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