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HERRERA ET AL .
Legal considerations Not applicable.
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 Not applicable.
R7.3. Which are the end points of the non-surgical step of peri-implantitis treatment, and when and how should they be evaluated?
Consistency Not applicable.
Additional question addressed by the WG
R7.3: Expert consensus-based recommendations 1. To assess the outcome of the non-surgical step of peri-implantitis treatment, we recommend monitoring residual inflammation/ suppuration and probing depths. Patient satisfaction, good OH and prosthesis cleansability should also be considered . 2.We recommend using, at implant level, residual probing depths ≤ 5mm with no BOP at more than one point a and no suppuration, as therapy endpoints . 3. If they are not achieved, we recommend considering additional treatment . 4.We recommend evaluating the outcome (re-evaluation) of the non- surgical step of therapy after 6 – 12 weeks; it may be prudent to monitor cases frequently during healing . 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 months of follow-up (10 with low, 3 with some concerns and 2 with high risk of bias) Grade of recommendation GradeA — "" Strength of consensus : Unanimous consensus (0% of the group abstained due to potential CoI) a BOP present at a single spot, not line or profuse bleeding, is compatible with control of inflammation. It should be assessed at six sites per implant using gentle forces (0.2 N) with a standard manual periodontal probe (0.5 mm tip).
Balance of benefit and harm Not applicable.
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Acceptability The evaluation of the outcomes after the non-surgical step of peri- implantitis treatment seems to be acceptable for patients, health providers and health authorities, although no direct evidence is available. Feasibility The evaluation of the outcomes after the non-surgical step of peri- implantitis treatment seems to be feasible.
Ethical considerations Not applicable.
Economic considerations Not applicable.
Background
Intervention
Legal considerations Not applicable.
The group identified follow-up intervals and outcomes among those described 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). In addition, the findings of the ID-COSM project (see Section 2) were also considered (Derks et al., 2022).
7.2
| Non-surgical sub-marginal instrumentation —
mechanical/physical cleaning/decontamination
The SR by Cosgarea and co-workers (Cosgarea et al., 2023) focused on mechanical/physical approaches for implant surface cleaning/ decontamination. Three PICOS questions were formulated, one to understand the efficacy of sub-marginal instrumentation versus no treatment or supramarginal instrumentation (PICOS #3) and two PICOS questions aimed to evaluate different mechanical/physical decontamination methods (e.g., air- polishing, sonic/ultrasonic devices, lasers), alone or in combination, compared with non- surgical sub-marginal instrumentation with/without placebo
Available evidence
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 recommendations.
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