63
HERRERA ET AL .
Consistency All reconstructive procedures improved clinical and radiographic outcomes as compared with baseline regardless of the biomaterials employed. Balance of benefit and harm None of the different reconstructive approaches was associated with early side effects or adverse events beyond what would be expected for this type of surgical procedure. Notably, the use of a combination of membrane and bone graft was associated with an increased risk for flap dehiscence in two studies.
R8.9. What are the preferred materials to be used in reconstructive procedures?
PICOS question addressed by an SR
R8.9: Evidence-based recommendation Bone grafts with or without barrier membranes may be considered in reconstructive procedures . Supporting literature (Donos et al., 2023) Quality of evidence Low Grade of recommendation GradeO $ Strength of consensus Consensus (19.0% of the group abstained due to potential CoI)
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Background
Intervention
Acceptability Based on one study, the use of a graft alone was associated with sig- nificantly less pain at 2 weeks as compared with the combined use of a graft and collagen membrane.
A variety of bone substitutes, barriers and bioactive agents have been proposed for reconstructive procedures.
Feasibility Not applicable.
Available evidence
Number and design of included studies Five RCTs and six prospective case series assessed the efficacy of reconstructive peri-implantitis therapy (Donos et al., 2023). Risk of bias Based on RoB 2, two of the five included RCTs were at high risk of bias, some concerns were raised for two studies and one was at low risk of bias. Based on ROBINSI, one CCT was at serious risk of bias, three prospective cohort studies were considered at serious risk of bias and two prospective cohort studies were at critical risk of bias (Donos et al., 2023). Effect sizes and their clinical relevance Regardless of the biomaterials applied, reconstructive therapy led to a mean PD reduction ranging from 2.0 to 4.5 mm and to a mean reduc- tion in BOP ranging from 44.8% to 86% at 12 months after therapy. Studies reporting on SOP showed a significant reduction at 12 months and 5 years post-surgery. Based on one study (45 patients and 75 implants), included in the network meta-analysis (4 studies; 160 patients and 190 implants) (Donos et al., 2023), an improved PD reduction was shown when a xenogeneic rather than an autologous graft was applied in combination with a collagen membrane. Implant survival at 12 months ranged from 92% to 100%, but when consider- ing composite outcomes for peri-implantitis resolution the range reported by the included studies was considerably wider (0% – 91%at 12 months).
Ethical considerations Not applicable.
Economic considerations No study addressed health economic outcomes on this topic. How- ever, it should be noted that reconstructive surgery represents an additional financial burden for the patient.
Legal considerations Not applicable.
R8.10. What is the preferable mode of healing (submerged versus transmucosal) to be used in reconstructive procedures?
Additional question addressed by the WG
R8.10: Expert consensus-based recommendation We do not know whether a submerged or transmucosal healing protocol would influence the outcomes of reconstructive procedures . Supporting literature (Donos et al., 2023) Quality of evidence Very low Grade of recommendation GradeO $ Strength of consensus Strong consensus (1.9% of the group abstained due to potential CoI)
Made with FlippingBook Annual report