46
HERRERA ET AL .
From evidence to recommendation — additional considerations
mouth rinse was compared with instrumentation plus a 0.12% CHX mouth rinse. Outcomes evaluated in these three studies were the percentage of BOP, PlI and PD. Risk of bias The overall risk of bias in the included studies was judged as ‘ moder- ate ’ (RoB 2 tool), with all the three studies with a moderate risk of bias.
Acceptability The population widely accepts antibiotics. Nevertheless, there is an issue related to the need of diminishing the usage of antibiotics due to the potential risks associated with antibiotic resistance.
Effect sizes and their clinical relevance At 3 months, results revealed:
Feasibility There are no perceived barriers.
• Statistically significant greater reduction in BOP (%) for antibiotics than controls ( n studies = 3; n patients = 101; WMD = 5.97%; 95% CI [1.34; 10.59]; p = .012; I 2 = 58.1%). • Statistically significant greater reduction in plaque (%) for antisep- tics than controls ( n studies = 3; n patients = 101; WMD = 14.74%; 95% CI [3.83; 25.65]; p = .008; I 2 = 83.2%). • Statistically significant differences in the reduction in PD (mm) for the use of systemic antibiotics than controls only for one study (n studies = 1; n patients = 28; MD = 1.8mm; 95% CI [1.37; 2.23]; p < .001). • Complete disease resolution was rarely reported. One study reported at 3 months an OR of 4.5 (95% CI [1.2; 17.0]; p < .05) of favourable treatment in favour of systemic azithromycin in com- parison with the control group.
Ethical considerations The issue has not been addressed. There are no perceived major ethi- cal considerations. Yet it must be reiterated the need of containing prescription of antibiotics for the population at large.
Economic considerations The specific economic considerations can be stated.
Legal considerations No specific legal consideration can be stated.
7 | RECOMMENDATIONS FOR NON-SURGICAL MANAGEMENT OF PERI-IMPLANTITIS
At 6 months, the results were the following:
7.1 | Introduction — general recommendations in the non-surgical step of peri-implantitis treatment
• Statistically significant greater reduction in BOP (%) for antibiotics than controls ( n studies = 2; n patients = 71; WMD = 20.79%; 95% CI [15.24; 26.34]; p < .001; I 2 = 30.60%). • Statistically significant greater reduction in plaque (%) for antisep- tics than controls ( n studies = 2; n patients = 7; WMD = 13.97%; 95% CI [4.10; 23.84]; p = .006; I 2 = 30.6%). • Only one study using amoxicillin reported statistically significant differences with control group ( n studies = 1; n patients = 28; MD = 2.60 mm; 95% CI [2.20; 3.00]; p < .001).
The management of peri-implantitis is a relatively new area of research and clinical practice. Although key differences impacting care between peri-implantitis and periodontitis have been identified, the theoretical foundation of peri-implantitis treatment is based on the successful approaches developed for the treatment of periodontitis. Therefore, a step-by-step approach may be appropriate, as it has been suggested for the treatment of periodontitis (Sanz et al., 2020), and described in Section 4 of the present CPG. Thus, the interventions included in the SRs of WG #3 (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023) are part of the non-surgical step of peri-implantitis treatment. This stepwise approach mirrors the one used in periodontal therapy (Sanz et al., 2020), and the included interventions are also similar to those proposed for periodontitis. The main objective of the non-surgical step of peri-implantitis treatment is to control peri-implant biofilms and inflammation, and therefore the central intervention would be sub-marginal instrumentation. In addition, interventions focusing on supramarginal biofilm control or on risk factor control are also part of the non-surgical step of peri- implantitis treatment.
No studies reported a longer follow-up than 6 months.
Consistency All studies reported the same tendency.
Balance of benefit and harm In one study that collected side effects, no adverse events were observed after antibiotic intake. No specific concerns can be raised for antibiotics as adjunctive use for treating peri-implant mucositis.
Overall certainty of the evidence Moderate.
Made with FlippingBook Annual report