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HERRERA ET AL .
Background
Legal considerations Not applicable.
Intervention
R6.7. In patients with peri-implant mucositis, which is the effect of modifying the implant-supported prosthesis to enable oral hygiene access?
If the end point of professionally administered non-surgical mechani- cal/physical therapy is not met following an intervention, it may be advisable to repeat the treatment.
Question not addressed by the SR
Available evidence
R6.7: Expert consensus-based recommendations In patients with peri-implant mucositis where the implant-supported prosthesis does not allow for proper self-performed and/or professional cleansability, we recommend cleaning/removal/modification of the prosthesis . Supporting literature (de Tapia et al., 2022; de Tapia, Mozas, et al., 2019) Quality of evidence High (one RCT with low risk of bias, n = 45) Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
There are no available RCTs or any observational study (with n = 30 patients or more), or single arms from RCTs (with n = 10 patients or more) evaluating the effect of repeated PMPR in the treatment of peri-implant mucositis.
Risk of bias Not applicable.
Effect sizes and their clinical relevance No RCTs were available, but in one of the included trials (Riben- Grundstrom et al., 2015), results were reported at multiple time points after providing repeated mechanical instrumentation. After an initial reduction of 20.9% – 28.6% in BOP extent, the effect of further repetitions was limited (1.9% – 6.3%, and 0.0 – 11.3%, respectively).
Background
Intervention
Modification of the implant-supported prosthesis to improve accessi- bility for OH and biofilm removal in surfaces of dental implants and restorative components.
Consistency Not applicable.
Balance of benefit and harm Not applicable.
Available evidence
Overall certainty of the evidence Not applicable.
There is one RCT ( n = 45) (de Tapia, Mozas, et al., 2019) evaluating the adjunctive effect of modifying the prosthesis to enable adequate OH. An additional publication reports on the 30-month follow-up of the same study (de Tapia et al., 2022).
From evidence to recommendation — additional considerations
Risk of bias Low risk of bias.
Acceptability Not applicable.
Effect sizes and their clinical relevance Results at 6 months demonstrated reductions in the modified bleed- ing index of 1.14 and 0.50 for test and control groups, respectively; these differences were statistically significant; and, at 6 months, dis- ease resolution was 66.6% and 9.6%, respectively.
Feasibility Non-surgical mechanical/physical treatment of peri-implant mucositis can be performed by dental hygienists, general dentists as well as specialist.
Consistency Not applicable.
Ethical considerations Not applicable.
Balance of benefit and harm There is a clear benefit and minimal harm in the prosthesis modifica- tion to improve access for biofilm control.
Economic considerations Not applicable.
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