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and harms. For the ‘ postbiotic gel ’ , potential unintentional side effects were not reported (Butera et al., 2022); based on the composition of the postbiotic gel, potential side effects, such as allergic reactions, cannot be excluded. For the CHX chip, numerous unintentional side effects are listed in the product information, but they are reported to be not frequent and usually mild. For the desiccant, no unintentional side effect was reported (Lombardo et al., 2019); however, potential side effects of sulphuric acid are listed by the company, and thus, the application is not recommended in patients if allergic to sulphur in any form and in the case of pre-existing skin disorders.
Legal considerations The NaOCl formulation (PeriSolv ® ) is approved as Class I medical device in the European Union, and the desiccant material (HybenX ® ) has also been approved as Class I medical device in the European Union and Canada. The implications of the use in other geographical locations or the use for indications besides the ones approved are unclear.
R6.10. In patients with peri-implant mucositis, what is the efficacy of locally administered photodynamic therapy adjunctive to PMPR?
Overall certainty of the evidence The certainty is weak lack of studies.
PICOS question addressed by an SR
R6.10: Evidence-based recommendation In patients with peri-implant mucositis, we suggest not to use
From evidence to recommendation — additional considerations
photodynamic therapy adjunctively to PMPR . Supporting literature (Dommisch et al., 2023)
Acceptability In general, the application of antiseptics is well accepted by patients when understanding the pathogenesis of peri-implant mucositis. Feasibility CHX gels, CHX chips, desiccant materials, ‘ postbiotics ’ and NaOCl formulations can be professionally applied by the general dentist or specialist. Their adjunctive use is not clinically demanding or time-con- suming. For the NaOCl formulation (PeriSolv ® , RLS Global AB, Möln- dal, Sweden); CHX chip (PerioChip, Karr Dental, Wollerau, Switzerland), the ‘ postbiotic ’ (Biorepair Parodontgel Intensive, Cos- well SPA, Funo di Argelato, BO, Italy), and the desiccant liquid (HybenX ® Oral Tissue decontaminant ™ , EPIEN Medical Inc., Saint Paul, MN, USA), specific brands were tested and the information pro- vided may only be valid for those products, which may not be avail- able in all markets. Ethical considerations Based on the available evidence, no evaluation of ethical aspects could be performed. Economic considerations CHX gels, CHX chips, desiccant materials, “ postbiotics ” and NaOCl formulations are associated with additional costs to the patient as well as to the dental professional team. The application of any antiseptic treatment adjunctive to non-surgical mechanical/physical therapy may lead to additional costs for the patients depending on individual health insurance plans in the individual countries. As examples, the additional costs associated with the use of the desiccant material, in Germany, are approximately € 100 for two syringes of 1 mL each, and for the use of CHX chips is approximately € 300 for 20 applications. No information on cost-effectiveness could be retrieved from the RCTs (Butera et al., 2022; Iorio-Siciliano et al., 2020; Lombardo et al., 2019; Menezes et al., 2016; Sahrmann et al., 2019).
Quality of evidence Low (five RCTs) Grade of recommendation GradeB — # Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Application of antimicrobial photodynamic therapy (aPDT) adjunctive to non-surgical mechanical/physical therapy in patients with peri- implant mucositis.
Available evidence
Number and design of included studies For the application of aPDT adjunctive to sub-marginal instrumentation, five RCTs (in total, n = 204 patients) analysed an estimated number of 231 implants over a time period of 3 months (Dommisch et al., 2023). Of these five studies on adjunctive application of aPDT, four included patients with habitual tobacco intake (cigarette smokers, smoke-less tobacco chewers and vaping individuals). In the control groups, aPDT was not applied. In the test groups, the intervention varied in terms of a range in the applied wavelength between 660 and 670 nm, power density between 100 milliwatts (mW) and 150 mW. One study did not report on treatment modalities. Outcome measures compared BOP, PD and PlI. Dis- ease resolution and PROMs were not reported. In the synthesis of data, three studies were evaluated for changes in BOP and PD and four studies for changes in PlI, comparing test and control groups. For BOP and PD, no difference was identified between test and control groups, whereas for PI, a significant difference was shown in favour of aPDT adjunctive to sub-marginal instrumentation (Dommisch et al., 2023). High heterogeneity
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