A systematic review and Bayesian network meta-analysis of randomized clinical trials on non-surgical treatments for peri-implantitis.

BACKGROUND/AIM: It remains unclear which type of non-surgical treatment is most appropriate as first-line intervention against peri-implantitis. This systematic review and Bayesian network meta-analysis aimed to compare the clinical effect of various non-surgical peri-implantitis therapies. METHODS: The PubMed, SCOPUS, CINAHL, DARE and Web of Knowledge databases were searched in duplicate for randomized controlled trials (RCTs) up to and including 01 January 2014. Additional relevant literature was identified using handsearching of reference lists within published systematic reviews, and screenings of OpenGrey, ClinicalTrials.gov and Controlled-Trials.com. Probing pocket depth (PPD) was the outcome measure assessed. Multilevel mixed modelling was used to perform the network meta-analysis, and Markov Chain Monte Carlo simulation to obtain random effects. RESULTS: Eleven studies were included in the network meta-analysis. Debridement in conjunction with antibiotics achieved the greatest additional PPD reduction in comparison to debridement only (0.490 mm; 95% credible interval: -0.647;1.252). The highest probabilities of being the most effective interventions were achieved by Vector system (p = 20.60%), debridement plus periochip (p = 20.00%) and photodynamic therapy (p = 18.90%). CONCLUSION: The differences between various non-surgical treatments were relatively small with large credible intervals. On the basis of currently available RCTs, there is insufficient evidence to support that any particular non-surgical treatment for peri-implantitis showed better performance than debridement alone.