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

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 2^nd 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