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HERRERA ET AL .
Background
R5.10. In patients with healthy peri-implant tissues, does reducing bruxing/parafunctional habits reduce the risk of incident peri-implant diseases?
Intervention
The risk factor is inadequate OH, and the preventive intervention is improving OH behaviours. The following toothbrushes were evalu- ated: (1) counter-rotational powered toothbrush, (2) sonic tooth- brush and (3) manual toothbrush. The following frequencies were evaluated: brushing at least twice/day or brushing at most once/day.
PICOS question addressed by an SR
R5.10: Expert consensus-based statement We do not know whether in patients with healthy peri-implant tissues, controlling bruxing/parafunctional habits reduces the risk of incident peri-implant diseases . Supporting literature (Carra et al., 2023) Quality of evidence Not applicable Grade of recommendation GradeO — $ Statement, additional research needed Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Available evidence
Number and design of included studies Three studies were selected: two RCTs and one case – control study (Carra et al., 2023). Risk of bias According to NOS, one study was at low risk of bias. According to RoB-II-RCT, two studies were at some concern. Effect sizes and their clinical relevance Due to the heterogeneity in reporting outcome measures, no analysis of pooled data was possible. One study found a significant difference in favour of a counter-rotational powered toothbrush in terms of peri- implant mucosal inflammation and implant survival compared with manual toothbrushing (Truhlar et al., 2000). One case – control study indicated that the frequency of tooth brushing (at least twice a day vs. at most once a day) had no impact on peri-implant PD, MBL and BOP (Alhakeem et al., 2023). Consistency The three studies included were inconclusive regarding the type of toothbrush to use (e.g., powered or manual toothbrush), or the fre- quency of toothbrushing that was most effective in maintaining peri- implant health. Balance of benefit and harm Not assessed in the studies were considered. However, advising patients about OH and promoting OH behaviour improvements (in terms of techniques and frequency) carry little risk compared with the benefit it brings.
Background
There were no studies that investigated the control of bruxing/ parafunctional habits in patients with healthy peri-implant tissues in preventing the risk of peri-implant diseases.
5.3
| Secondary and tertiary prevention:
Recommendations for SPIC
This section aims to answer the following questions: in patients treated for peri-implantitis, what is the efficacy of: (1) supportive care, (2) SPIC with adjunctive local antiseptic agents and (3) of SPIC with a frequency of more than once a year in achieving peri-implant tissue stability. An SR (Stiesch et al., 2023) was designed to evaluate the efficacy of providing SPIC, as well as specific SPIC protocols and frequency upon peri-implant stability after a minimum recall period of 3 years. Fifteen studies were identified that met the inclusion criteria, which included a minimum of 20 volunteers. No studies were specifically designed to eval- uate SPIC provision, protocol or frequency, and all studies were surgical intervention trials that included SPIC as part of their design. Therefore, there were no studies that compared specific SPIC protocols or fre- quency of provision, or the use of adjunctive therapies versus none, or studies that compared the provision of SPIC versus no SPIC. There were 10 prospective and 5 retrospective studies, 14 of which provided SPIC using various techniques for professional mechanical pla- que removal (PMPR) in combination with ( n = 10) or without ( n = 4) OH instruction. Disease recurrence/progression outcomes were defined by the authors of the respective studies ( n = 13), or were based upon pro- gressive deterioration in BOP, PD or MBL ( n = 2). Stability outcomes and disease recurrence were reported at both the implant and the patient levels. The three PICOS questions documented below could not be answered by the SR, and a meta-analysis was inappropriate due to the
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Not applicable.
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