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HERRERA ET AL .
From evidence to recommendation — additional considerations
group compared with 0% in the test group receiving CTG (partial split- mouth design) (Hosseini et al., 2020). Meta-analysis was performed pooling together two studies comparing CTG versus no intervention (Frisch et al., 2015; Hosseini et al., 2020), and including 37 implants in CTG-augmented sites versus 69 implants in non-augmented sites. It showed no significant difference between the two groups for the rate of incident peri-implantitis (OR = 1.97; 95% CI [0.20; 19.72]; p = .56; I 2 : 0%). Consistency Data are consistent, although based on a very limited number of studies. Balance of benefit and harm Not assessed. However, the decision-making process should bal- ance the risks associated with the different surgical procedures aimed at increasing PIKM thickness against the risks of surgery and the additional related costs, in people with peri-implant mucosal health. Overall certainty of the evidence No study design provided direct evidence. Care must be taken regard- ing the interpretation of the results, due to the high clinical heteroge- neity of the included studies, in particular the high variability of the timeline at which the augmentation procedure was performed (before or after dental implant placement, after dental implant loading, simul- taneously to the dental implant placement, at the stage 2 surgery, etc.). Most of the studies described clinical peri-implant outcomes in the short term (6 – 12 months follow-up).
Not applicable.
R5.9. In patients with healthy and thin peri-implant tissues (<2 mm in thickness), does soft tissue augmentation lower the likelihood of incident peri- implant diseases?
PICOS question addressed by an SR
R5.8: Evidence-based statement We do not know if undertaking procedures to augment soft tissue thickness prevents the development of peri-implant diseases, since there is lack of evidence to support an association between increasing soft tissue thickness and peri-implant tissue health . Supporting literature (Carra et al., 2023; Tavelli et al., 2021; Valles et al., 2022) Quality of evidence — Low Grade of recommendation GradeB — # Strength of consensus Consensus (7.8% of the group abstained due to potential CoI)
Background
Intervention
Peri-implant soft tissue augmentation to increase PIKM thickness includes the following surgical procedures: (1) connective tissue graft (CTF), (2) FGG, (3) the use of xenogenic collagen matrix (XCM) and (4) or acellular dermal matrix allograft.
From evidence to recommendation — additional considerations
Not applicable.
Available evidence
R5.9. In patients with healthy peri-implant tissues, does improved oral hygiene prevent incident peri- implant diseases?
Number and design of included studies Eight studies, including one NRCT and six RCTs (Carra et al., 2023).
Risk of bias According to NOS, one study is at high risk of bias; according to RoB- II-RCT, two studies were at low risk of bias and four studies presented some concern. According to RoBins-NRTC, one study is at moderate risk of bias. Effect sizes and their clinical relevance Pooled data analyses were based on four studies, including 179 implants, and found no difference between CTG/FGG versus XCM for mean PPD, MBL and BOP. One CCT with a small sample size (19 patients) observed a 4.3% rate of peri-implantitis in the control
PICOS question addressed by an SR
R5.9: Expert consensus-based recommendation In patients who have dental implants, we recommend specific, individually tailored OH instructions to reduce the risk of incident peri- implant diseases Supporting literature (Carra et al., 2023) Quality of evidence Very low Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
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