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0.1% – 0.2% chlorhexidine digluconate) (Sahm et al., 2011; Schwarz et al., 2005, 2006).
decontamination (non-aiming at mechanical/physical decontamina- tion, for example, scalers to remove hard deposits with adjunctive saline irrigation) with (PICOS #2) or without (PICOS #1) other con- comitant interventions. The review initially identified nine RCTs, but for the consensus report seven RCTs were finally considered, five (Abduljabbar et al., 2017; Alpaslan Yayli et al., 2022; Roccuzzo, Klossner, et al., 2022; Schwarz et al., 2005, 2006) assessing various types of laser therapies (i.e., Nd:YAG, diode laser, Er,Cr:YSGG and Er:YAG), and two (Merli et al., 2020; Sahm et al., 2011) assessing an air-abrasive decontamination system. Two presented a high risk of bias, and the other five a low risk of bias.
Available evidence
Number and design of included studies No study was found answering this question.
Risk of bias Not applicable
Effect sizes and their clinical relevance Due to the lack of studies, indirect evidence was used, analysing the clinical impact in control groups in the 15 RCTs identified in the three SRs (Cosgarea et al., 2023; de Waal et al., 2023; Liñares et al., 2023). Of 17 control groups, statistically significant benefits were observed in 11 for PD reduction and in seven for BOP. The percentage of disease resolution was provided for seven control groups, and it ranged 14% – 55%. Limited evidence of harm was presented. Consistency Most control groups found a statistically significant impact of the treatment; this was similar to that reported in test groups.
R7.4. What is the efficacy of sub-marginal instrumentation in the non-surgical step of peri- implantitis treatment?
PICOS question addressed by an SR
R7.4: Expert consensus-based recommendation In patients with peri-implantitis, we recommend performing non-surgical supra- and sub-marginal instrumentation with curettes and/or sonic/ ultrasonic devices . 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 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 : Strong consensus (0% of the group abstained due to potential CoI)
Balance of benefit and harm No proper evaluation of PROMs was carried out.
Overall certainty of the evidence Moderate.
Background
From evidence to recommendation — additional considerations
Intervention
Acceptability There is no evidence so far for clinicians' or patients' acceptability.
For the present CPG development process, the control intervention to evaluate non-surgical sub-marginal instrumentation approaches was defined as those approaches not aiming at mechanical/physical decontamination, which includes scalers or sonic/ultrasonic devices to remove hard deposits with/without adjunctive irrigation with an inac- tive solution (i.e., saline). For answering the proposed question, stud- ies comparing control decontamination with no treatment or supragingival instrumentation were searched for. Since no direct evi- dence was found, indirect evidence derived from the control groups of the selected studies was used: in some control groups, in addition to sub-marginal instrumentation, additional interventions were included (that were also part of the treatment protocol in the test group), such as adjunctive decontamination with chlorhexidine diglu- conate as subgingival irrigation (0.1% – 0.2%), as subgingival application (1% chlorhexidine digluconate gel) or as mouth rinsing (2 weeks with
Feasibility Implementation of therapy may be negatively influenced by the lack of retrievability and/or shape of the prosthetic suprastructure.
Ethical considerations No data are available to address ethical considerations.
Economic considerations Cost-effectiveness has not been evaluated in these studies.
Legal considerations So far, if the manufacturer's indications are respected, there are no legal considerations.
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