Efficacy of a Surgical versus a Nonsurgical Approach in the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis.

The objective of the study was to compare the surgical vs. the nonsurgical techniques in the treatment of peri-implant diseases and to obtain a comprehensive analysis of the effects on BOP/probing depths when applying either the surgical technique vs. a nonsurgical technique. Twenty-seven articles with a total of 29 trials were selected from PubMed, Medline, Embase and Cochrane library. The articles were published in the past 10 years and complied with the inclusion criteria. Three metanalyses were performed evaluating the effects of surgical and nonsurgical treatments on the reduction in probing depths as well as on bleeding on probing. Fifteen studies involved the treatment of peri-implant diseases with the surgical approach and 14 studies involved the application of the nonsurgical protocol (6 treating peri-implantitis and 8 treating mucositis). A mean reduction in probing depths of 2.31 mm were obtained when the surgical approach was applied for peri-implantitis and a mean of 57% reduction in bleeding on probing was obtained with the surgical protocols. Inflammation was significantly reduced when nonsurgical protocols were applied for mucositis. The highest reduction in probing depths and bleeding on probing was found when emdogain was used with allograft and resorbable membranes. Nonsurgical treatments with extensive hygiene measures were mainly indicated in the treatment of mucositis and do not present bone gain but lowers or maintains probing depths and reduced bleeding on probing. Further studies should be performed with a standardized definition of peri-implantitis with the same surgical or nonsurgical protocol applied as well as the same follow-up period in order to correctly identify the ideal treatment of choice.