Peri-implantitis — absence of evidence to support specific treatment protocols: Which anti-infective therapies are effective in peri-implantitis?

Data sources Medline was searched to January 2002. Manual searches were made of the Journal of Periodontology, Journal of Clinical Periodontology, International Journal of Maxillofacial Implants, Clinical Oral Implants Research and Clinical Implant Dentistry and Related Research dated to December 2001, and of bibliographies of all relevant articles. There were no language restrictions. Study selection Human studies were included if they provided a clinical diagnosis and treatment of peri-implantitis. Animal experiments on the treatment of peri-implantitis were also included. Data extraction and synthesis Information regarding quality and study characteristics was extracted independently by two reviewers. A qualitative summary of included studies was carried out. Results No clinical randomised controlled trials (RCT) were available. Six human and 15 animal studies were identified. A multitude of treatment regimens, including anti-infective therapy, was reported. The antibiotic regimens varied between studies. No standardised medication protocol was used. Type of antibiotic, dosage, duration and time for initiation of antibiotic treatment were different for all studies, but details were not always reported. A nonmedicated control group was reported in one animal experiment only. The outcomes following anti-infective treatment of peri-implantitis are highly variable. Conclusions Several anti-infective treatment strategies have demonstrated a beneficial clinical effects in humans but there is insufficient evidence to support a specific treatment protocol. All studies had only a small number of subjects and the study periods, in general, were relatively short. No evidence exists on the significance of anti-infective treatment for the longevity of the implant. Clinical RCT for the treatment of peri-implantitis should be conducted.