Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis.

Aim: To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis. Materials and Methods: Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Results: Evidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5–0.9) for every millimetre in increase of mean PD at baseline. During the follow‐up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Conclusions: Access flap and pocket elimination surgery are effective procedures in the management of peri‐implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions. [ABSTRACT FROM AUTHOR]