Se evalúa el efecto añadido de la instrumentación subgingival previa al tratamiento quirúrgico de la periimplantitis en un ensayo clínico multicéntrico. El estudio buscó determinar si esta fase adicional no quirúrgica, realizada seis semanas antes de la cirugía, mejoraba los resultados clínicos en comparación con la instrumentación supragingival aislada. Los parámetros analizados incluyeron la reducción de la profundidad de sondaje, el éxito del tratamiento definido por criterios específicos (ausencia de pérdida de implantes, progresión ósea limitada, ausencia de sangrado o supuración y profundidad de sondaje reducida) y otros parámetros secundarios y exploratorios. Los hallazgos sugieren que la instrumentación subgingival previa no ofreció beneficios clínicos significativos a los 12 meses en términos de profundidad de sondaje o éxito del tratamiento, aunque requirió una menor duración del tratamiento no quirúrgico en el grupo control. Se necesitan estudios a mayor escala para confirmar estos resultados y optimizar los protocolos de manejo de la periimplantitis.
Aim The present multi‐centre randomized clinical trial with 12 months of follow‐up aimed at studying the added effect of sub‐marginal instrumentation before surgical treatment of peri‐implantitis. Materials and Methods Forty‐two patients diagnosed with peri‐implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra‐ and sub‐marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra‐marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12‐month examination were regarded as the primary outcomes of the trial. Results At the 12‐month examination, changes in the deepest PPD with respect to baseline amounted to −2.96 mm in the control group and to −3.11 mm in the test one (MD = −0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non‐surgical treatment duration in the control group (differences in = −14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft‐tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra‐operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. Conclusions The present multi‐centre randomized clinical trial did not demonstrate an added effect of performing sub‐marginal instrumentation 6 weeks before the surgical treatment of peri‐implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).
Romandini M, Laforí A, Pedrinaci I, Baima G, Ferrarotti F, Lima C, et al. Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial. Journal of Clinical Periodontology. 2022. doi:10.1111/jcpe.13713
