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HERRERA ET AL .
Ethical considerations Important concerns are related to patient's health and the impact of systemic antibiotic use to public health. Economic considerations Although economic considerations have not been analysed in the included studies, some indications can be given. The cost of systemic antimicrobials is low, particularly in comparison to other potential adjuncts (e.g., local antimicrobials or probiotics). Although there is not enough evidence to provide any strong recommendation, the prescription of systemic antimi- crobials in specific cases may reduce the need for additional treatment, including surgical procedures, reducing added costs and morbidity.
Risk of bias Some concerns.
Effect sizes and their clinical relevance No adjunctive effect of the use of probiotics was observed on PD orBOP.
Consistency Not applicable.
Balance of benefit and harm No proper evaluation of PROMs was carried out, although the extrap- olation from the periodontal field suggests that this formulation is safe, and patients do not frequently report adverse effects.
Legal considerations There are no specific legal considerations.
Overall certainty of the evidence Very low.
R7.11. What is the efficacy of adjunctive probiotics in the non-surgical step of peri-implantitis treatment?
From evidence to recommendation — additional considerations
PICOS question addressed by an SR
R7.11: Evidence-based recommendation We suggest not to use probiotics as an adjunct to sub-marginal instrumentation, in non-surgical peri-implantitis therapy . Supporting literature (Liñares et al., 2023) Quality of evidence Very low — one RCT with some concerns in risk of bias Grade of recommendation GradeB — # Strength of consensus : Strong consensus (0% of the group abstained due to potential CoI)
Acceptability No specific information is available. However, probiotics are normally easy to use by the practitioners. Conversely, some patients/clinicians may not be willing to use these products. Feasibility Adjunctive probiotics to non-surgical peri-implant therapy are a feasi- ble approach since these products can be prescribed in many coun- tries. Moreover, the procedure does not demand high clinical skills.
Background
Ethical considerations Not applicable.
Intervention
Economic considerations There is an additional cost associated with the use of probiotics that is borne by the patient.
Probiotics are defined as ‘ live microorganisms which, when adminis- tered in adequate amounts, confer a health benefit on the host ’ (Hill et al., 2014). Probiotics have been proposed to modulate oral micro- biota and host immune response (Gatej et al., 2018; Invernici et al., 2020). While it has been suggested that probiotics may not be used as an adjunct to subgingival instrumentation in the treatment of stages I – III periodontitis (Sanz et al., 2020), regarding peri-implantitis, available studies reveal contradictory results.
Legal considerations There are no specific legal considerations.
8 | RECOMMENDATIONS FOR THE SURGICAL MANAGEMENT OF PERI- IMPLANTITIS
Available evidence
8.1
| Introduction — general recommendations in
the surgical step of peri-implantitis treatment
Number and design of included studies One placebo-controlled RCT assessed the adjunctive effect of probiotics to non-surgical sub-marginal instrumentation (Laleman et al., 2020), with a preparation containing L. reuteri , to be applied both locally and systemically.
The purpose of a surgical approach in the management of peri- implantitis is to provide access to the implant to facilitate surface decontamination. The goal is to achieve the resolution of the
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