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HERRERA ET AL .
Overall certainty of the evidence Not applicable.
with PMPR, demonstrating significant BOP reduction at 3 months in patients with peri-implant mucositis.
From evidence to recommendation — additional considerations
Risk of bias The overall risk of bias of the included studies was judged as ‘ moder- ate ’ (RoB 2 tool), with one study with a low risk of bias and one with a moderate risk of bias. Effect sizes and their clinical relevance These two RCTs show imprecision in the effect estimates, the results are not consistent and publication bias could not be assessed.
Acceptability Self-performed OH measures are generally well accepted by individuals.
Feasibility Non-surgical mechanical/physical treatment of peri-implant mucositis can be performed by dental hygienists, general dentists as well as specialist.
Consistency The reported results are not consistent.
Ethical considerations Not applicable.
Balance of benefit and harm It could not be assessed.
Economic considerations Not applicable.
Overall certainty of the evidence Two RCTs have evaluated the adjunctive self-use of oral irrigators, one using 0.06% chlorhexidine (CHX) as the irrigating fluid and the other water, one study was at low and the other at moderate risk of bias. Furthermore, the imprecision of the effect estimates, the lack of consistency of the results and the potential risk of publication advises downgrading the quality of the evidence.
Legal considerations Not applicable.
R6.3. In patients with peri-implant mucositis, what is the efficacy of oral irrigators adjunctively used toPMPR?
Acceptability Oral irrigators are usually well accepted by patients.
PICOS question addressed by an SR
R6.3: Evidence-based recommendation In patients with peri-implant mucositis the self-use of oral irrigation devices with water may be considered as an adjunct to PMPR . Supporting literature (Gennai et al., 2023) Quality of evidence Low (two RCTs, one with low and the other with moderate risk of bias) Grade of recommendation GradeO — $ need for further research Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Feasibility There are no perceived barriers.
Ethical considerations There are no perceived ethical considerations.
Economic considerations There is an additional cost on buying the irrigator.
Legal considerations There are no perceived legal considerations.
Background
R6.4. In patients with peri-implant mucositis, what is the effect of any single mode of PMPR, compared with other single modes of PMPR?
Intervention
Oral irrigators can be used regularly as adjuvants to PMPR in addition to regular OH practices.
PICOS question addressed by an SR
R6.4: Evidence-based recommendation In patients with peri-implant mucositis, ultrasonics with plastic coated tips or air-polishing devices with glycine powder or titanium curettes or chitosan brushes may be considered as a single mode of PMPR .
Available evidence
Number and design of included studies The SR (Gennai et al., 2023) included two RCTs evaluating the effect of oral irrigators used by the patient adjunctively to PMPR compared
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