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HERRERA ET AL .
Risk of bias According to NOS: seven studies were at low risk of bias and six studies were at high risk of bias. According to RoB-II-RCT. one study was at some concern. Effect sizes and their clinical relevance Twelve studies compared patients regularly attending the recom- mended SPIC programme (adherent) versus non-attending patients or those attending SPIC visits irregularly. Pooled data analyses revealed that patients attending SPIC regularly were at significantly lower risk of presenting with peri-implant diseases (including both peri-implant mucositis and peri-implantitis) (OR = 0.42; 95% CI [0.24; 0.75]; p = .003; I 2 : 57%; analysis based on six studies including 736 patients) during the study follow-up period (ranging from 1 to 20 years). This was also observed for the specific diagnosis of peri-implantitis, both at the patient (OR = 0.45; 95% CI [0.30; 0.68]; p = .0002; I 2 : 51%; analysis based on six studies including 736 patients) and implant level (OR = 0.26; 95% CI [0.15; 0.46]; p < .0001; I 2 : 21%; analysis based on six studies including 1337 implants). No significant differences were observed between regular and irregular adherence to SPIC for the diagnosis of peri-implant mucositis. In a sensitivity analysis excluding those studies that involved patients with a history of periodontitis, dental implants undergoing regular SPIC showed an OR = 0.23 (95% CI [0.08; 0.64]; p = .005; I 2 : 0%) of developing peri-implantitis compared to dental implants with no SPIC (based on two studies). When dental implants were used as the statistical unit of analy- sis, those subjected to regular SPIC demonstrated a lower PD (MD: 0.48 mm; 95% CI [ 0.67; 0.29]; p < .0001; I 2 : 32%; analysis based on five studies including 867 implants) and a reduced risk of exhibiting a MBL > 2 mm (OR: 0.4; 95% CI [0.25; 0.66]; p = .0003; I 2 : 73%; analysis based on three studies including 689 implants). Irregular SPIC was associated with a 3.76 increased risk of implant failure (95% CI [1.50; 9.45]; p = .005; I 2 : 0%) compared with regular SPIC. All studies reporting dental implant survival evaluated study sam- ples that included a proportion of patients with a history of periodon- titis. Overall, the estimated mean implant survival was 99.3% (95% CI [98.6%; 100%]) in the regular SPIC group (based on 564 implants) and 97.8% (95% CI [95.6%; 99.9%]) in the irregular SPIC group (based on 454 implants) (follow-up ranging from 4.5 to 20 years after implant loading). The RCT that was evaluated compared four different SPIC protocols (including a 3-monthly SPIC with curettes, with sonic scalers or air-polishing, and with or without chlorhexidine varnish application) and found no significant differences between the groups in terms of PD, BOP, and survival at 1 year (Ziebolz et al., 2017). When comparing patients with a history of generalized moderate-to-severe periodontitis presenting with deep residual pockets (>6 mm) during SPC, with patients who had a history of gen- eralized moderate-to-severe periodontitis but without residual deep pockets, a significantly higher occurrence of peri-implantitis (3.5%
occurrence of peri-implant diseases. Further research is needed to provide confidence in the estimated effect of glycaemic control on the risk of peri-implant diseases.
From evidence to recommendation — additional considerations
Not applicable.
R5.6. In patients with healthy peri-implant tissues, does provision of regular supportive peri-implant care (SPIC) reduce the risk of incident peri-implant diseases?
PICOS question addressed by a systematic review
R5.6: Evidence-based recommendation We recommend regular supportive peri-implant care in patients who have healthy peri-implant tissues, to reduce the risk of incident peri- implant diseases, emphasizing to the patient the importance of their adherence to SPIC visits and home care . Supporting literature (Carra et al., 2023) Quality of evidence Moderate Grade of recommendation GradeA — "" Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Intervention
The risk factor/exposure is a lack of appropriate patient follow-up, including periodontal and peri-implant care, and the preventive interven- tion is promoting and attaining adequate/regular patient adherence to the supportive periodontal/peri-implant care (SPC/SPIC). Various inter- ventions were employed (tab. 3 in Carra et al., 2023). The term ‘ SPIC ’ covers the following terms used by the authors of individual studies: (1) supportive care (one study); (2) SPIC (two studies); (3) supportive peri- implant therapy (four studies); (4) supportive periodontal therapy (two studies); (5) supportive periodontal and peri-implant therapy (three stud- ies); and (6) supportive therapy (two studies). For regular supportive care, the interval between the intervention sessions was: (1) tailored (three studies); (2) 3 months (one study); (3) 4 months (one study); (4) 3 – 6 months (one study); (5) ≤ 6 months (one study); (6) ≤ 12 months (three studies); and (7) unknown (four studies).
Available evidence
Number and design of included studies Fourteen studies, 13 observational studies and 1 randomized clinical trial (RCT) (Carra et al., 2023).
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