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adjunctive to ultrasonics and curettes. No patient-reported outcomes were reported.
PICOS question addressed by an SR
R6.5: Evidence-based recommendations Grade of recommendation GradeB — # Strength of consensus Consensus (15.4% 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 Moderate.
Background
Intervention
From evidence to recommendation — additional considerations.
Professionally administered PMPR therapy aims at reducing soft tissue inflammation by removing hard and soft deposits from the surface of dental implants and/or its supra-structure. Combinations of PMPR therapy have been used and include laser adjunctive to ultrasonics and curettes, and air-polishing adjunctive to ultrasonics. The end point of treatment is absence of inflammation, that is, 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.
Available evidence
Number and design of included studies Three RCTs addressed the PICOS question ( n = 313 patients). Two RCTs analysed the effect of laser therapy adjunctive to ultrasonics and curettes ( n = 289), and one RCT analysed the effect of air-polishing adjunctive to ultrasonics ( n = 24), all with a 3-month follow-up. One study compared ultrasonics with carbon fibre tip plus glycine powder air polishing versus ultrasonics alone ( n = 24). The results on mean BOP severity were 1.1 and 1.0, respectively. The second study ( n = 220) compared ultrasonics with carbon fibre tip and titanium-coated curettes with and without diode laser (980 nm) application. Results were 34.5% and 30.9% disease resolution, respectively. BOP extent at 3 months was 23.2% and 26.8%, respectively. The third study ( n = 69) compares ultrasonic with plastic tips and plastic curettes with and without diode laser (810 nm). The reported BOP extent was 0.26 and 0.57 respectively at 3 months, this difference being statistically significant. Risk of bias Study quality assessment identified some concerns of risk of bias in two studies, and a third had a high risk of bias. Effect sizes and their clinical relevance One RCT reported disease resolution/treatment success in 30.9% – 34.6% and 23.2% – 26.8% BOP extent at 3 months. Another RCT reported BOP extent of 0.26 and 0.57 in favour of adjunctive laser at 3 months, which was statistically significant. The third RCT reported BOP severity of 1.0 and 1.1 at 3 months. Consistency Evidence was consistent in the studies with a reduction in BOP, but statistically significant only in one of the RCTs with laser therapy
Ethical considerations Not applicable.
Economic considerations Additional costs associated with adjunctive laser therapy may not be justified.
Legal considerations Not applicable.
R6.6. In patients with peri-implant mucositis, what is the effect of repeating PMPR procedures, compared to a single administration of PMPR?
PICOS question addressed by an SR
R6.6: Expert consensus-based recommendation In patients with peri-implant mucositis, we recommend repeating PMPR if the end points of therapy have not been achieved within 3 months after the administration of PMPR. These end points and the evaluation times should be modified according to the patient's OH, risk factor profile and the cleansability of the prosthesis . Supporting literature No studies evaluating the impact of repeated PMPR on peri-implant mucositis outcomes were identified (Verket et al., 2023) Quality of evidence No evidence from clinical studies identified. Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
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