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HERRERA ET AL .
Background
R8.4. What considerations should be made about the implant-supported prosthesis when performing surgical treatment of peri-implantitis?
Intervention
Surgical therapy of peri-implantitis may consist of different approaches, including simple access flap, pocket elimination or recon- structive procedures. All modalities incorporate flap elevation, removal of inflamed tissues and implant surface debridement/ decontamination.
Additional question addressed by the WG
R8.4: Expert consensus-based recommendations 1. We recommend that implant-supported prostheses that do not allow access for self-performed OH be adjusted prior to surgical therapy of peri-implantitis . 2. We suggest that implant-supported prostheses be removed, if feasible, in conjunction with surgical treatment of peri-implantitis to facilitate access and peri-implant tissue healing . Supporting literature Not applicable Quality of evidence Not applicable Grade of recommendation GradeA — "" (1); Grade B — " (2) Strength of consensus (1) Unanimous consensus (0% of the group abstained due to potential CoI) (2) Consensus (0% of the group abstained due to potential CoI)
Available evidence
Number and design of included studies Data from 13 prospectively collected studies (649 patients) with a follow-up ranging from 1 to 5 years addressed access flap and resec- tive surgery. Seven RCTs assessed the efficacy of reconstructive sur- gery (194 patients) compared with access flap surgery. The respective datasets were evaluated in two SRs (Donos et al., 2023; Karlsson et al., 2023). All studies reported on reduction of PD and BOP. Clini- cally relevant end points (e.g., PD < 6 mm), PROMs, health economic parameters and adverse events were not consistently reported. Risk of bias The 13 studies on access flap and resective surgery were generally found to be at low RoB, while multiple studies evaluating reconstruc- tive measures were judged to show high RoB. Effect sizes and their clinical relevance For access flap and resective surgery, the estimated reduction of PD was 2.2 mm (95% CI [1.8; 2.7]). Reconstructive surgery resulted in similar PD reduction (additional effect relative to access flap alone: 0.39 95% CI [ 1.16; 0.24]) at 12 months. For access flap and resective surgery, reduction of standardized mean %BOP was estimated at 27.0 (95% CI [19.8; 34.2]) and an overall bone gain of 0.2 mm (95% CI [0.0; 0.5]) was noted. Reconstructive surgery resulted in an additional bone gain of 0.75 mm (95% CI [ 1.39; 0.11]) over access flap alone at 12 months (CI is presented with negative values, since in the original analyses positive values indi- cated more gain for access flap and negative for reconstructive pro- cedures). Over 5-year observation periods, disease recurrence/ progression was observed at 32% – 44% of treated implants. Corre- sponding implant loss was low in the short term but after 5 years ranged from 14% to 21%. Consistency Results were consistent across studies for changes of PD and MBL. Reduction of BOP was heterogenous across studies. Data were generated in various clinical settings, including university centres and private clinics. Balance of benefit and harm In general, considerable improvements in clinical and radiographic parameters were noted. However, disease recurrence and implant
Background
Adequate levels of self-performed OH are a prerequisite for success- ful outcomes of surgical treatment for peri-implantitis. Studies have shown that inadequate access for OH around implants is associated with higher risk for peri-implantitis (Serino & Strom, 2009; Tormena et al., 2020); therefore, adjustment of the implant-supported prosthe- sis with the aim to facilitate access for OH is an important measure prior to surgical treatment of peri-implantitis.
8.2
| Indications of the surgical treatment of peri-
implantitis and efficacy of access/resective approaches
R8.5. When is surgical treatment of peri-implantitis indicated?
PICOS question addressed by an SR
R8.5: Expert consensus-based recommendation In peri-implantitis patients in whom end points of non-surgical therapy (PD ≤ 5mmand ≤ 1 point of BOP) have not been achieved, we recommend performing surgical therapy . Supporting literature (Donos et al., 2023; Karlsson et al., 2023) Quality of evidence Moderate Grade of recommendation GradeA — "" Strength of consensus Consensus (0% of the group abstained due to potential CoI)
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