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HERRERA ET AL .
Overall certainty of the evidence Low.
sub-marginal instrumentation compared with sub-marginal instru- mentation alone or combined with a negative control or a placebo in terms on BOP reduction at 3 months in patients with peri- implant mucositis. In these five RCTs, self-administered antiseptics as adjuvant to PMPR were used in the format of gels (0.5% CHX) or mouth rinses. In this latter delivery format (mouth rinses), the following active agents have been tested: CHX at different concentrations (0.03%, 0.12% or 0.2%) alone or combined with cetylpyridinium chloride (CPC) (0.05%); herbal-based mouth rinses; delmopinol (0.2%). Risk of bias The overall risk of bias of the included studies was judged as ‘ low ’ (RoB 2 tool), with all five studies with a low risk of bias. Effect sizes and their clinical relevance For CHX gel: 29 patients received PMPR at the implant sites, they were instructed to brush around the implant twice daily using a chlor- hexidine gel (0.5%) ( n = 15) or a placebo gel ( n = 14) for a period of 4 weeks, and there were significant reductions in the mean number of sites with BOP from baseline to 1 month for both test and control groups ( p < .05), with little apparent change between 1 and 3 months ( p > .1); there was no statistically significant difference in the changes in BOP between the test and control groups at 1 month or at 3months ( p > .1). For CHX mouth rinses, four RCTs with 166 patients compared the efficacy of self-administered CHX mouth rinses versus distilled water/saline or placebo, for 2 weeks, 1 month or 1 year, and the results showed significant reductions over time of BOP, with conflict- ing results in terms of superiority versus control. Statistically signifi- cant differences in BOP or in modified gingival index (MGI) were noted after 3 months, while no statistically significant differences in terms of BOP were reported at 1 month or with the usage of 0.05% CHX plus 0.05% CPC at 1 year (Pulcini et al., 2019). For herbal mouth rinses, 2 RCTs with 62 patients were managed with self-administered herbal-based mouth rinses for 2 weeks or NaCl/distilled water. At 3 months, statistically significant differences in BOP and MGI, between test and control groups, were reported, with better performance in the herbal mouth rinse groups. For delmopinol, one RCT analysed the efficacy of 1-month self- performed delmopinol mouth rinse versus placebo, with 59 patients. Both treatments showed reduction on BOP with no differences among test and control groups.
From evidence to recommendation — additional considerations
Acceptability Antiseptics are widely accepted by the population.
Feasibility There are no perceived barriers.
Ethical considerations The issue has not been addressed. There are no perceived ethical considerations. Economic considerations For dentifrices, it may not be relevant since it is always combined with mechanical tooth brushing. For mouth rinses use, the extra cost should be taken into consideration. Legal considerations It should also be noted that the evidence base contains studies using products that may no longer be available.
R6.12. In patients with peri-implant mucositis, what is the efficacy of patient self-administered probiotics adjunctive to PMPR?
PICOS question addressed by an SR
R6.12: Evidence-based recommendation In patients with peri-implant mucositis, the professionally guided self- administration of probiotics may be considered as adjunctive to PMPR . Supporting literature (Gennai et al., 2023) Quality of evidence Moderate (six RCTs) Grade of recommendation GradeO — $ Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Consistency Conflicting results were reported when using CHX.
Intervention
Balance of benefit and harm In the included studies, some antiseptics have been associated with undesirable side effects, such as transient anaesthetic sensation in the oral mucosa (delmopinol) or higher levels of staining on the teeth or tongue (CHX). Moreover, other rarer side effects cannot be excluded.
Adjunctive probiotic tablets containing Lactobacillus reuteri . In two tri- als, the adjunctive measurement was combined with a 0.12% CHX mouth rinse, 15 days before starting probiotics intake. The most fre- quent posology was one tablet per day for 1 month. In contrast, the shortest posology was two tables per day for 3 weeks and the longest, twice per day for 3 months.
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