Peri-implant mucositis – are chemical adjunctive therapies effective? Part 2!

PD Dr. Kristina Bertl, PhD MSc MBA

The 18th European Workshop on Periodontology was held in autumn 2022. The subject of the workshop was the treatment of peri-implant diseases – both peri-implant mucositis and peri-implantitis. An earlier report („Peri-implant mucositis – are chemical adjunctive therapies effective?'') summarised the results on the treatment of peri-implant mucositis with chemical adjunctive therapies applied in dental practices. However, the workshop also includes a second part on the treatment of peri-implant mucositis, which looks at measures that the patient can take themselves locally or implement systemically.

Peri-implant mucositis – are chemical adjunctive therapies effective? Part 2!

This systematic review by Gennai and colleagues (2023) sthe results of 14 studies (16 publications); all the studies looked at the treatment of peri-implant mucositis and had a minimum follow-up period of three months. Purely mechanical cleaning was compared with mechanical cleaning combined with an additional measure locally applied or taken systemically by the patient.

Generally speaking, the test groups using an additional measure showed a significantly higher reduction in bleeding and plaque indices as well as probing pocket depths for up to 6 months after treatment compared to purely mechanical cleaning. In the case of the bleeding indices, antiseptics in the form of mouth-rinse solutions proved to be the most effective, followed by probiotics and systemic antibiotics. However, systemic antibiotics should not be administered due to the risk of developing resistance in the case of peri-implant mucositis (Ramanauskaite 2021). Unfortunately, there is insufficient data on additional oral hygiene items (interdental brushes, oral irrigators) and the actual success rate (= peri-implant mucositis fully healed) was only reported in 6 of the 14 studies and was subject to wide variation (36 to 95% after 3 months). Due to the paucity of studies reporting the success rate, it is also not possible to draw any clear conclusions here.

As such, we have drawn a similar conclusion to that in our earlier report. The primary treatment recommendation for patients with peri-implant mucositis is: 1) optimisation of access to home oral hygiene and optimum education of the patients, and 2) mechanical cleaning of the prosthetic restoration. The additional use of local antiseptics or probiotics could however have a positive effect. Nevertheless, this should be followed up closely, as a 100% success rate cannot be guaranteed, and more frequent recurrence can be expected.

Reference

1. Gennai, S., Bollain, J., Ambrosio, N., Marruganti, C., Graziani, F., & Figuero, E. (2023). Efficacy of adjunctive measures in peri-implant mucositis. A systematic review and meta-analysis. Journal of Clinical Periodontology, 1–27. Ramanauskaite A, Fretwurst T, Schwarz F (2021) Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent. 15;7(1):112.