66
HERRERA ET AL .
Background
Ethical considerations The lack of efficacy together with possible side effects, such as hyper- sensitivity, suggests that these treatments are not justified. Economic considerations The additional costs associated with adjunctive PDT therapy are not justified.
Intervention
Adjunctive antimicrobial chemical therapy is an approach used to improve the standard implant surface decontamination methods. CHX has antiseptic properties that kill bacteria. PDT functions by light acti- vation of a photosensitizing dye to generate reactive oxygen species that destroy those bacteria.
Legal considerations PDT is an off-label use during surgery, with no clear benefits.
Available evidence
Number and design of included studies Evidence was available for PDT from two RCTs ( n = 43) and for CHX from two RCTS ( n = 130) (Wilensky et al., 2023). Both with a follow- upof ≥ 6 and up to 12 months. Only RCTs reporting mean PD changes and BOP changes were included. Risk of bias For PDT, the risk of bias was low to unclear, and for CHX it was unclear to high risk of bias. Effect sizes and their clinical relevance No benefits were observed with the adjunctive application of CHX; no improvement was observed for PDT in terms of PD reduction, and only minor reductions in BOP (MD = 7.4).
8.5
| Adjunctive use of local/systemic
antimicrobials
R8.13. Do adjunctive systemically administered antibiotics improve clinical outcomes of surgical treatment of peri-implantitis?
PICOS question addressed by an SR
R8.13: Evidence-based recommendation Due to concerns about patients' health and the impact of systemic antibiotic use on public health and inconsistent evidence, its use as adjunct to surgical therapy of peri-implantitis is not recommended . Supporting literature (Teughels et al., 2023) Quality of evidence Low Grade of recommendation GradeA — ## Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Consistency For PDT, heterogeneity was low, and for CHX it was medium to high.
Balance of benefit and harm One study did not report on adverse events, while three studies reported no to minor adverse effects. One study reported gastrointes- tinal problems in five patients who were taking systemic antibiotics. One study reported no adverse effects, and another study reported two patients with one complication. Overall certainty of the evidence The GRADE analysis showed a very low certainty of evidence for both adjunctive treatments in all the tested parameters.
Background
Intervention
Tissue destruction at peri-implantitis sites is more pronounced than periodontitis around teeth due to anatomical differences, larger size of the inflammatory lesion and extent of the lesion to the bone crest. Therefore, clinicians are tempted to use systemic antibiotics in addi- tion to the surgical treatment of peri-implantitis.
From evidence to recommendation — additional considerations
Acceptability None of the studies reported patient-reported outcomes and there is no evidence supporting one approach over the other, including the standard therapy. Feasibility While CHX solution is affordable and easily available, PDT results in additional costs without any documented clinical benefit.
Available evidence
Number and design of included studies Two RCTs including 49 patients (25 test and 24 control) and 39 patients (20 test and 19 control) and followed for 1 year showed inconsistent results in terms of PD, BOP and bone level changes: one assessed the systemic application of amoxicillin, 750 mg, twice per
Made with FlippingBook Annual report