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HERRERA ET AL .
Background
Legal considerations Not applicable.
Intervention
In reconstructive procedures, submerged and transmucosal healing have been documented.
8.4
| Additional methods for implant surface
decontamination
Available evidence
R8.11. Do photo /mechanical and physical implant surface decontamination procedures improve outcomes of surgical treatment?
Number and design of included studies No focused question in the current SR (Donos et al., 2023) was for- mulated to address this topic. Nevertheless, none of the included studies compared submerged with unsubmerged healing protocol.
PICOS question addressed by an SR
R8.11: Evidence-based recommendations (1, 2) and statement (3) 1.We suggest not to use air-polishing or Er:YAG laser for implant surface decontamination during surgical treatment of peri-implantitis . 2. Titanium brushes may be considered as an alternative/adjunct to standard decontamination . 3. There is insufficient evidence to make any recommendation regarding the use of implantoplasty . Supporting literature (Ramanauskaite et al., 2023) Quality of evidence Low Grade of recommendation GradeB — # (1); Grade O — $ (2); Statement (3) Strength of consensus (1) Consensus (7.8% of the group abstained due to potential CoI) (2) Consensus (0% of the group abstained due to potential CoI) (3) Consensus (0% of the group abstained due to potential CoI)
Risk of bias Not applicable.
Effect sizes and their clinical relevance Not applicable.
Consistency Not applicable.
Balance of benefit and harm The main advantage of submerged healing would be to achieve pri- mary wound closure and to promote an aseptic healing environment, which are crucial factors for stabilizing the blood clot, improving graft stability and maximizing the regenerative potential of the intra-bony compartment. On the other hand, unsubmerged healing eliminates the need for prosthesis removal, reduces treatment time, costs and possi- bly the overall complexity of treatment.
Background
Intervention
Overall certainty of the evidence Very low.
As substantial evidence supports the bacterial aetiology of peri- implantitis, removal of the biofilm from contaminated implant surfaces is a crucial treatment step in obtaining disease resolution (Berglundh et al., 2018; Lang et al., 2011; Schwarz et al., 2018).
From evidence to recommendation — additional considerations
Available evidence
Acceptability It should be noted that a submerged healing protocol may result in the need of temporary tooth replacement.
Number and design of included studies In total, five RCTs (4 two-armed and 1 three-armed; 183 patients/242 implants) with follow-up periods ranging from 6 to 24 months were included (Ramanauskaite et al., 2023). One RCT investigated the alter- native use of air polishing with erythritol powder in conjunction with non-reconstructive surgical peri-implantitis therapy compared with standard instrumentation (Hentenaar et al., 2022); another RCT, with three arms, assessed the efficacy of titanium brushes (test 1) and air polishing with glycine powder (test 2) as alternative decontamination measures for implant surface decontamination compared with stan- dard instrumentation in conjunction with non-reconstructive surgical peri-implantitis therapy (control) (Toma et al., 2019); two RCTs
Feasibility Not applicable.
Ethical considerations Not applicable.
Economic considerations No study addressed health economic outcomes on this topic. It should be noted that unsubmerged healing eliminates the need of prosthesis removal, thus reducing treatment time and possibly costs.
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