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Consistency Evidence was consistent in the two studies with limited reduction in BOP. The only patient-reported outcome showed no difference in pain during treatment when titanium curettes were compared with chitosan brush.
PICOS question addressed by an SR
R6.4: Evidence-based recommendation Supporting literature (Verket et al., 2023)
Quality of evidence Low (two RCTs demonstrating positive effects within the single mode of PMPR, but without differences among them) Grade of recommendation : GradeO — $ (need for further research) Strength of consensus Consensus (5.3% of the group abstained due to potential CoI)
Balance of benefit and harm An overall consideration of the benefit versus harm of professionally administered non-surgical mechanical/physical therapy supports the recommendation.
Overall certainty of the evidence Low.
Background
Intervention
From evidence to recommendation — additional considerations.
PMPR aims at reducing soft tissue inflammation by removing hard and soft deposits from the surface of the dental implant and/or its supra-structure without scratching the surface of the smooth trans- mucosal element (implant collar, abutment). Several modalities including ultrasonics with carbon fibre or plastic tip, air-polishing, curettes of plastic, carbon or titanium or rotating/oscillating brushes and lasers have been used within PMPR. The end point of treatment is to eliminate inflammation, evaluated by BOP and suppuration.
Acceptability Patients usually accept and understand the need for treatment.
Feasibility Non-surgical mechanical/physical treatment of peri-implant mucositis can be performed by dental hygienists, general dentists as well as specialist.
Ethical considerations Not applicable.
Available evidence
Two RCTs comparing two single modes of mechanical therapies were identified (Verket et al., 2023). One is a 12-month parallel group RCT ( n = 37 patients) comparing glycine powder air polishing and ultrasonic with plastic coated tips. The mean BOP reductions were 31.8% and 35.1%, respectively at 12 months, without statistically significant differ- ences between both modes of therapy. The other is a 6-month split- mouth RCT ( n = 11 patients) comparing titanium curettes and chitosan brushes after a period of OH. The mean reduction in BOP severity (modi- fied sulcus bleeding index), was 0.84 and 0.61, respectively. The mean dis- ease resolution at implant level (up to one spot BOP) was 50% and 35% at 6months. Risk of bias Study quality assessment identified some concerns of risk of bias in one study and high risk of bias in the other. Effect sizes and their clinical relevance One study reported disease resolution/treatment success in 8.3% – 16.7% at 6 months, and BOP severity of 0.70 – 0.74. In this study, OH instruction was performed before the baseline examina- tion. Another study reported BOP extent at 12.1% – 18.6% at 12months.
Economic considerations Not applicable.
Legal considerations Not applicable.
R6.5. In patients with peri-implant mucositis, what is the effect of combinations of PMPR procedures, compared to single modes?
PICOS question addressed by an SR
R6.5: Evidence-based recommendations In patients with peri-implant mucositis , we suggest not to add air- polishing devices to conventional PMPR (curettes, ultrasonics or both), even though these devices have shown efficacy when used as a single mode of treatment . In patients with peri-implant mucositis, we suggest not to add diode lasers with conventional PMPR (curettes, ultrasonics or both) . Supporting literature (Verket et al., 2023) Quality of evidence Moderate (three RCTs, n = 313 patients)
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