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HERRERA ET AL .
After delivery of treatment, progress in controlling inflamma- tion and suppuration should be monitored, and the outcomes should be re-assessed. While in periodontitis treatment, end points of therapy have been well established, and success of steps 1 and 2 of treatment is a reasonable expectation (Suvan et al., 2020), comparable evidence for the treatment of peri-implantitis is still scarce. The rationale for using a stepwise approach and for a non- surgical phase of peri-implantitis treatment, therefore, comes from (i) attempting biofilm and inflammation control with relatively sim- ple approaches before escalating treatment complexity and inva- siveness; (ii) the fact that subjects with peri-implantitis frequently present with poorly controlled periodontitis that requires a con- comitant stepwise treatment approach; and (iii) the ability to deliver any surgical treatment at a later step and in a subject with better biofilm and risk factor control.
recommendations. For the present recommendation, outcomes from both test and control groups are considered.
Risk of bias Ten presented with low risk of bias, three with some concerns and two with high risk. Effect sizes and their clinical relevance The observed improvements after treatment are significant in magni- tude and consistent across the considered RCTs. Taken together, the evidence is unlikely to arise from the placebo or the Hawthorne effect. Still, it is not possible to assess the relative contribution of the different components that have been tested.
Consistency Not applicable.
Balance of benefit and harm Benefits were observed in both the test and control groups. Of 17 test groups, statistically significant benefits were observed in 11 for PD reduction and 9 for BOP. Of 17 control groups, statistically significant benefits were observed in 11 for PD reduction and 7 for BOP. The percentage of disease resolution was provided by seven test groups (ranging 0% – 65%) and seven control groups (ranging 14% – 55%). Lim- ited evidence of harm was presented.
R7.1. Is peri-implantitis treatable?
Additional question addressed by the WG
R7.1: Expert consensus-based recommendation In patients with peri-implantitis, we recommend therapy to retain an individually acceptable implant/prosthesis as the first line of treatment . We recommend that peri-implantitis therapy starts with a non-surgical step, followed by re-evaluation and, depending on the outcomes, progress to the surgical step or to SPIC . Supporting literature (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023) and Expert opinion Quality of evidence Moderate — indirect evidence derived from 15 RCTs, with at least 6-month follow-up (10 with low, 3 with some concerns and 2 with high risk of bias) Grade of recommendation GradeA — "" Strength of consensus : Strong consensus (0% of the group abstained due to potential CoI)
Overall certainty of the evidence Moderate.
From evidence to recommendation — additional considerations
Acceptability The interventions for treating peri-implantitis seem to be acceptable for patients, health providers and health authorities, although no direct evidence is available. Feasibility The interventions for treating peri-implantitis are feasible, although some of them may need specific training. Ethical considerations The interventions for treating peri-implantitis may negatively impact equity, if public services are not covering the cost, and those will need to be directly covered by patients.
Background
Intervention
The interventions for treating peri-implantitis differ among studies, but they most commonly include sub-marginal instrumentation and peri-implant biofilm control (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023) in both test and control groups.
Available evidence
Economic considerations Limited evidence is available, see Section 1.
Number and design of included studies In the SRs prepared for the present project (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023), 15 RCTs with at least 6-month follow-up were considered as valid for developing
Legal considerations Not applicable.
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