Disease recurrence after surgical treatment of peri-implantitis—systematic review and meta-analysis

Background: Peri-implantitis is a destructive pathology with a considerable prevalence. Peri-implantitis surgical treatment is still unpredictable. In order to help clinicians do decide about the applicability of peri-implantitis surgical treatment a systematic review and meta-analysis was conducted to evaluate the rate of peri-implantitis recurrence (RecPI) and implant loss (LoPI) after surgical treatment of peri-implantitis.Methods: A search of randomized trials including patients submitted to surgical treatment of peri-implantitis was performed. Two independent reviewers screened titles and abstracts and selected full papers for full reading according the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) methodology. Analyzed patient centered outcomes were RecPI and LoPI after a minimum follow-up of 6 months. Surgical approaches were divided in open flap debridement (OFD), regenerative (REG), resective (RES), implantoplasty (IP) and combined (COMBI). Also results considering short, medium and long term follow up were analyzed. For each meta-analysis, a forest-plot was prepared and the heterogeneity was analyzed by the Cochran Q test and by the I2 heterogeneity statistic, with a significance level of 0.05.Results: Thirteen randomized controlled trials (RCTs) were eligible for quantitative synthesis. The RecPI and LoPI was 3% (95% CI: 1% to 5%) and 4% (95% CI: 2% to 6%) respectively. COMBI surgical approach was associated with the highest RecPI rate 7% (95% CI: –2% to 15%) and REG surgery with the lowest 2% (95% CI: –1% to 6%). OFD had the highest LoPI rate 15% (95% CI: –11% to 41%) and REG approach was associated with the lowest 3% (95% CI: 0% to 6%). Regarding short-term follow-up periods 3% (95% CI: 1% to 5%) and 4% (95% CI: 2% to 6%) of the patients had RecPI and LoPI, respectively. For the long term follow-up LoPI was 36% (95% CI: 15% to 55%). There were no data that allow to calculate medium term follow up for RecPI and LoPI and long term for RecPI.Conclusions: The RecPI and LoPI are similar and low, 3% and 4%, respectively. After 12 months of follow-up RecPI and LoPI are low but LoPI increases to 36% at the long term follow up. Results should be interpreted with caution due to heterogeinity.