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R7.2. Which interventions should be provided as part of the non-surgical step of peri-implantitis treatment?
ment of periodontitis should follow available guidelines (Sanz et al., 2020).
Additional question addressed by the WG
Available evidence
R7.2: Expert consensus-based recommendation We recommend that the following interventions should be provided as part of the non-surgical step of peri-implantitis : • OH instructions and motivation . • Risk factor control . • Prosthesis cleaning/removal/modification including controlling biofilm retentive factors and evaluation of the components of the prosthesis, whenever needed and feasible . • Supramarginal and sub-marginal instrumentation . • Concomitant periodontal therapy as needed . Supporting literature (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023) and Expert opinion Quality of evidence Low — 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)
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 months of follow-up were considered as valid for developing recommenda- tions. For the present recommendation, both test and control groups are considered. Risk of bias Ten presented with a low risk of bias, three with some concerns and two with high risk.
Effect sizes and their clinical relevance Not applicable.
Consistency Not applicable.
Background
Balance of benefit and harm Benefits were observed in both test and control groups (see back- ground text of previous recommendation). Limited evidence of harm was presented.
Intervention
The group identified interventions within those detailed and per- formed in test and control groups of the 15 RCTs included in the three SRs (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023). Among them, the most relevant were selected and placed in chronological sequence:
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
• OH instructions and motivation, see Section 5. • Risk factor control, see Section 6.
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, as in these situa- tions they will need to be directly covered by patients.
• Prosthesis cleaning/removal/modification, including controlling biofilm retentive factors and evaluation of the components of the prosthesis, whenever needed and feasible. If renewal is necessary, additional evaluation of the overall treatment planning should be made, considering the added costs and the cost-effectiveness ratio (Karlsson et al., 2022). • Supramarginal and sub-marginal instrumentation. For the latter, for the present work, instrumentation performed with curettes and/or sonic/ultrasonic devices was considered as the basic/ control intervention. Additional or alternative methods to clean/ decontaminate the implant surface are discussed in the follow- ing recommendations. • Concomitant periodontal therapy as needed. If periodontal dis- eases are detected, they should be properly managed, in particular periodontitis, which is a recognized risk factor for peri-implantitis (Berglundh et al., 2018; Schwarz et al., 2018). Concomitant treat-
Economic considerations Limited evidence is available, see Section 1.
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