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J Am Dent Assoc, Vol 140, No 3, 340-341. © 2009 American Dental Association

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	Clinical question.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
What are the most effective treatments for peri-implantitis, the progressive marginal bone loss around dental implants induced by bacterial plaque infection?

	Review methods.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
For this systematic review, the authors selected for inclusion randomized controlled trials (RCTs) involving patients with at least one stable implant demonstrating marginal bone loss who were treated for peri-implantitis. The authors included studies in which surgical and nonsurgical procedures aimed at treating peri-implantitis were evaluated. Outcome measures included change in probing pocket depth (PPD) and probing attachment level (PAL), as well as implant failure.

The authors conducted an all-language search of several electronic databases (from as early as 1966 through January 2008) and relevant dental journals. They contacted selected authors and dental implant manufacturers to locate unpublished or ongoing RCTs. Two of the authors served as reviewers and independently duplicated the selection of studies for inclusion, evaluation of study quality, and data extraction.

	Main results.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
The authors identified seven studies (146 patients total) that met their inclusion criteria. In these studies, investigators evaluated the following treatments:

– use of topical antibiotic (metro-nidazole gel) versus ultrasonic débridement;

– manual débridement with and without use of topical antibiotic (10 percent doxycycline hyclate gel);

– different techniques of subgingival débridement;

– laser versus manual débridement with chlorhexidine (applied either via irrigation or in gel form);

– apical flap–repositioning surgery with and without implant polishing;

– augmentation with either nanocrystalline hydroxyapatite or bovine-derived xenograft and resorbable membrane.

	FOOTNOTES

The systematic review described here was funded by the School of Dentistry, The University of Manchester, England.

A critical summary of Esposito M, Grusovin MG, Kakisis I, Coulthard P, Worthington HV. Interventions for replacing missing teeth: treatment of perimplantitis. Cochrane Database Syst Rev 2008;(2):CD004970. doi: 10.1002/14651858.CD004970

Editor’s note: This new feature provides concise analyses and appraisals of evidence-based systematic reviews from other publications. These appraisals, prepared by experts working with the American Dental Association Center for Evidence-based Dentistry, are offered as a resource for dentists to use in clinical decision making. Additional critical summaries are available online at "http://ebd.ada.org".

Systematic review conclusion. Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis.

Critical summary assessment. There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis.

Evidence quality rating. Limited.

	Importance and context.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
Dental implants have found increasing acceptance as a treatment option for replacing missing teeth. Maintaining osseointegration is as important as achieving it, and, as with natural teeth, dental implants may be compromised by periodontal infection across time. This review focused exclusively on the treatment of peri-implantitis induced by plaque infection. Although various treatments and combinations of treatments have been recommended, solid evidence is lacking to determine which treatments are most effective for long-term implant maintenance.

	Strengths and weaknesses of the systematic review.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
In a comprehensive search, including gray literature (unpublished or difficult-to-access studies) and ongoing RCTs, the authors found 10 RCTs, of which they judged only seven suitable for inclusion in the review. They detailed specific weaknesses of each study and suggested improvements in study design.

	Strengths and weaknesses of the evidence.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
The authors describe weaknesses that limit the reliability of each study’s results and the inability to extrapolate that information to other populations. The small trial sizes make it difficult to detect differences in treatment effectiveness, and because the studies were of limited duration, they do not provide evidence of long-term treatment benefit. Six of the seven studies were judged to be at high risk of bias, and at least five of the studies were supported by manufacturers. In the seven studies the authors included, researchers evaluated six different therapies and combinations of therapy, and no study compared the tested treatment with a placebo or a no-treatment control. The results do not allow us to confirm the effectiveness of different treatments for peri-implantitis or discriminate between those that may be effective.

	Implications for dental practice.

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

 
Dental practitioners need reliable evidence on which to base treatment recommendations. A critical assessment of all available research provides insufficient evidence at this time regarding the long-term clinical benefit of different treatments for peri-implantitis on which to base treatment decisions. In the majority of studies, simple sub-gingival débridement appeared to provide results similar to those of the more complex and expensive treatments. Local antibiotics and bone augmentation may prove more effective in the treatment of peri-implantitis, but properly designed and conducted RCTs are needed to establish that.

	FOOTNOTES

TOP Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strengths and weaknesses of... Implications for dental...

Critical Summaries is supported by grant 1 G08 LM008956-01A2 from the National Library of Medicine and the National Institute of Dental and Craniofacial Research.

For more information on the evidence quality rating provided above, please visit "http://ebd.ada.org".

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				R. Niederman Evidence-based dentistry finds a new forum: Exelauno. J Am Dent Assoc, March 1, 2009; 140(3): 272 - 274. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McMullan-Vogel, C. G. Search for Related Content PubMed Articles by McMullan-Vogel, C. G. Related Collections Periodontics