43
HERRERA ET AL .
Feasibility The application of aPDT can only be performed by a trained operator and appropriate eye protection must be used by the dental profes- sional team and the patient.
and a high level of asymmetry were evident (Dommisch et al., 2023). Two RCTs were excluded due to the lack of reporting mean and standard devi- ation or assessing a modified bleeding index instead of BOP. Changes in SOP as well as PROMs were not reported. The main findings were that aPDT did not additionally improve clinical outcomes for changes in BOP, PDorPlI. Risk of bias For aPDT, study quality assessment using the RoB 2 tool identified a low risk of bias for one study, whereas some concerns indicated a risk of bias in four studies on aPDT. Effect sizes and their clinical relevance For aPDT, based on three RCTs (204 patients) included in the meta- analysis, no additional effect of the adjunct application of aPDT was demonstrated regarding reduction in BOP and PD (Dommisch et al., 2023). A significant reduction of PlI was identified in the meta- analysis; however, clinically, this reduction was not related to the reduction of surrogate parameters for disease resolution (reduction or absence of BOP, reduction in PD) (Dommisch et al., 2023). Consistency For aPDT, the identified RCTs included male patients only, and from these five RCTs four focused on patients with habitual tobacco intake (cigarette smokers, smoke-less tobacco chewers and vaping individuals). The analysis of data revealed high heterogeneity among the studies (Dommisch et al., 2023). This inconsistency among the studies may be explained by the heterogeneity of reported outcome parameters as well as regarding the variation of tobacco intake habits, even though only male patients were evaluated. In addition, the intervention varied in terms of a range in the applied wavelength between 660 and 670 nm, power density between 100 mW and 150 mW, and choice of photosensitizer (phenothi- azine chloride, methylene blue) in the respective test groups. Balance of benefit and harm For the additional application of aPDT adjunctive to sub-marginal instru- mentation, no benefit was identified in the meta-analysis (Dommisch et al., 2023). Potential harm of aPDT adjunctive to sub-marginal instru- mentation has not been studied to date. However, potential adverse effects cannot be entirely ruled out due to various wavelength, power density and photosensitizer available on the market. Overall certainty of the evidence The overall certainty regarding the additional effect of aPDT is weak. The quality of evidence is low.
Ethical considerations Not applicable.
Economic considerations The application of aPDT causes comparatively high costs for the den- tal team with regard to the acquisition and maintenance of the corre- sponding equipment. For the patient, aPDT adjunctive to sub- marginal debridement may lead to additional costs depending on individual health insurance plans in the individual countries. No infor- mation on cost-effectiveness could be retrieved from the five selected RCTs. Additional costs associated with adjunctive laser therapy may not be justified.
Legal considerations Not applicable.
R6.11. In patients with peri-implant mucositis, what is the efficacy of patient self-administered antiseptics adjunctive to PMPR?
PICOS question addressed by an SR
R6.11: Evidence-based recommendation In patients with peri-implant mucositis, the time limited self- administration of oral rinse antiseptics (chlorhexidine and herbal-based) adjunctive to PMPR may be considered . Supporting literature (Gennai et al., 2023) Quality of evidence Moderate (six RCTs, using different antiseptic agents, CHX and herbal-based). Grade of recommendation GradeO — $ Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Application of antiseptics adjunctive to PMPR in patients with peri- implant mucositis.
From evidence to recommendation — additional considerations
Available evidence
Acceptability The adjunct application of aPDT is accepted by patients when under- standing the pathogenesis of peri-implant mucositis.
Number and design of included studies The SR (Gennai et al., 2023) included five RCTs evaluating the effect of antiseptics used by the patient adjunctively to
Made with FlippingBook Annual report