The Effect of Nonaugmentative Approaches in the Surgical Treatment of Peri-implantitis: A Systematic Review and Network Meta-analysis

PURPOSE: This systematic review and Bayesian network meta-analysis (NMA) were performed to compare the clinical effects of nonaugmentative adjunctive approaches in the surgical treatment of peri-implantitis. MATERIALS AND METHODS: A systematic search of six electronic databases was performed up to June 20, 2020. Additional relevant literature was identified through gray literature and hand searches. Randomized controlled trials (RCTs) of surgical treatment of periimplantitis with nonaugmentative adjunctive approaches were included. Probing depth (PD) changes, marginal bone level (MBL) changes, and treatment success rates were extracted and assessed. Pairwise meta-analysis and Bayesian NMA were performed. This review was registered at PROSPERO (CRD42020191113). RESULTS: The search yielded 7,419 articles, of which 10 studies with 11 articles were included in the quantitative analysis. In the NMA of mechanical approaches and photodynamic therapy (PDT), compared with hand curettes, implantoplasty provided significant additional PD improvement at the 6-month follow-up evaluation (mean difference [MD]: 1.29; 95% confidence interval [CI]: 0.17, 2.38) and 12-month follow-up evaluation (MD: 1.39; 95% CI: 0.91, 1.74). In the NMA of antiseptics and systemic antibiotics, adjunctive use of antiseptics and/or systemic antibiotics did not provide significant improvement in PD or MBL. In the NMA of all adjunctive approaches, no significant differences were found in PD improvements. CONCLUSION: Within the limitations of this systematic review and NMA, implantoplasty is more effective than hand curettes in improving PD in the surgical treatment of peri-implantitis. Chemical antiseptics or systemic antibiotics have a limited effect on improving PD and MBL.