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HERRERA ET AL .
R7.5. What is the efficacy of lasers in the sub-marginal instrumentation of the non-surgical step of peri- implantitis treatment?
lasers at 6 months, in terms of either PD or BOP reductions. Only in one study did the adjunctive application of a Er,Cr:YSGG laser show statisti- cally significantly larger PD reductions at 6 months, compared with sub- marginal instrumentation alone (Alpaslan Yayli et al., 2022). An Er:YAG laser as monotherapy (Schwarz et al., 2005, 2006) led to statistically sig- nificant differences in BOP. Their magnitude, however, was small. Consistency Positive results for the primary outcomes were observed in all five RCTs, for both control and test groups.
PICOS question addressed by an SR
R7.5: Evidence-based recommendation We suggest not to use lasers, either adjunctively or as monotherapy, for non-surgical sub-marginal peri-implant instrumentation . Supporting literature (Cosgarea et al., 2023) Quality of evidence Low — fiveRCTs ( n = 178 patients, n = 225 implants) with a minimum follow-up of 6 months (two studies at high risk and three studies with low risk of bias) Grade of recommendation GradeB — # Strength of consensus : Unanimous consensus (0% of the group abstained due to potential CoI)
Balance of benefit and harm No proper evaluation of PROMs was carried out in the studies.
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Background
Intervention
Acceptability None of the included studies provides evidence of superior patients' acceptance of laser application as compared with mechanical instru- mentation with curettes. There is no evidence so far for clinicians' acceptability. Feasibility Implementation of therapy may be negatively influenced by the lack of retrievability and/or shape of the prosthetic suprastructure.
Lasers have received significant attention as a method for sub- marginal instrumentation as they may enhance biofilm removal and/or surface decontamination. Lasers are a wide class of biomedical instru- ments, each one of them working based on specific principles. In the selected studies, different lasers have been tested, either alone as monotherapy (three studies) or as an adjunct to conventional sub- marginal instrumentation (two studies).
Ethical considerations No data are available to address ethical considerations.
Available evidence
Economic considerations Cost-effectiveness has not been evaluated in these studies.
Five RCTs ( n = 178 patients, n = 225 implants) with a minimum follow- up of 6 months, with various types of laser (Nd:YAG, diode laser, Er,Cr: YSGG and Er:YAG) assessed the sub-marginal peri-implant instrumenta- tion with lasers alone or in combination with additional chlorhexidine irri- gation (Abduljabbar et al., 2017; Alpaslan Yayli et al., 2022; Roccuzzo, Klossner, et al., 2022; Schwarz et al., 2005, 2006). Two of them used Er:YAG laser as monotherapy, one study used Nd:YAG laser as mono- therapy, two studies used diode laser adjunctive to mechanical decon- tamination with curettes, of which one study also had a group using Er,Cr:YSGG laser as an adjunctive treatment.
Legal considerations So far, the manufacturer's indications are respected, there are no legal considerations.
R7.6. What is the efficacy of sub-marginal instrumentation with air-polishing in the non-surgical step of peri-implantitis treatment?
Risk of bias Two studies were at high risk, and three studies at low risk of bias.
PICOS question addressed by an SR
R7.6: Evidence-based recommendation We suggest not to use air polishing for non-surgical sub-marginal peri- implant instrumentation . Supporting literature (Cosgarea et al., 2023; Renvert et al., 2011)
Effect sizes and their clinical relevance Due to heterogeneity in the treatment protocol, no meta-analysis was carried out. All studies showed improvements in both test and control groups in PD and BOP, at 3 and/or 6 months compared with baseline. In general, studies showed no additional benefit from the application of
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