Optimizing implant hygiene: the added value of interproximal cleaning devices around implant-supported restorations-a systematic review and meta-analysis.

Abstract

<h4>Statement of problem</h4>A well-defined protocol for self-performed interproximal oral hygiene around implant-supported restorations is currently lacking.<h4>Purpose</h4>To assess the efficacy of home-care interproximal cleaning measures used adjunctively to mechanical toothbrushing in reducing signs of inflammation in patients with peri-implant mucositis.<h4>Methods</h4>A systematic electronic literature search followed by a manual search using the PRISMA guidelines was performed. Randomized controlled trials and prospective studies evaluating the effectiveness of different interproximal cleaning devices in reducing inflammation signs in patients with peri-implant mucositis were selected according to pre-determined inclusion and exclusion criteria. The meta-analysis was carried out using the Rev Man 5.4 software program.<h4>Results</h4>Out of a preliminary pool of 792 articles, 6 relevant studies were identified for final evaluation. Interproximal cleaning devices investigated were: dental floss, interproximal brush, oral irrigator(water), oral irrigator(CHX). The following clinical variables were analysed: plaque index(PI), gingival index(GI), bleeding on probing (BOP) and interleukin 6. Due to hetergeneity, only two studies fulfilled the eligibility criteria for meta-analysis. Oral irrigators and interdental brushes showed a higher but not-significant improvement in signs of peri-implant mucositis than dental floss. The meta-analysis revealed no statistically significant difference between toothbrushing alone and toothbrushing with an oral irrigator (water) in reducing BOP and PI.<h4>Conclusion</h4>All interproximal cleaning devices evaluated in this review demonstrated some degree of effectiveness in controlling biofilm accumulation and mitigating peri-implant inflammation. However, evidence on self-performed oral hygiene around dental implants-especially concerning interproximal devices-remains limited.