The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis

Aim: To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP) and suppuration (SOP) in peri-implantitis-related bone defects at ≥ 12-month follow-up. Materials and methods: Three databases were searched for RCTs and CCTs that compared bone reconstructive therapies to access flap surgery (Focused Question - FQ 1) and RCTs, CCTs and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when ≥3 studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. Results: Seven RCTs were identified for FQ1, while 5 RCTs and 6 prospective case series for FQ2. There was no significant difference in PPD change between access flap surgery and reconstructive surgery (-0.387; p=0.325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. Conclusions: Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to access flap surgery at 12-months. It was not possible to establish a hierarchy of efficacy amongst the different biomaterials employed for reconstructive surgery. This article is protected by copyright. All rights reserved.