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HERRERA ET AL .
Balance of benefit and harm Harms have not been explicitly reported and evaluated in two RCTs. A slight pigmentation of peri-implant soft tissues was observed in one out of 30 patients treated with implantoplasty. One RCT reported on adverse events observed in one out of 16 patients associated with persistence of suppuration and swelling following air polishing. Another RCT reported on membrane exposure during the healing, fol- lowing reconstructive therapy of peri-implantitis, however, without providing the number of implants/patients experiencing this complication. Overall certainty of the evidence The evidence was graded as low due to a low number of studies with a considerable heterogeneity.
investigated the efficacy of Er:YAG laser compared with either stan- dard instrumentation (Schwarz et al., 2012) or debridement with pie- zoelectric scaler and stainless-steal scaler (Wang et al., 2021) during reconstructive therapy and as an adjunct to implantoplasty; and one RCT evaluated the added value of a titanium brush, on top of ultra- sonic decontamination and hydrogen peroxide in regenerative surgery (de Tapia, Valles, et al., 2019). Risk of bias Based on RoB 2, two RCTs were judged to have an overall low risk of bias, two RCTs had an overall high risk of bias and one RCT had an unclear risk of bias. Effect sizes and their clinical relevance Based on two RCTs with 6- to 12-month follow-ups, the adjunctive/ alternative use of an air-abrasive device with glycine or erythritol powders did not result in improved BOP reductions compared with the control during surgical therapy of peri-implantitis (Hentenaar et al., 2022; Toma et al., 2019). One RCT indicated a significantly higher PD reduction following the alternative use of air polishing with glycine powder and titanium brushes compared with the standard decontamination (Toma et al., 2019). Based on one RCT, after 6 months, alternative use of titanium brush resulted in significantly higher BOP reduction compared with either air polishing or the stan- dard instrumentation (i.e., curettes to remove hard deposits plus gauze soaked in saline/saline irrigation) (Toma et al., 2019). During reconstructive therapy, a titanium brush resulted in signifi- cantly greater reduction of the deepest PD values compared with the control group (i.e., mechanical and chemical implant surface decon- tamination) (de Tapia, Valles, et al., 2019). An Er:YAG laser resulted in significantly higher PD reductions after 6 months in one RCT, but was not associated with improved BOP reductions over respective control measures (i.e., implantoplasty and standard instrumentation or debridement with piezoelectric scaler and stainless-steal scaler) as shown in two RCTs (Schwarz et al., 2012; Wang et al., 2021). Consistency Two RCTs reported on no benefit of air polishing either with ery- thritol or glycine powder on the reduction of BOP values (Hentenaar et al., 2022; Toma et al., 2019). A beneficial effect of the use of a titanium brush was reported in two RCTs in terms of BOP (Toma et al., 2019) and PD reductions (de Tapia, Valles, et al., 2019). Two RCTs consistently reported on no benefits of Er:YAG laser on changing BOP values after 6 and 12 months in con- junction with reconstructive therapy and as an adjunct to implanto- plasty (Schwarz et al., 2012; Wang et al., 2021). Inconsistencies were found between the studies with respect to the PD changes following Er:YAG laser application. In fact, significantly higher PD reduction following the use of Er:YAG laser was reported after 6 months in one RCT (Wang et al., 2021), whereas after 24 months another RCT indicated no benefits of ER:YAG laser in reducing PD values (Schwarz et al., 2012).
From evidence to recommendation — additional considerations
Acceptability None of the studies investigated PROMs.
Feasibility Certain decontamination protocols may be considered as technically demanding.
Ethical considerations Certain decontamination protocols have not been tested for safety.
Economic considerations Economic aspects could not be assessed due to the lack of reporting.
Legal considerations Not applicable.
R8.12. Do chemical implant surface decontamination procedures improve outcomes of surgical treatment?
PICOS question addressed by an SR
R8.12: Evidence-based recommendation We suggest not to use chlorhexidine or photodynamic therapy for implant surface decontamination during surgical therapy of peri- implantitis . Supporting literature (Wilensky et al., 2023) Quality of evidence Very low (due to uncertainty of evidence) Grade of recommendation GradeB — # Strength of consensus Consensus (1.7% of the group abstained due to potential CoI)
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