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Table 3 Result summary of systematic reviews of adjunctive antiseptic treatments

From: The effectiveness of adjunctive measures in managing peri-implant mucositis: an umbrella review

Author, year
Title
Review characteristicsa Review findingb Conclusion
Antiseptic treatments
Barootchi et al., 2020
Nonsurgical treatment for peri-implant mucositis: A systematic review and meta-analysis
5 RCTs (250)
AMSTAR2: low
Meta-analysis Clinical parameter (unspecified)
No additional benefit from the adjunctive treatments (100%)
PD
MA shows no significant differences between the test and control groups in PD reduction
CAL
MA shows no significant differences between the test and control groups in CAL improvement
   Outcomes Studies Certainty (GRADE) Effect size  
      Type Value (CI) p-value§  
   PD 3 RCTs (NR) WMD − 0.07 [−  0.33, 0.20] P = 0.62  
   ATL 2 RCTs (NR)   − 0.13 [−  0.60, 0.35] P = 0.6  
   Clinical parameter (unspecified)
- 5/5 studies reported no significant difference between tests and controls
 
Liu et al., 2020
Does chlorhexidine improve outcomes in non-surgical management of peri-implant mucositis or peri-implantitis?: a systematic review and meta-analysis
4 RCTs (212)
AMSTAR2: low
Meta-analysis PD
No additional benefit from the adjunctive treatments (100%)
MA shows no significant differences between the test and control groups in PD reduction
BOP
No additional benefit from the adjunctive treatments (100%)
CAL
Inconclusive
(available studies less than three)
   Outcomes Studies Certainty (GRADE) Effect size  
      Type Value (CI) p-value§  
   PD 4 RCTs (NR) SMD 0.11 [− 0.16, 0.38] P = 0.42  
   PD
- 4/4 studies† reported no significant difference between tests and controls
BOP
- 4/4 studies reported no significant difference between tests and controls
CAL
- 1/1 study reported a significant difference favoured test
 
(linked systematic reviews)
Schwarz, Becker, & Sager, 2015
Efficacy of professionally administered plaque removal with or without adjunctive measures for the treatment of peri‐implant mucositis. A systematic review and meta‐analysis
Schwarz, Schmucker, & Becker, 2015
Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: A systematic review and meta-analysis
2 RCTs (64)
AMSTAR2: critically low, low
PD
- 1/2 study reported significant differences favoured test
- 1/2 studies reported no significant difference between tests and controls
BOP
- 2/2 studies reported no significant difference between tests and controls
GI
- 1/1 study reported no significant difference between tests and controls
mBI
- 1/1 study† reported no significant difference between tests and controls
Microbiological
- 1/1 study reported no significant difference between tests and controls
Inconclusive
(available studies less than three)
Zhao et al., 2020
Clinical efficacy of chlorhexidine as an adjunct to mechanical therapy of peri-implant disease: A systematic review and meta-analysis
5 RCTs (250)
AMSTAR2: low
Meta-analysis BOP
No additional benefit from the adjunctive treatments (80%)
MA shows no significant differences between the test and control groups in BOP reduction
PD
MA shows no significant differences between the test and control groups in PD reduction
CAL
MA shows no significant differences between the test and control groups in CAL improvement
   Outcomes Studies Certainty (GRADE) Effect size  
      Type Value (CI) p-value§  
   BOP (reduction in 1 month) 2 RCTs low MD 0.10 [− 0.6, 0.25] P = 0.21  
   BOP (reduction in 3–4 months) 3 RCTs moderate MD 0.06 [− 0.03, 0.15] P = 0.19  
   BOP (reduction in 6–8 months) 2 RCTs moderate MD 0.05 [− 0.04, 0.13] P = 0.30  
   PD (reduction in 1 month) 3 RCTs moderate MD − 0.16 [− 0.38, 0.06] P = 0.16  
   PD (reduction in 3–4 months) 4 RCTs moderate MD 0.02 [− 0.17, 0.20] P = 0.86  
   PD (reduction in 6–8 months) 2 RCTs moderate MD 0.10 [− 0.07, 0.27] P = 0.24  
   CAL (reduction in 1 month) 2 RCTs moderate MD − 0.24 [− 0.69, 0.20] P = 0.29  
   CAL (reduction in 3–4 months) 2 RCTs moderate MD − 0.20 [− 0.77, 0.38] P = 0.50  
   BOP
- 4/5 studies reported no significant difference between tests and controls
- 1/5 study reported significant improvement in the test groups
 
Probiotic treatment
Albaker, 2019
The Effect of Probiotic Administration in the Treatment of Peri-implant Diseases: A Systematic Review and Meta-analysis
5 RCTs (195)
AMSTAR2: critically low
Meta-analysis PD, BOP, PI
No additional benefit from the adjunctive treatments (100%)
MA shows no significant differences between the test and control groups in PD, BOP and PI reduction
   Outcomes Studies Certainty (GRADE) Effect size  
      Type Value (CI) p-value§  
   PPD 4 RCTs (NR) WMD − 0.11 [− 0.43, 0.21] 0.50  
   BOP 2 RCTs (NR) OR 1.03 [0.40, 2.62] 0.94  
   PI 2 RCTs (NR) OR 0.8 [0.29, 2.18] 0.66  
   PD,
- 3/3 studies‡ reported no significant difference between tests and controls
BOP
- 4/4 studies‡ reported no significant difference between tests and controls
PI
- 5/5 studies‡ reported no significant difference between tests and controls
 
Barootchi et al., 2020
Nonsurgical treatment for peri-implant mucositis: A systematic review and meta-analysis
2 RCTs (62)
AMSTAR2: low
PD
- 1/1 study† reported no significant difference between tests and controls
BOP
- 2/2 studies† reported no significant difference between tests and controls
PI
- 2/2 studies​​† reported no significant difference between tests and controls
Total bacteria load
- 1/1 study ​† reported no significant difference between tests and controls
Inconclusive
(available studies less than three)
Gao et al., 2020
Does Probiotic Lactobacillus Have an Adjunctive Effect in the Nonsurgical Treatment of Peri-Implant Diseases? A Systematic Review and Meta-analysis
6 RCTs (221)
AMSTAR2: critically low
Meta-analysis PD, BOP, PI
MA shows no significant differences between the test and control groups in PD, BOP and PI reduction
   Outcomes Studies Certainty (GRADE) Effect size  
      Type Value (CI) p-value§  
   PPD (immediately after treatment) 4 RCTs moderate MD − 0.05 [− 0.28, 0.18] 0.67  
   PPD (≥ 2 months after treatment) 5 RCTs low MD − 0.17 [− 1.01, 0.67] 0.69  
   BOP (immediately after treatment) 4 RCTs moderate OR 0.75 [0.36, 1.56] 0.44  
   BOP (≥ 1 months after treatment) 4 RCTs moderate SMD 0.77 [0.38, 1.56] 0.47  
   PI (immediately after treatment) 5 RCTs moderate SMD − 0.03 [− 0.38, 0.31] 0.85  
   PI (≥ 1 months after treatment) 4 RCTs moderate SMD − 0.37 [− 0.76, 0.02] 0.06  
Silva et al., 2020
Effect of Adjunctive Probiotic Therapy on the Treatment of Peri-implant Diseases–A Systematic Review
4 RCTs (201)
AMSTAR2: low
PD
- 4/4 studies† reported no significant difference between tests and controls
BOP
- 2/2 studies†‡ reported no significant difference between tests and controls
PI
- 4/4 studies‡ reported no significant difference between tests and controls
PD, BOP
No additional benefit from the adjunctive treatments (100%)
PI
No additional benefit from the adjunctive treatments (100%)
Air-polishing treatment
Barootchi et al., 2020
Nonsurgical treatment for peri-implant mucositis: A systematic review and meta-analysis
1 RCT (33)
AMSTAR2: low
Clinical parameter (unspecified)
- 1/1 study reported no additional clinical benefits of adjunctive glycine powder air polishing
PD, BI, PI
- 1/1 study reported no significant difference between tests and controls
Inconclusive
(available studies less than three)
(linked systemaic reviews)
Schwarz, Becker, & Renvert, 2015
Efficacy of air polishing for the non‐surgical treatment of peri‐implant diseases: A systematic review
Schwarz, Schmucker, & Becker, 2015
Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: A systematic review and meta-analysis
1 RCT (33)
21 CCT
(30 patients)
AMSTAR2: low
PD
- 1/2 study reported no significant difference between tests and controls
- 1/2 study reported significant differences favoured test
BI
- 1/2 study reported no significant difference between tests and controls
- 1/2 study reported significant differences favoured test
Inconclusive
(available studies less than three)
Schwarz, Becker, & Sager, 2015
Efficacy of professionally administered plaque removal with or without adjunctive measures for the treatment of peri‐implant mucositis. A systematic review and meta‐analysis
1 RCT (33)
AMSTAR2: critically low
Clinical parameter (unspecified)
- 1/1 study reported limited efficacy of the adjunctive glycine powder air polishing
PD, BI
- 1/1 study reported no significant difference between tests and controls
Inconclusive
(available studies less than three)
Laser and photodynamic treatment
Chala et al., 2020
Adjunctive Use of Lasers in Peri-Implant Mucositis and Peri-Implantitis Treatment: A Systematic Review
2 RCTs (288)
AMSTAR2: critically low
Clinical parameter (unspecified)
- 1/2 study reported no significant clinical benefits of adjunctive use of lasers compared to conventional treatments
- 1/2 study reported the benefit of adjunctive use of lasers in reducing bleeding on probing
PD
- 1/1 study† reported no significant difference between tests and controls
BOP
- 1/2 study† reported no significant difference between tests and controls
- 1/2 study reported a significant difference favoured test
PI
- 1/1 study† reported no significant difference between tests and controls
Inconclusive
(available studies less than three)
Sánchez-Martos, Samman, Priami, et al., 2020
The diode laser as coadjuvant therapy in the non-surgical conventional treatment of peri-implant mucositis: A systematic review and meta-analysis
2 RCTs (288)
AMSTAR2: critically low
PD
- 2/2 studies reported no significant difference between tests and controls
BOP
- 1/2 study no significant difference between tests and controls after 3 months
- 1/2 study reported significant differences favoured test after 3 months
PI
- 2/2 studies reported no significant difference between tests and controls
Meta-analysis
(There was an insufficient presentation of information about the meta-analysis.)
Inconclusive
(available studies less than three)
Saneja et al., 2020
Efficacy of different lasers of various wavelengths in treatment of peri-implantitis and peri-implant mucositis: A systematic review and meta-analysis
2 RCTs (288)
AMSTAR2: low
Outcomes Studies Certainty (GRADE) Effect size PD
MA shows no significant differences between the test and control groups in PD reduction
      Type Value (CI) p-value§  
   PD 2 RCTs (NR) MD − 0.10 [− 0.18, − 0.02] 0.02  
   PD
- 2/2 studies reported no significant difference between tests and controls
 
Antibiotic treatment
Barootchi et al., 2020
Nonsurgical treatment for peri-implant mucositis: A systematic review and meta-analysis
2 RCTs (69)
AMSTAR2: low
Clinical parameter (unspecified)
- 1/2 study reported slightly better results in the local antibiotic group with no statistical significance
- 1/2 studies reported no additional clinical and microbiological benefits of adjunctive systemic antibiotics
PD
- 1/1 study reported a greater reduction of PD in the antibiotic group.*
BOP
- 2/2 study reported greater BOP reduction in the test group.*
BI
- 1/1 study reported a greater reduction of BI in the antibiotic group.*
PI
- 1/1 study reported a greater reduction of PI in the antibiotic group.*
Microbiological
- 1/1 study reported no significant difference in the bacterial counts for all bacterial species between tests and controls
Inconclusive
(available studies less than three)
(linked systematic reviews)
Schwarz, Becker, & Sager, 2015
Efficacy of professionally administered plaque removal with or without adjunctive measures for the treatment of peri‐implant mucositis. A systematic review and meta‐analysis
Schwarz, Schmucker, & Becker, 2015
Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: A systematic review and meta-analysis
2 RCTs (69)
AMSTAR2: critically low, low
Clinical parameter (unspecified)
- 1/1 study reported no significant differences between antibiotic and control groups for all clinical and microbiological parameters
BOP
- 1/1 study reported BOP reduction in the antibiotic group, while BOP increased in the control group.*
Inconclusive
(available studies less than three)
  1. RCT—randomized controlled clinical trial; PD—probing depth, BOP—bleeding on probing, BI—bleeding index, mBI—modified bleeding index, PI—plaque index, CAL—clinical attachment level; MD—mean difference; NR—not reported
  2. aThese tables only report parts of the characteristic of included primary studies and quality assessment of the systematic reviews (AMSTAR2). The characteristic of the population, intervention/comparisons, outcomes and quality assessment of the included primary studies are summarized in Tables S3–S7
  3. bReview finding is a summary of the information reported in the systematic reviews. The general effectiveness (by studies) is reported on the top, followed by the effectiveness of each parameter. The comparison between test and control groups are in bold. An asterisk indicates the result with the test of statistical significance at the end
  4. cConclusion is provided when there are results from at least three studies available. The first conclusion is about the effectiveness of the treatment with adjunctive when comparing between baseline and last follow-up. The second conclusion is about the effect of adjunctive treatments when comparing between test and control groups. The third conclusion is the report of meta-analysis between test and control groups
  5. *The result without the test of statistical significance
  6. The additional information was from the original sources (the primary studies) since the systematic reviews’ information was unspecific
  7. The data provided in the systematic reviews were corrected by consulting with the original sources (the primary studies)
  8. §p-value of the test of the overall effect