Clinical outcomes of peri-implantitis treatment and supportive care: A systematic review

Objectives: To report the clinical outcomes for patients with implants treated for peri-implantitis who subsequently received supportive care (supportive peri-implant/periodontal therapy) for at least 3 years. Material and methods: A systematic search of multiple electronic databases, grey literature and hand searching, without language restriction, to identify studies including ≥10 patients was constructed. Data and risk of bias were explored qualitatively. Estimated cumulative survival at the implant- and patient-level was pooled with random-effects meta-analysis and explored for publication bias (funnel plot) at different time intervals. Results: The search identified 5,761 studies. Of 83 records selected during screening, 65 were excluded through independent review (kappa = 0.94), with 18 retained for qualitative and 13 of those for quantitative assessments. On average, studies included 26 patients (median, IQR 21–32), with 36 implants (median, IQR 26–45). Study designs (case definitions of peri-implantitis, peri-implantitis treatment, supportive care) and population characteristics (patient, implant and prosthesis characteristics) varied markedly. Data extraction was affected by reduced reporting quality, but over 75% of studies had low risk of bias. Implant survival was 81.73%–100% at 3 years (seven studies), 74.09%–100% at 4 years (three studies), 76.03%–100% at 5 years (four studies) and 69.63%–98.72% at 7 years (two studies). Success and recurrence definitions were reported in five and two studies respectively, were heterogeneous, and those outcomes were unable to be explored quantitatively. Conclusion: Therapy of peri-implantitis followed by regular supportive care resulted in high patient- and implant-level survival in the medium to long term. Favourable results were reported, with clinical improvements and stable peri-implant bone levels in the majority of patients.