional beneficial effect in treatment of peri-implant mucositis
Deeb et al. (2020) RCT, parallel, 3 arm 45 male patients
Test 1: 15 patients; mean age: 52.6(0.9) years;
Test 2: 15 patients; mean age: 53.8(0.7) years;
Control: 15 patients
All patients smokers
Nr of implants – NR
BOP + no signs of bone loss 3 months Test 1
OHI + mechanical debridement with titanium curettes and polishing with rubber cups and paste + aPDT (photosensitizer: Phenothiazine chloride (HELBO) application for 2 min, light exposure (diode laser 660 nm 10 s.) + CHX 0.12% mouthrinse twice daily 2 weeks
Test 2
debridement with titanium curettes and polishing with rubber cups and paste + aPDT (aPDT (photosensitizer: Phenothiazine chloride (HELBO) application for 2 min, light exposure (diode laser 660 nm 10 s.) + CHX 0.12% mouthrinse twice daily 2 weeks + Azithromycin 500 mg (1st day), 150 mg (following 2–4 days)
OHI + mechanical debridement with titanium curettes and polishing with rubber cups and paste + CHX 0.12% mouthrinse twice daily 2 weeks Subject level
BOP
Test 1 baseline: 12.3 (4.8)%, 3 months: 8.0 (3.7)%; p < 0.001
Test 2 baseline: 15.7 (3.9)%, 3 months: 10.1 (3.1)%; p < 0.001
Control baseline: 13.6 (4.0)%, 3 months: 11.8 (4.0); p < 0.001. Between-group comparison: p > 0.05
PD
Test 1 baseline: 4.8 (1.0) mm, 3 months: 3.9 (0.9) mm; p < 0.001
Test 2 baseline: 4.6 (1.1) mm, 3 months: 3.9 (1.0) mm; p < 0.001
Control baseline: 4.5 (0.8) mm, 3 months: 4.1 (1.0); p < 0.001. Between-group comparison: p > 0.05
Adjunctive aPDT to mechanical debridement was as efficacious as adjunctive antibiotic therapy
Additional benefits in reducing BOP scores were observed for adjunctive aPDT among the smokers
Adjunctive local antiseptic/systemic antibiotic therapy
Porras et al. (2002) RCT,
parallel
16 patients
Mean age: 58.9 (8.4) years (range: 34–76)
Smokers excluded
Periodontal status – NR
28 implants
Test: 16
Control: 12
3 implant types
(plasma-sprayed Ti/
cp Ti (HA-coated Ti)
Supra- and subgingival plaque + PD ≤ 5 mm BOP
 + “incipient”
radiographic lesion
3 months OHI + mechanical cleansing
(plastic scaler, rubber cups, polishing paste) + local irrigation
CHX (0.12%) and topical CHX gel application + 0.12%
CHX mouthrinse twice for 10 days
OHI + mechanical cleansing
(plastic scaler, rubber cups, polishing paste)
Implant level
mSBI and BOP (%) scores: no sign. differences between
groups at 1 and 3 months
PD values
Test: baseline: 3.27 (0.81); 3 months: 2.71
(0.70)mm
Control: baseline: 3.48 (0.61); 3 months: 2.55
(0.72) mm
Changes in mean PD between test and control groups at 3 months were statistically significant (p = 0.035)
The addition of CHX to mechanical debridement did not enhance the outcomes as compared to mechanical debridement alone
Thöne-Mühling et al. (2010) RCT,
parallel
11 patients with treated chronic periodontitis
Mean age: 51.5 years (range: 37–67)
Smokers included
36 implants
Tests: 22
Control: 14
2 implant types (MK ii; Nobel Biocare and Osseotite 3i Implant innov.)
BOP + and/or gingival index (GI) ≥ 1
absence of
radiographic bone
loss during the last
2 years
8 months OHI + mechanical cleansing (plastic scaler and
polyetheretherketone-coated ultrasonic instruments) + 
topical CHX gel application once + full mouth
disinfection (deep scaling in one session + CHX
disinfection of tongue and tonsils) + 0.2% CHX
mouthrinse 2 × /day and tonsil spraying 1 × /day for 14 days
OHI + mechanical cleansing
(plastic scaler and
polyetheretherketone-coated
ultrasonic instruments) + full
mouth scaling in one session
Implant level
BOP
Test baseline: 0.22 (0.11); 8 months: 0.16
(0.09) %
Control baseline: 0.17 (0.19); 8 months: 0.17 (0.11) %
PD
Test baseline: 3.49 (0.78); 8 months: 2.84 (0.64) mm
Control baseline: 3.4 (0.62) mm; 8 months: 2.82 (0.59) mm
PD reduced significantly after 8 months compared to baseline (test: p = 0.033; control: p = 0.004). No significant difference between the groups
ML (recession)
Test baseline: 0.21 (0.25) mm; 8 months: 0.35 (0.65) mm;
Control baseline: 0.33 (0.42) mm; 8 months: 0.33 (0.44) mm
Both treatments lead to an improvements of the clinical parameters, but without significant differences between the groups after 8 months
Hallström et al. (2012) RCT,
parallel
45 patients, 45 implants: 22 test, 23 control
Mean age: test 54.6 (18.2) years; control 54.6 (19.8) years
PD ≥ 4 mm BOP + and/or
SUPP + radiographic bone loss
 ≤ 2 mm
6 months OHI + mechanical cleansing
(titanium curettes + rubber
cups + polishing paste) + 
Azithromycin® 500 mg day 1
and 250 mg days 2–4
OHI + mechanical cleansing
(titanium curettes + rubber cups + polishing paste)
Subject level
BOP
Test baseline: 82.6 (24.4)%, 6 months: 27.3
(18.8)%
Control baseline: 80.0 (25.0)%, 6 months: 47.5
(32.3)%;
Between group comparison: p > 0.05
Mean PD
Test baseline: 4.4 (1.0) mm, 6 months: 3.5 (1.1) mm
Control baseline: 4.1 (0.9) mm; 6 months: 4.1 (1.2) mm;
Between-group comparison: p < 0.16
Odds ratio of a positive
treatment outcome (PD ≤ 
4.0 mm and BOP ≤ 1) was
4.5:1 (test vs. control)
No short-term differences were found between study groups
Menez et al. (2016) RCT,
parallel
37 patients: 6 male, 31 female. Age range: 33–75 years, mean age: 57.4 years
Only non-smokers included
Test: 61 implants; control: 58 implants
BOP + PD ≥ 5 mm + no radiographic evidence of bone loss beyond the first two threads of the implants 6 months OHI + subgingival debridement with plastic curets + CHX (0.12%) mouthrinse used for brushing the dorsum of the tongue for 1 min. + rinsing for 10 s. + subgingival irrigation for 10 min. + CHX mouthrinse (0.12%) every 12 h, 30 min. 14 days OHI + subgingival debridement with plastic curets + placebo mouthrinse used for brushing the dorsum of the tongue for 1 min. + rinsing for 10 s. + subgingival irrigation for 10 min. + placebo mouthrinse every 12 h, 30 min. 14 days Implant level
BOP
Test baseline: 75.82 (33.98)%, 6 months: 45.76 (34.85)%, p < 0.001
Control baseline: 67.54 (34.38)%, 6 months: 41.08 (41.0)%; p < 0.001
Between-group comparison: p = 0.21
PD
Test baseline: 2.85 (0.60) mm; 6 months: 2.49 (0.60) mm; p < 0.001;
Control baseline: 2.72 (0.68) mm; 6 months: 2.49 (0.67) mm, p < 0.001;
Between-group comparison: p = 0.32
Patients were further motivated with respect to oral hygiene habits during the entire period of the study
Use of 0.12% CHX did was not more effective than placebo
Iorio-Siciliano et al. (2020) RCT, parallel 45 patients
Smokers included;
Patients with gingivitis or treated periodontitis included;
67 implants
Test: 22 patients; mean age: 46.5(15.35) years; 22.7% smokers; 40.9% of patients with treated periodontitis; 33 implants
Control: 23 patients; mean age: 45.96(9.84) years; 26.1% smokers; 43.5% of patients with treated periodontitis; 34 implants
 ≥ 1 site with BOP + absence of radiographic bone loss compared to previous radiograph 6 months Amino acid buffered sodium hypochlorite (Perisolv) application + ultrasonic scaler + application of Perisolv repeated 5 times + CHX (0.12%) gel twice daily for 2 weeks Application of placebo gel + ultrasonic scaler + application of placebo gel repeated 5 times + CHX (0.12%) gel twice daily for 2 weeks Implant level
BOP-positive implants
Test baseline: 33%, 6 months: 18%; p < 0.001
Control baseline: 34%, 6 months: 23%, p < 0.001. Between-group comparison: p = 0.271
PD
Test baseline: 3.93 (1.09) mm, 6 months: 3.04 (0.46) mm; p < 0.001;
Control baseline: 3.68 (0.85) mm; 6 months: 3.07 (0.58) mm; p < 0.001
Between-group comparison: p = 0.53
Clinical parameters were recorded at 1, 3 and 6 months following the treatment
Test: 110 patients; mean age: 58.1 ± 10.1 years; 78 female; light smokers; 14; history of periodontitis: 54 patients
Changes in PD from baseline to 6 months were not statistically significantly different between groups. Complete resolution was not achieved with either of the therapies
Adjunctive probiotics
Pena et al. (2019) RCT, parallel 50 patients, 50 implants
Test: 25 patients; mean age: 55.96(10.81) years; 0% smokers; 64% of patients with a history of treated periodontitis
Control: 25 patients; mean age: 61.16(10.62) years; 4% smokers; 68% of patients with a history of treated periodontitis
BOP ± gingival redness, swelling + no bone loss (7th EWOP) 135 days (4.5 months) OHI + mechanical debridement (ultrasound titanium tip) + CHX 0.12% mouthrine twice a day, 2 weeks + after 15 days: probiotic tablets containing two strains of L. reunteri for 1 month OHI + mechanical debridement (ultrasound titanium tip) + CHX 0.12% mouthrine twice a day, 2 weeks + after 15 days: placebo tablets Subject level
BOP
Test baseline: 100%; 135 days: 64%
Control baseline: 100%, 135 days: 60%;
Between group comparison: p = 0.771
PD
Test baseline: 3.10 (0.74) mm, 135 days: 2.88 (0.62) mm;
Control baseline: 3.32 (0.65) mm, 135 days: 2.98 (0.60) mm;
Between-group comparison: p = 0.599
None of the patients received any other mechanical periodontal treatment during the follow-up
Administration of probiotics did not seem to provide an additional clinical benefit. Complete disease resolution was not always achieved
Galofre et al. (2018) RCT, parallel 22 patients with history of periodontitis; 22 implants
Test: 11 patienst; mean age: 61.5(10.4) years; 27% female
Control: 11 patients; mean age: 60.0(9.5) years; 45% female
Inflammed mucosa with BOP and/or suppuration and no evidence of radiographic bone loss (8th EWOP) 3 months Mechanical debridement (ultrasound with carbon tip and titanium curettes) + 30 probiotic lozenges (once a day, 30 days) (L. reuteri, PerioBalance) Mechanical debridement (ultrasound with carbon tip and titanium curettes) + 30 placebo lozenges (once a day, 30 days) Subject level
BOP
Test baseline: 0.61 (0.27)%, 3 months: 0.29 (0.09)%, p = 0.01
Control baseline: 0.42 (0.18)%, 3 months: 0.35 (0.22)%, p = 0.377
Between-group comparison of the difference baseline-3 months: p = 0.024
PD
Test baseline:3.84 (0.55) mm, 3 months: 3.35 (0.76) mm, p = 0.09
Control baseline: 3.82 (0.64) mm; 3 months: 3.66 (0.62)mm, p = 0.187
Between-group comparison: p = 0.094
During the study period patients received neither oral hygiene instructions nor any other mechanical periodontal treatment
Administration of probiotics together with mechanical debridement improved clinical parameters at peri-implant mucositis sites
Adjunctive home care mouthrinse
Pulcini et al. (2019) RCT, parallel 46 patients, 54 implants
Untreated or recurrent periodontitis patients excluded
Test: 24 patients; 27 implants; mean age: 61.3(8.9) years; smokers: 7.4%; 11 female; 6 patients with systemic diseases
Control: 22 patients; 27 implants; mean age: 61.0(12.0) years; smokers: 14.8%; 14 female; 4 patients with systemic diseases
BOP and/or SUPP without progressive radiographic bone loss 12 months OHI + mechanical debridement (ultrasound with plastic tip and air-polishing with erythritol) + home care mouthrinse (0.03% CHX + 0.05% cetylpiridinium chloride (CPC)) (twice a day, 30 s.) 12 months OHI + mechanical debridement (ultrasound with plastic tip and air-polishing with erythritol) + home care placebo mouthrinse (twice a day, 30 s.) 12 months Implant level
BOP
Test baseline: 58.64 (27.49)%, 12 months: 10.42 (13.74)%
Control baseline: 46.30 (24.17)%, 12 months: 14.39 (18.04)%
Between group comparison: p = 0.402
PD
Test baseline: 3.36 (0.78) mm; 12 months: 2.50 (0.43) mm
Control baseline:3.38 (0.60) mm; 12 months: 2.57 (0.57) mm
Between group comparison: p = 0.650
After 12 months, 58.3% of test implants, and 50% of control implants demonstrated complete disease resolution (i.e., absence of BOP); p > 0.05
The use of test mouthrinse demonstrated some adjunctive benefits. Complete disease resolution could not be achieved in every case
Bunk et al. (2020) RCT,
parallel, three-arm
60 patients/60 implants
Test 1: 20 patients, 20 implants
Test 2: 20 patients, 20 implants
Control: 20
Periodontally healthy
Smokers excluded
BOP and/or SUPP + absence of radiographic bone loss compared to previous examination, visual signs of inflammation (modified gingival index ≠ 0) 3 months Test 1
OHI + mechanical debridement (titanium curettes + polishing with low-abrasive paste) + home use of oral irrigator (Waterpick) with water once a day, 3 months
Test 2
OHI + mechanical debridement (titanium curettes + polishing with low-abrasive paste) + home use of oral irrigator (Waterpick) with 0.06% CHX solution once a day, 3 months
OHI + mechanical debridement (titanium curettes + polishing with low-abrasive paste) Subject level
BOP-positive sites
Test 1 baseline: 2.25 (1.02), 3 months: 0.45 (0.69)
Test 2 baseline: 2.40 (0.88), 3 months: 0.10 (0.45)
Control baseline: 2.35 (0.99), 3 months: 0.85 (1.09)
Test 2 group showed significantly lower BOP-positive sites compared to control group (p = 0.004)
After 3 months prevalence of peri-implant mucositis was 5% in Test 2, 35% in Test 1, and 50% in the control group
All patients returned for follow-up and data collection after 4, 8, 12 weeks. Mechanical debridement was not performed at follow-up visits
The adjunctive use of oral irrigator with 0.06% CHX in addition to mechanical debridement can reduce the presence of peri-implant mucositis
Philip et al. (2020) RCT,
Parallel 3-arm
Test 1: 31 patients/31 implants; 15 female; mean age: 59 (10.6) years; current smokers: 4; 19 implant in maxilla; 12 in mandible
Test 2: 30 patients/30 implants; 14 female; mean age: 62 (9.3) years; current smokers: 2; 19 implant in maxilla; 11 in mandible
Control: 28 patients/28 implants; 12 female; mean age: 65 (10.3) years; current smokers: 3; 20 implant in maxilla; 8 in mandible
BOP and/or suppuration with SUPP progressive radiographic bone loss compared to baseline radiograph 3 months OHI + ultrasonic scaler with plastic tip + homecare mouthrinse:
Test 1: Decapinol mouthrinse consisting (0.2%) delmopinol hydrochloride
Test 2: CHX (0.2%)
OHI + ultrasonic scaler with plastic tip + homecare Placebo mouthrinse Subject level
mBI
Baseline test 1: 1.0 (0.49); 3 months: 0.13 (0.23)
Baseline test 2: 1.03 (0.44); 3 months: 0.28 (0.30)
Baseline control: 1.08 (0.52); 3 months: 0.19 (0.32); statistically significant reduction compared to baseline (p = 0.001); between-group comparison: p = 0.42
BOP
Baseline test 1: 45 (25.52); 3 months: 3.22 (10.01)
Baseline test 2: 43.88 (22.52); 3 months: 8.88 (12.17)
Baseline control: 47.02 (24.45); 3 months: 7.73 (13.96); statistically significant reduction compared to baseline (p = 0.001); between-group comparison: p = 0.14
PD
Baseline test 1: 3.18 (0.69) mm; 3 months: 2.65 (0.45) mm
Baseline test 2: 3.44 (0.60) mm; 3 months: 2.76 (0.47) mm
Baseline control: 3.17 (0.78) mm; 3 months: 2.40 (0.67) mm; statistically significant reduction compared to baseline (p = 0.001); between-group comparison: p > 0.05
Complete disease resolution (i.e., absence of BOP)
3 months:
Test 1: 27 (87%)
Test 2: 18 (60%)
Control: 20 (71%); p = 0.29
Supragingival maintenance care was provided at 1 and 3 months
Mechanical debridement combined with OHI is effective in treating peri-implant mucositis
  1. RCT randomized clinical trial, OHI oral hygiene instructions, BOP bleeding on probing, mBOP modified bleeding on probing index, PD probing depth, SUPP suppuration, BI bleeding index, mBI modified bleeding index, aPDT antibacterial photodynamic therapy