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HERRERA ET AL .
Background
Feasibility The adjunctive use of desiccant material following sub-marginal instrumentation is not clinically demanding or time-consuming. Cur- rently, there is only one brand name/manufacturer for this material (HybenX ® , EPIEN Medical Inc., Saint Paul, MN, USA).
Intervention
In some studies, patients diagnosed with chronic periodontitis were trea- ted with a desiccant material, consisting of a gel or liquid of concentrated aqueous mixture of hydroxybenzenesulphonic and hydroxymethoxyben- zene acids, together with sulphuric acid. Results were promising regard- ing improvements in clinical parameters, microbiological variables and inflammatory mediators when compared with subgingival instrumenta- tion alone (Isola et al., 2018; Lombardo et al., 2015). The same principles were used for its application as an adjunct to sub-marginal instrumenta- tion in the treatment of peri-implantitis.
Ethical considerations There is no evidence for ethical considerations.
Economic considerations There are additional costs associated with the use of the desiccant mate- rial (e.g., in Germany the cost are ca. € 100 for two syringes of 1 mL each). Legal considerations The product has been approved as Class I medical device in the European Union and Canada. The implications of the use in other geographical loca- tions or the use for indications besides the ones approved are unclear.
Available evidence
Number and design of included studies One factorial design RCT with two control and two test groups (16 of 16 patients and 16 of 16 implants) assessed the adjunctive desiccant antiseptic gel and the method of sub-marginal instrumentation (Merli et al., 2020). No studies were found testing efficacy as monotherapy.
7.4
| Non-surgical sub-marginal instrumentation —
Adjunctive therapies
The SR by Liñares and co-workers (Liñares et al., 2023) explored the added value of adjunctive therapies by answering the following PICOS question: ‘ in patients diagnosed with peri-implantitis (population), which is the efficacy of patient-performed or administered adjunctive measures to non-surgical therapy (intervention) as compared to no adjunct (comparison), in terms of PD and/or BOP reductions (primary outcomes), reported in RCTs or CCTs with at least 6 months of follow-up (study design)? ’ Initially, eight studies were identified, but for the consensus develop- ment, five RCTs were finally considered: two on local antimicrobials, two on systemic antimicrobials and one on probiotics. Two studies presented some concerns and three studies a low risk of bias. The other studies were excluded due to different reasons: non-sustained release for local antimicrobials; inadequate control group (treated with aPDT) and inclu- sion criteria (abscess) for systemic antimicrobials; and antibiotic intake in test and control groups, when assessing probiotics.
Risk of bias The study was considered at low risk of bias.
Effect sizes and their clinical relevance PD and CAL reduction were greater in patients treated with the desic- cant material, regardless of the sub-marginal instrumentation method (ultrasonic scaler alone or combined with glycine powder air-polishing). The magnitude of the additional improvements in PD was 0.5 mm. There were no significant differences for any of the other outcomes reported.
Consistency Not applicable.
Balance of benefit and harm No adverse effects were reported. However, since the product is an acid, a negative impact on the surrounding tissues may happen (caus- tic effect on the soft tissues). Overall certainty of the evidence Due to the limited number of studies, the certainty of the evidence is very low.
R7.9. Do adjunctive locally administered antimicrobials improve the clinical outcome of subgingival instrumentation?
PICOS question addressed by an SR
From evidence to recommendation — additional considerations
R7.9: Evidence-based recommendation We suggest not to use locally administered antimicrobials, adjunctively to sub-marginal instrumentation or as monotherapy, in non-surgical peri- implantitis therapy . Supporting literature (Liñares et al., 2023; Renvert et al., 2006, 2008)
Acceptability There are insufficient data to support the use of desiccant material as an adjunct to sub-marginal instrumentation in the non-surgical treat- ment of peri-implantitis.
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