title: The efficacy of interventions to treat peri-implantitis: a Cochrane systematic review of randomised controlled clinical trials.
abstract: OBJECTIVE
  To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants.
  
  
  METHODS
  The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched and several journals were handsearched with no language restriction up to January 2008.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing interventions for treating peri-implantitis were eligible. Screening of studies, quality assessment and data extraction were conducted in duplicate. Missing information was requested. Outcome measures were: implant failure; complications; changes in radiographic marginal bone level, probing 'attachment' level (PAL), probing pocket depth (PPD), and recession; aesthetics evaluated by patients and dentists; cost and treatment time.
  
  
  RESULTS
  Ten eligible trials were identified, and seven were included (148 patients). They tested: (1) local antibiotics vs ultrasonic debridement; (2) adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser vs manual debridement and chlorhexidine irrigation/ gel; (5) systemic antibiotics plus resective surgery plus two local antibiotics with and without implant surface smoothening; and (6) nanocrystalline hydroxyapatite vs Bio-Oss and resorbable barriers. Follow up ranged from 3 months to 2 years. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of peri-implant bone showed improved PAL and PPD (0.6 mm). After 6 months, peri-implant infrabony defects > 3 mm treated with Bio-Oss and barriers gained 0.5 mm more PAL and PPD than those treated with hydroxyapatite. In four trials subgingival mechanical debridement seemed to achieve results similar to more complex therapies.
  
  
  CONCLUSIONS
  There is very little reliable evidence suggesting which could be the most effective interventions for peri-implantitis. Sample sizes were too small and follow up too short. This is not to say that currently used interventions are ineffective. Larger well-designed RCTs are needed.
authors.affiliation: Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. espositomarco@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Grusovin
authors.forename: Paul
authors.initials: P
authors.lastname: Coulthard
authors.forename: Helen V
authors.initials: HV
authors.lastname: Worthington
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use; D003646:Debridement; D015921:Dental Implants / Q000009:adverse effects*; D019232:Dental Restoration Failure; D005500:Follow-Up Studies; D006801:Humans; D016348:Osseointegration / Q000502:physiology; D010518:Periodontitis / Q000145:classification / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D018786:Bone Substitutes; D015921:Dental Implants