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Interventions for replacing missing teeth: treatment of perimplantitis

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Abstract

Background

One of the key factors for the long‐term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective.

Objectives

To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants.

Search methods

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 28 June 2004.

Selection criteria

All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. We contacted the authors for missing information. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

Main results

Only two eligible trials were identified, but one was excluded due to insufficient data presented. The included study compared the use of locally applied metronidazole gel versus ultrasonic debridement in patients affected possibly by a slight form of perimplantitis. Both interventions were repeated 1 week after. Twelve weeks after treatment there was no statistically significant difference in probing pocket depths among the two groups (mean difference = 0.1; 95% CI ‐0.59 to 0.79). No side effects occurred. This trial was judged to be at high risk of bias.

Authors' conclusions

There is no reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. More quality research is needed.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

As with natural teeth, dental implants can be lost due to gum disease (perimplantitis). This review looked at which are the most effective treatments to arrest perimplantitis.

Only one study was included in the review and evaluated whether local antibiotics are more effective than cleaning implants with ultrasonic instruments in patients possibly affected by a slight form of perimplantitis. Twelve weeks after treatment there was no difference in healing among the two groups. However, this trial was judged to be at high risk of being not reliable.
In conclusion, at present, there is no reliable evidence to determine which is the most effective way to treat perimplantitis. This is not to say that currently used interventions are not effective.