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HERRERA ET AL .
Available evidence
R5.4. How should the peri-implant health status be assessed at each clinical examination?
Number and design of included studies Eleven observational studies including six case – control studies and five cohort studies (Carra et al., 2023). Risk of bias According to the Newcastle – Ottawa scale (NOS), eight studies were at low risk of bias and three studies were at high risk of bias. Effect sizes and their clinical relevance Pooled data analyses revealed a significantly lower rate of peri- implantitis (OR = 0.16; 95% CI [0.03; 0.96]; p = .004; I 2 : 0%; analysis based on two studies including 385 implants), and significantly lower marginal bone level changes over time ( 0.36 mm; 95% CI [ 0.65; 0.07]; p < .0001; I 2 : 95%; analysis based on six studies including 591 implants) in patients with good glycaemic control compared with poor glycaemic control. The mean difference (MD) in PD and BOP was not significantly different between the groups. With respect to dental implant survival, diabetes patients with poor glycaemic control were found to have a 7.59 increased risk of dental implant failure compared with patients with good glycaemic control (OR = 7.59; 95% CI [1.63; 35.3]; p = .01; I 2 : 0%; based on two studies including 524 implants). The estimated mean implant survival was 99% (95% CI [97.8%; 100%]; based on five studies including 253 dental implants) in patients with good glycaemic control and 95.6% (95% CI [91.4%; 99.8%]; based on five studies including 271 dental implants) in patients with poor glycaemic control. The effect size of these findings is considered clinically relevant, but it must be highlighted that the results are based on a limited number of studies with small sample sizes, that the analyses were performed at the implant level only, and that the definition of good and poor glycaemic control was not consistent among the studies (i.e., good glycaemic con- trol was defined as HbA1c between 6.1% and 8% in five studies, <7% in one study, and <6% in another study; poor glycaemic control was defined as HbA1c level ranging between 8.1% and 10% in 5 studies, as HbA1c > 8% in one study, and as HbA1c ranging between 7% and 9% in another study; three studies also included a group of very poorly con- trolled type-2 diabetes patients, as HbA1c > 9 or >10%). Consistency Consistency was found in the overall results, favouring good glycaemic control over poor glycaemic control. However, the definition of good and poor glycaemic control was not consistent among the available studies. Balance of benefit and harm Not assessed. However, glycaemic control in patients with diabetes is advised independently of implant therapy. Overall certainty of the evidence No study provided direct evidence. The results are inferred from stud- ies with various working hypotheses that were not originally devel- oped to test the effectiveness of a preventive measure on the
Additional question addressed by the WG
R5.4: Expert consensus-based recommendations
We recommend peri-implant probing to assess the presence of BOP, and to monitor changes in PD, and changes in the mucosal margin level . The following are advised : 1. baseline probing within 3 months of prosthesis delivery ; 2. re-probe at every clinical examination ; 3. use a probe with a 0.5 - mm diameter tip and a light probing force (0.2 N) 4. record peri-implant probing depths circumferentially (ideally at 6 sites) and BOP ; 5. assess and record the width of keratinized attached peri-implant mucosa . In addition, we recommend a baseline intra-oral radiograph be obtained at the completion of physiological remodelling to document marginal bone levels. At subsequent visits, if there is an increase in PD in conjunction with BOP/suppuration, we recommend an intra-oral radiograph to evaluate the marginal bone levels . Supporting literature (Berglundh et al., 2018; Jepsen et al., 2015; Lindhe et al., 2008; Renvert et al., 2018; Sanz et al., 2022) Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
This question was not addressed by the SR and therefore represents an expert consensus-based recommendation, derived from indirect evidence using the cited supporting literature.
R5.5. In patients with diabetes and healthy peri- implant tissues, does glycaemic control reduce the risk of incident peri-implant diseases?
PICOS question addressed by a systematic review
R5.5: Evidence-based recommendation In patients with diabetes who have healthy peri-implant tissues, we recommend glycaemic control to maintain peri-implant health . Supporting literature (Carra et al., 2023) Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Intervention
The exposure/risk factor of interest for peri-implantitis is diabetes, and the preventive intervention is glycaemic control (as measured by % of HbA1c).
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