Efficacy of mechanical/physical approaches for implant surface decontamination in nonsurgical submarginal instrumentation of peri-implantitis. A systematic review.

AIM: To evaluate the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination, compared to non-surgical submarginal instrumentation alone/with placebo decontamination, in patients with peri-implantitis.

MATERIALS AND METHODS: Three focused questions were addressed and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials and prospective cohort studies with definitions of peri-implantitis and a minimal follow-up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri-implant bone level changes, patient related outcomes and adverse events, implant survival, treatment success and disease resolution were assessed as secondary outcomes.

RESULTS: Out of 2398 findings, full-text articles were assessed for eligibility and nine (n=9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types and in four studies efficacy of air-abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in 9 studies but only Er,Cr:YSGG laser showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in 2 studies following application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air-polishing device as compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Due to the large heterogeneity of study designs, no meta-analysis was performed.

CONCLUSION: Available evidence on efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination is limited by a low number of controlled studies and a high heterogeneity of study protocols. Clinical and patient-reported benefits remain to be demonstrated.