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Table 2 Included studies reporting on non-surgical treatment of peri-implantitis

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
Schwarz et al. (2005) RCT, parallel 20 patients
Test: 10, mean age: 48 years
Control: 10, mean age: 51 years
Smokers excluded
32 implants rough and
medium-rough surfaces
PD ≥ 4 mm + BOP/SUPP + radiographic bone loss 6 months OHI + Er:YAG laser device (cone-shaped glass fiber tip) at 12.7 J/cm2 OHI + mechanical debridement
(plastic curettes), 0.2% CHX pocket irrigation and 0.2% CHX gel
Subject level
BOP
Test baseline: 83.2 (17.2)%, 6 months: 31.1 (10.1)%; p < 0.001
Control baseline: 81.3 (19.0)%, 6 months: 58.3
(16.9)%; p < 0.001
Between group comparison: p < 0.001
PD
Test baseline: 5.4 (1.2) mm, 6 months: to 4.6 (1.1) mm; p < 0.001
Control baseline: 5.5 (1.5) mm, 6 months: 4.8 (1.4) mm; p < 0.001
Between group comparison: p > 0.05
ML (recession)
Test baseline: 0.4 (0.6) mm, 6 months: 0.5 (0.6) mm
Control baseline: 0.7 (0.8)mm, 6 months: 0.8 (0.8) mm
Er:YAG treatment results in statistically significantly higher reduction of BOP
Schwarz et al. (2006) RCT, parallel 18 patients
Test: 10; mean age: 56 (14) years
Control: 8; mean age: 54 (11) years
Smokers excluded
36 implants rough and
medium-rough surfaces
PD ≥ 4 mm + BOP/SUPP + radiographic bone loss 12 months OHI + Er:YAG laser device (cone-shaped glass fiber tip) at 12.7 J/cm2 OHI + mechanical debridement
(plastic curettes), 0.2% CHX pocket irrigation and 0.2% CHX gel
Subject level
Moderately deep sites (PD 4–6 mm)
BOP
Test baseline: 81.7 (6.7)%, 12 months: 35.0 (6.3) %; p < 0.01
Control baseline: 81.6 (5.2)%, 12 months: 53.3 (7.3) %
Deep sites
Test baseline: 79.9 (4.8)%, 12 months: 55.0 (6.5)%
Control baseline: 88.3 (3.5)%, 12 months: 66.6 (5.5) %
Significantly higher reduction in test group (p < 0.01)
PD (PD > 7 mm)
Moderately deep sites
Test baseline: 4.5 (1.4) mm, 12 months: 4.0 (0.1) mm
Control baseline: 4.4 (0.2) mm, 12 months: 4.3 (0.1) mm
Deep sites
Test baseline: 5.9 (0.1) mm, 12 months: 5.4 (0.1) mm
Control baseline: 5.9 (0.3) mm. 12 months: 5.5 (0.2) mm
No significant differences
between groups
Er:YAG treatment results in significantly higher BOP reduction, however, its effectiveness seemed to be limited to a period of 6 months
Renvert et al. (2009) RCT,
parallel
31 patients
Test: 14; mean age: 60.3(12.9) years; 7 female; 7 male; 2 patients current smokers
Control: 17; mean age: 62.7(12.1) years; 7 female; 10 male; 3 current smokers;
31 implants machined
and medium-rough
surfaces
PD ≥ 4 mm + BOP/SUPP + bone loss < 2.5 mm 6 months OHI + ultrasonic device with hydroxyapatite fluid polish OHI + mechanical
debridement (titanium curettes)
Subject level
BI
Test baseline: 1.7 (0.6); 6 months: 1.2 (0.7)
Control baseline: 1.7 (0.9); 6 months: 1.4 (1.0)
No significant differences
between groups
PD
Test baseline: 4.3 (0.6) mm, 6 months: 3.9 (0.8) mm
Control baseline: 6.2 (1.6) mm; 6 months: 6.3 (2.2) mm
No significant differences
between groups
All patients received OHI at all study timepoints
No group differences were found in the treatment outcomes
Renvert et al. (2011) RCT,
parallel
42 patients
Tests: 21; mean age: 68.5 (6.4) years;
Control: 21; mean age: 68.9 (12.5) years
Smokers included
90 implants machined
and medium-rough
surfaces
PD ≥ 5 mm, BOP + and/or
SUPP + bone loss > 3 mm
6 months OHI + air abrasive device with
glycine powder
OHI + Er:YAG laser device (cone-shaped glass fiber tip, 12.7 J/cm2) Implant level
BOP 6 months
Test: 25% of implant showed no bleeding
Control: 30.9% of implant showed no bleeding
Between-group comparison: p = 0.22
PD change
Tests: 0.9 (0.8) mm
Control: 0.8 (0.5) mm
Between-group comparison: p = 0.55
RBL change:
Test: − 0.3 (0.9)mm
Control: − 0.1 (0.8)mm
No significant differences
between groups
Positive treatment outcome (i.e., PD reduction ≥ 0.5 mm + no further bone loss): Test: 47%
Positive treatment outcome: Control: 44%
Between-group comparison: p = 0.84
All patients received OHI at all study timepoints
The clinical treatment results were limited and similar between the two methods compared with those in cases with severe peri-implantitis
Sahm et al. 2011, John et al. (2011) RCT,
parallel
30 patients
Smokers excluded
Test: 15 patients, 22 implants
Control: 15 patients, 19 implants
8 implant systems
12 months
25 patients
Test: 12 patients
Control: 13 patients
PD ≥ 4 mm + BOP with
SUPP + bone loss ≤ 33%
12 months OHI + air abrasive device with
glycine powder
OHI + mechanical debridement (carbon curettes + 0.1% CHX) Subject level
BOP
Test baseline: 99.0 (4.1)%, 12 months: 57.8 (30.7) %
Control baseline: 94.7 (13.7)%, 12 months: 78.1 (30.0) %; Between-group comparison: p < 0.05
PD
Test baseline: 3.7 (1.0) mm, 12 months: 3.2 (1.1)mm
Control baseline: 3.9 (1.1) mm, 12 months: 3.5 (1.2) mm
Between-group comparison: p > 0.05
ML (recession)
Test baseline: 1.5 (1.4) mm, 12 months: 0.1 (0.9) mm
Control baseline: 1.0 (1.1) mm, 12 months: 0.1 (0.7) mm;
Between-group comparison: p > 0.05
Supragingival professional implant/tooth cleansing and reinforcement of oral hygiene was performed at each follow-up visit: 2,4,6,8,10,12 and 24 weeks after the treatment
Both treatment procedures results in comparable outcomes
Adjunctive diode laser/aPDT therapy
Arisan et al. (2015) CCT,
parallel
10 patients
Patients with ongoing or history of periodontitis excluded
48 two piece, rough-surface implants
BOP + pain ± SUPP + PD 4–6 mm + marginal bone loss < 3 mm 6 months Suprastructures removed + mechanical debridement with plastic curette + diode laser (810 nm) 1 min + irrigation with sterile saline solution Suprastructures removed + mechanical debridement with plastic curette + irrigation with sterile saline solution Implant level
BOP
Test baseline: 100%; 6 months: 95.8%
Control baseline: 100%, 6 months:100%
PD
Test baseline: 4.71 (0.67) mm, 6 months: 4.54 (0.74) mm
Control baseline: 4.38 (0.42) mm, 6 months: 4.17 (0.41) mm
RBL
Test baseline: 2.12 (0.47) mm, 6 months: 2.79 (0.48) mm
Control baseline: 2.35 (0.56), 6 months: 2.63 (0.53) mm
No statistically significant difference between the groups
Adjunctive use of diode laser did not yield any additional positive influence compared with conventional scaling
Wang et al. (2019) RCT,
parallel
131 patients
Patients with long history of smoking excluded
Test: 66; mean age: 42.6 (13.0) years; patients with history of smoking: 21
Control: 65; mean age: 42; mean age: 44.1(9.8) years; patients with history of smoking: 13
PD ≥ 6 mm + BOP + radiographic bone loss 6 months OHI/full mouth cleansing 2 weeks prior to the therapy + subgingival air abrasive device with glycine powder + irrigation with sterile saline + aPDT (toluidine blue photosensitized application for 3 min.) + 19 s. light emitting didoe lidht (LED) OHI/full mouth cleansing 2 weeks prior to the therapy + subgingival air abrasive device with glycine powder + irrigation with sterile saline Subject level
SBI
Test baseline: patients with no bleeding 0%, 6 months: 93.8% Grade 1
Control baseline: patients with no bleeding 0%, 6 months: 81.8% Grade 3; Significantly higher reduction in the test group (p < 0.001)
PD
Test baseline: 4.93 (1.07); 6 months: 3.06 (0.29), p < 0.001
Control baseline: 5.07 (0.72), 6 months: 4.62 (0.45), p < 0.001. Significantly higher reduction in the test group (p < 0.001)
Adjunctive aPDT significantly improved PD and SBI values
Adjunctive local antiseptic/antibiotic therapy
Renvert et al. (2006) RCT, parallel 32 patients
Test: 16; mean age: 65.5 (8.6) years; female: 7; male: 9; present smokers: 5; former smokers: 6
Control: 14; mean age: 61.1 (8.6) years; 11 female; 3 male; present smokers: 3; former smokers: 7
1–5 (test)/1–6 (control)
implants per patient
machined surfaces
PD ≥ 4 mm + BOP
 + SUPP + bone loss ≤ 3
threads
12 months OHI + mechanical debridement (scalers + rubber cup + polishing)
 + 1 mg minocycline microspheres
OHI + mechanical debridement (scalers + rubber cup + polishing)
 + 1.0% CHX gel
Subject level
BOP
Test baseline: 88 (12)%, 12 months: 71 (22) %
Control baseline: 86 (14)%, 12 months: 78 (13) %
No significant difference between the groups
PD
Test baseline: 3.9 (0.7) mm, 12 months: 3.6 (0.6) mm
Control baseline: 3.9 (0.3) mm, 12 months: 3.9 (0.4) mm
Significantly higher reduction in the test group (p < 0.001)
Use of local antibiotics as an adjunct to mechanical treatment og incipient peri-implantitis lesions demonstrated improvements in PD values that were sustained over 12 months
Renvert et al. (2008) RCT, parallel 32 patients
Test: 17; mean age: 60.82 (12.72) years; female: 13, male: 4; present smokers: 2; former smokers: 8
Control: 15; mean age: 62.40 (7.72) years; 9 female, 6 male; present smokers: 5; former smokers: 3
95 implants machined
surfaces
PD ≥ 4 mm + BOP
 + SUPP + bone loss ≤ 3
threads
12 months OHI + mechanical debridement + 
1 mg minocycline microspheres
Treatment was repeated at
days 30 and 90
OHI + mechanical debridement + 
0.5 ml of 1.0% CHXgel
Treatment was repeated at
days 30 and 90
Implant level
BOP
Test baseline: 86.5 (20.1)%, 12 months: 48.1 (20.7) %; p < 0.001
Control baseline: 89.2 (17.2)%, 12 months: 63.5 (19.2) %; p < 0.001
Significantly higher reduction in test group
PD
Test baseline: 3.85 (1.04) mm, 12 months: 3.55 (0.98) mm; p < 0.001
Control baseline: 3.87 (1.16) mm, 12 months: to 3.72 (1.02) mm; p < 0.001
No significant difference between the groups
RBL
Test baseline: 0.77 (0.85)
Mm, 12 months: 0.7 (0.85)mm
Control baseline: 0.41 (0.7) mm, 12 months: 0.46 (0.76) mm
No significant difference between groups
The use of repeated local antibiotics as an adjunct to mechanical treatment of peri-implantitis lesions demonstrated significant improvements in BOP values
Schär et al. 2012, Bassetti et al. (2013) RCT,
parallel
40 patients
Test: 20; 10 female; mean age: 59 (range: 27–78); 18 patients with history of periodontitis
Control: 20; 10 female; mean age: 57 (range: 29–75)
Smokers excluded
40 implants medium rough
surfaces
PD 4–6 mm + 
BOP + bone loss
 = 0.5–2 mm
12 months OHI + mechanical debridement
(titanium curettes + glycine powder
air polishing, pocket irrigation using
3% H2O2) + aPDT
(660 nm, phenothiazine chloride dye)
OHI + mechanical debridement
(titanium curettes + glycine powder
air polishing, pocket irrigation using
3% H2O2)
 + minocycline microsphere
Subject level
BOP change
Test: 57%
Control: 65%
PD change
Test: 0.56 mm
Control: 0.11 mm
Complete resolution of mucosal
inflammation
Test: 31.6%
Control: 35%
No significant differences
between groups
Oral hygiene reinforcement at 1,2,3,8 weeks. In the presence of BOP at implant sites after 3 and 6 months, additional treatment procedures equivalent to initial therapy was provided
Mechanical debridement with aPDT was equally effective in reducing mucosal inflammation as with adjunctive delivery of local antibiotics
Machtei et al. (2012) Multicentre
RCT, parallel
60 patients
77 implants
Test: 30 patients; 40 implants; mean age: 57.42 (10.5) years; 20 female; current smokers: 5, former smokers: 7
Control: 30 patients; 37 implants; mean age: 60.95(7.9) years; 15 female; current smokers: 5, former smokers: 6
PD 6–10 mm
 + BOP + 
radiographic
bone loss
6 months OHI + ultrasonic debridement
 + matrix containing 2.5-mg
CHX chips (i.e., up to 4 per
implant site)
Repeated application at sites with PD ≥ 6 mm at 2, 4, 6, 8, 12 and 18 weeks
OHI + ultrasonic
debridement + 
biodegradable
crosslinked gelatin
matrix chip
Repeated application at
sites with PD ≥ 6 mm at
2, 4, 6, 8, 12 and 18 weeks
Subject level
BOP
Test baseline: 100 (0.0)%, 6 months:
42.5 (50.0) %
Control baseline: 100 (0.0)%, 6 months:
54.5 (50.5) %
PD
Test baseline: 7.6 (1.1), 6 months: 5.47 (1.86)mm
Control baseline: 7.21 (1.08) mm, 6 months: 5.48 (1.25) mm
BOP and PD reductions not significantly different between groups
At 12 weeks, supragingival debridement was performed
Treatment in both groups results in a substantial improvement
Machtei et al. (2020) Multicentre
RCT, parallel
290 patients
Test: 146; mean age: 62.5 (11.2) years; female: 91; current smokers: 15; former smokers: 51
Control: 144; mean age: 62.6 (11.6) years; female: 81; current smokers: 14; former smokers: 55
386 implants
Test: 197
Control: 189
10 centers
PD 5–8 mm + BOP/SUPP + radiographic bone loss at least 3 mm from implant shoulder 6 months OHI + subgingival debridement at baseline and 3 months + matrix containing 2.5-mg
CHX chips (i.e., up to 2 per
implant site)
Repeated supragingival plaque removal and CHX chips application for 12 weeks every 2nd week
OHI + subgingival debridement at baseline and 3 months
Repeated supragingival plaque removal for 12 weeks every 2nd week
Subject level
BOP
Test baseline: 100%, 6 months: 50.31%
Control baseline: 100%, 6 months: 55.21%
PD
Test baseline: 6.16 (1.0) mm, 6 months: 4.40 (1.25) mm
Control baseline: 6.06 (0.92), 6 months: 4.52 (1.27) mm. Significantly higher reduction in test group (p = 0.01)
ML (recession)
Test baseline: 0.51 (0.99) mm, 6 months: 0.80 (1.21)mm
Control baseline: 0.26 (0.72), 6 months: 0.42 (0.85) mm. Significantly higher change in test group (p = 0.0017)
Test group showed significantly greater improvements in PD values
Merli et al. (2020) RCT, parallel 58 patients
Patients with intreated periodontitis excluded
58 implants
Test 1 (adjunctive desiccant material): 15; mean age: 60.3(10.7) years; female: 12; smokers: 4
Test 2 (adjunctive air-flow): 13; mean age: 66.4(9.4) years; 9 female; 2 smokers
Test 3 (air-flow + desiccant material): 14; mean age: 60.3(8.5) years; 10 female; 4 smokers
Control: 16; mean age: 64.5(8.3) years; smokers: 3; female: 9
PD 5–8 mm + BOP/SUPP + bone loss beyond initial bone remodeling + infraosseous defect component (radiographic) ≤ 5 mm + radiographic suprabobe component of defect ≤ 4 mm 6 months OHI + supragingival/supramucosal debridement prior to treatment
Removal of prosthetic reconstruction + 
mechanical debridement with ultrasonic scaler
 + 
Test 1: application of desiccant material (gel of concentrated mixture of hydroxybenzenesulphonic and hydromethyloxybenzene acids and sulphuric acid (HybenX)) in peri-implant pocket for 30 s. followed by saline rinsing
Test 2: + air polishing with glycine powder
Test 3: Test 2 + Test 1
 + 0.12% CHX mouthrinse twice a day, 15 days
OHI + supragingival/supramucosal debridement prior to treatment
Removal of prosthetic reconstruction + 
mechanical debridement with ultrasonic scaler
Subject level
BOP (number of sites per implant with bleeding)
Test 1 baseline: 2.9 (1.3); 6 months: 2.5 (1.7)
Test 2 baseline: 3.6 (0.8); 6 months: 2.8 (1.3)
Test 3 baseline: 3.6 (0.8); 6 months: 2.7 (1.3)
Control baseline: 3.3 (0.8); 6 months: 2.9 (0.8)
No significant difference between groups
PD
Test 1 baseline: 5.0 (1.2) mm; 6 months: 4.5 (1.2) mm
Test 2 baseline: 5.1 (1.5) mm; 6 months: 4.8 (1.3) mm
Test 3 baseline: 4.9 (1.1) mm; 6 months: 4.0 (1.2) mm
Control baseline: 4.4 (1.1) mm; 6 months: 4.2 (1.3) mm
Reduction was higher in patients treated with desiccant material
ML (recession)
Test 1 baseline: 0.4 (0.5) mm; 6 months: 0.3 (0.5) mm
Test 2 baseline: 0.2 (0.9) mm; 6 months: 0.3 (0.7) mm
Test 3 baseline: 0.1 (0.2) mm; 6 months: 0.2 (0.4) mm
Control baseline: 0.1 (0.1) mm; 6 months: 0.1 (0.2) mm
No significant difference between groups
Radiographic mean bone defect
Test 1 baseline: 3.9 (1.2) mm; 6 months: 4.0 (1.8) mm
Test 2 baseline: 3.6 (1.7) mm; 6 months: 4.0 (1.8) mm
Test 3 baseline: 3.6 (1.7) mm; 6 months: 3.5 (1.0) mm
Control baseline: 3.3 (1.2) mm; 6 months: 3.1 (1.5) mm
No significant difference between groups
Treatment success (no PD ≥ 5 mm with BOP/SUPP + no further bone loss): Test 1: 3 (25%)
Test 2: 2 (14%)
Test 3: 6 (43%)
Control: 6 (37%)
No significant difference between groups
Patients were seen at 1 wee, 1 month, 3 and 6 months for maintenance with supragingival prophylaxis
Pocket reduction was more pronounced in groups treated with adjunctive desiccant material
Adjunctive systemic antibiotics
Gomi et al. (2015) RCT,
parallel
20 patients; 11 female; mean age: 67.6 (5.3) years (range: 55–78)
All patients periodontally compromised
Smokers excluded
PD > 5 mm + BOP + bone loss > 2 mm 12 months Azithromycin® 500 mg 3 days before treatment + mechanical full-mouth scaling
(implants with plastic curettes and plastic ultrasonic scaler)
Mechanical full-mouth scaling
(implants with plastic curettes and plastic ultrasonic scaler)
Subject level
BOP
Test baseline: 27.9 (4.3)%, 6 months: 4.4
(0.3)%
Control baseline: 25.7 (4.3)%, 6 months: 19.8
(5.7) %;
Between-group comparison: p < 0.001
PD
Test baseline: 4.28 (0.85) mm, 6 months: 4.35 (0.22) mm
Control baseline: 5.7 (0.8) mm; 6 months: 4.22 (0.29) mm;
Between-group comparison: p = 0.002
All clinical parameters showed better
improvements in test group
Shibli et al. (2019) CCT, parallel 40 patients; 29 female; mean age: 58.5 (11.1) years
Current smokers excluded
PD > 5 mm + bone loss > 4 mm + BOP 12 months Mechanical debridement with teflon curettes + metronidazole 400 mg and amoxicillin 500 mg three times a day, 14 days Mechanical debridement with teflon curettes Subject level
BOP
Test baseline: 90.0 (31.6)%, 12 months: 39.0 (48.8%), p < 0.05
Control baseline: 97.0 (34.5)%, 12 months: 50.0 (53.5%); p < 0.05;
Between-group comparison: p > 0.05
PD
Test baseline: 9.9 (2.6)mm, 12 month: 5.1 (1.8), p < 0.05
Control baseline: 7.6 (1.8) mm, 12 months: 3.8 (1.6), p < 0.05; Between-group comparison: p > 0.05
Periodontal supragingival maintenance therapy every 3 months
Addition of systemic antibiotics to the mechanical treatment of severe peri-implantitis did not improve clinical outcomes
Adjunctive probiotics
Tada et al. (2017) RCT,
parallel
30 patients
Test: 15; mean age: 68.80 (7.46) years; 3 smokers
Control: 15; mean age: 65.87 (8.84) years; 1 smokers
PD > 4 mm and < 7 mm + BOP/SUPP + bone loss > 2 mm 6 months OHI + supragingival scaling + Azithromycin® 500 mg once a day for 3 days + after 1 week probiotic tablets (L. reuteri two strains; ProDentis) once a day for 6 months OHI + supragingival scaling + Azithromycin® 500 mg once a day for 3 days Subject level
mBI
Test baseline: 3.20 (1.26), 6 months: 1.53 (1.41), p = 0.235
Control baseline: 3.67 (1.59), 6 months: 2.33 (1.95), p = 0.375
PD
Test baseline: 3.90 (0.60), 6 months: 3.21 (0.84), p = 0.033
Control baseline: 4.04 (1.14) mm, 6 months: 3.47 (0.95) mm, p = 1
PDs were significantly reduced only in test group
Laleman et al. (2019) RCT, parallel 19 patients
Smokers and patients with uncontrolled periodontitis excluded
Test: 9; 4 female; mean age: 64 (11)
Control: 10; 6 female; mean age: 69 89)
PD ≥ 4 mm + BOP + bone loss at least 1 mm compared to the baseline 6 months OHI + mechanical debridement (titanium curettes + scaler) + Air polishing + topical application of probiotic drops containing L. reuteri two stains + probiotic tablets (BioGaia) for 6 months OHI + mechanical debridement (titanium curettes + scaler) + Air polishing + topical application of placebo drops + placebo tablets for 6 months Subject level
BOP (number of bleeding sites pro implants 0 to 6)
Test baseline: 87 (23)%, 6 months: 59 (32), p < 0.01
Control baseline: 87 (22), 6 months: 53 (39), p < 0.01
Between-group comparison: p = 0.876
PD
Test baseline: 5.17 (0.92), 6 months: 4.15 (0.96), p < 0.01
Control baseline: 5.45 (1.20), 6 moths: 4.18 (1.26), p < 0.01
Between-group comparison: p = 0.801
No adjunctive effects of the use of L. reuteri probiotics were found
  1. RCT randomized clinical trial, CHX chlorhexidine digluconate, OHI oral hygiene instructions, BOP bleeding on probing, PD probing depth, SUPP suppuration, BI bleeding index, mBI modified bleeding index, RBL radiographic bone level, RDF radiographic bone defect fill, ML soft-tissue level, H2O2 hydrogene peroxide, aPDT antibacterial photodynamic therapy