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HERRERA ET AL .
Economic considerations As SPIC may prevent peri-implantitis recurrence, it is an important tool to support overall oral health and well-being of patients with implants. The loss of an implant may be associated with bone loss, psychological distress, pain, and costly and time-demanding retreat- ments, which may require specialist management.
R6.2. In patients with peri-implant mucositis, what is the effect of oral hygiene as an adjunct to professional mechanical plaque removal (PMPR)?
PICOS question addressed by an SR
R6.2: Expert consensus-based recommendation In patients with peri-implant mucositis, we recommend self-performed effective OH along with PMPR Supporting literature (Verket et al., 2023) Quality of evidence No clinical studies were identified. Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Legal considerations There were no legal constraints.
6 | RECOMMENDATIONS FOR THE MANAGEMENT OF PERI-IMPLANT MUCOSITIS
6.1
| Introduction — general recommendations in
Background
the management of peri-implant mucositis
Intervention
R6.1. In patients with peri-implant mucositis, which are the goals/end points of treatment?
There are no available clinical studies with an arm with OH alone without PMPR. Furthermore, for obvious ethical reasons, there are no studies with- out implementing OH measures. However, there is indirect evidence from experimental mucositis studies demonstrating that OH can revert the inflammatory signs in the peri-implant mucosa. This evidence has concluded that experimental peri-implant mucositis is caused by biofilm accumulation and that it may be reversible by means of OH reinforcement alone (Chan et al., 2019; Salvi et al., 2012; Zitzmann et al., 2001). Due to this microbial aetiology, there is a clear rationale to combine professionally administered non-surgical mechanical/physical therapy with patient-performed OH rein- forcement in the treatment of peri-implant mucositis. This combination results in biofilm disruption and leads to improved clinical outcomes.
Additional question addressed by the WG
R6.1: Expert consensus-based recommendations We recommend that clinicians use as end point of peri-implant mucositis treatment at implant level: ≤ 1 point of BOP a and absence of suppuration We recommend that clinicians evaluate these end points 2 – 3months after the intervention, and in presence of ≥ 2 BOP sites, or ≥ 1 sites with profuse BOP, or presence of suppuration, re-treatment should be rendered . Supporting literature (Chan et al., 2019; Monje et al., 2021; Reinedahl et al., 2018; Salvi et al., 2012; Zitzmann et al., 2001) Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI) a BOP should be a spot rather than profuse bleeding using gentle forces (0.2 N) with a manual periodontal probe (0.5 mm tip), provided the contours of the restoration allow for adequate probing. In sites where probing is not feasible, peri-implant mucosal inflammation should be assessed through the modified sulcus bleeding index (Mombelli et al., 1987).
Available evidence
There are no RCTs, nor observational studies (with n = 30 patients or more), or single arms from RCTs (with n = 10 patients or more) evalu- ating the efficacy of OH reinforcement alone as treatment for peri- implant mucositis. Similarly, there are no RCTs where professionally administered non-surgical mechanical/physical instrumentation was implemented without OH reinforcement.
Background
Risk of bias Not applicable.
This recommendation is an expert-based recommendation supported by experimental studies (Reinedahl et al., 2018), experimental peri- implant mucositis studies (Chan et al., 2019; Salvi et al., 2012; Zitzmann et al., 2001) and studies evaluating the probe penetration and BOP in healthy periodontal versus peri-implant tissues (Monje et al., 2021). All these studies have assessed the similarities and differences between peri-implant and periodontal tissues, how peri-implant tissues respond to biofilm accumulation, and which is the degree of reversibility when the biofilm is eliminated (experimental peri-implant mucositis model).
Effect sizes and their clinical relevance Not applicable.
Consistency Not applicable.
Balance of benefit and harm Not applicable.
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