62
HERRERA ET AL .
Background
Consistency Overall, inconsistency in the direction of effect was noticed for the included studies, as only one showed a significant improvement in PD change and one in BOP change, when reconstructive procedures were employed. Balance of benefit and harm A similar number of adverse events and complications was associated with reconstructive and access flap surgeries. In the long-term, a number of implants are expected to develop disease recurrence, which may require additional surgical procedures or could lead to implant loss. Overall certainty of the evidence The certainty of evidence is low based on the quality of the studies (RoB) and inconsistency of outcomes.
Intervention
See previous section.
Available evidence
Number and design of included studies None of the identified studies in the SR was designed to investigate the site prerequisites for a reconstructive surgery (Donos et al., 2023). Nevertheless, the five RCTs of the network meta-analysis included ≥ 3 mm, angular peri-implant bone defects, which showed significant improvements in clinical and radiographic parameters from baseline to 12 months post-reconstructive therapy. Deeper defects are more likely to result in radiographic defect fill and 3- and 4-wall defects result in higher reduction in PD and BOP. Risk of bias Based on RoB 2, the risk of bias varied from low to high in the rele- vant studies.
From evidence to recommendation — additional considerations
Acceptability Only two studies considered PROMs, with no significant differences in terms of pain scores, number of tablets taken and satisfaction.
Effect sizes and their clinical relevance Not applicable.
Feasibility Related procedures are clinically demanding.
Consistency Despite the three identified studies showed consistency on the impact of defect morphology on the treatment outcome, none of these studies was designed to answer this question.
Ethical considerations Some decontamination procedures applied in the studies have not been tested for safety. Economic considerations No study addressed health economic outcomes on this topic (Donos et al., 2023). Reconstructive surgery represents an additional financial burden for the patient, which should be discussed with the patient.
Balance of benefit and harm Not applicable.
Overall certainty of the evidence Low.
Legal considerations Not applicable.
From evidence to recommendation — additional considerations
R8.8. What are the specific prerequisites (e.g., dimensions of intra-bony defects) for a reconstructive approach?
Acceptability Not applicable.
Feasibility Not applicable.
PICOS question addressed by an SR
R8.8: Evidence-based recommendations We suggest that reconstructive procedures preferably be applied at intra-osseous defects with a depth of ≥ 3mm. Supporting literature (Donos et al., 2023) Quality of evidence Low Grade of recommendation GradeB — " Strength of consensus Consensus (13.3% of the group abstained due to potential CoI)
Ethical considerations Not applicable.
Economic considerations Not applicable.
Legal considerations Not applicable.
Made with FlippingBook Annual report