Meta-analysis Of The Clinical Efficacy Of Glycine Powder Air-polishing Instead Of Mechanical Debridement In The Treatment Of Peri-implantitis

Objective:Mechanical debridement(MD)is the primary method for the non-surgical treatment of peri-implantitis,aiming to remove plaque biofilm on the implant surface and reduce microbial load and inflammatory parameters.In recent years,air-polishing based on glycine powder with low wear performance can quickly remove dental plaque and implant surface,with little change in implant surface morphology and almost no damage to gingival mucosa and periodontal tissue.This study evaluated the clinical efficacy of glycine powder air-polishing(GPAP)instead of mechanical debridement in the treatment of peri-implantitis by evidence-based Meta-analysis.Methods:Intervention studies relevant to glycine air-polishing versus mechanical debridement,including ultrasounds and curettes,for treating peri-implant diseases were retrieved through computer and manual methods.The database included:China National Knowledge Infrastructure(CNKI),VIP,Wan fang,Du Xiu,China Biomedical Literature Database(CBM)),PubMed,The Cochrane Library,Web of Science,Scopus,and other databases.The retrieval time is from the database construction to September 2021.The quality of the included Random controlled Trials(RCT)and non-random controlled trials(nRCT)was assessed according to the Cochrane Risk Bias assessment tool and the MINORS items.and data were extracted and cross-checked from the included literature.Statistical analysis was performed using Stata 16 software.Weighted mean differences(WMD)and 95%confidence intervals(CI)were used to combine effect sizes.The Q test and I2 test based on Chi-square value were used to test heterogeneity,and Egger linear regression test was used to detect publication bias.The effect of a single study on the combined effect size was analyzed for sensitivity analysis.Results:Nine publications were included in this study,including 8 RCT and I nRCT,including 4 Chinese publications and 5 English publications.291 subjects were included,144 in the test group and 147 in the control group.The probing depth(PD),clinical attachment level(CAL),plaque index(PLI),and bleeding on probing(BOP)were included as outcome indicators.The follow-up time of the included literature was significantly different.The difference between 13 months and 6-12 months after treatment and the clinical indicators at baseline was combined with the effect size for meta-analysis.1.PD reduction was statistically significant at 1-3 months[WMD=0.091,95%CI(0.055,0.128),P<0.0001]and 6-12 months[WMD=0.543,95%CI(0.187,0.899),P=0.003].The clinical effect of GPAP is better than MD.2.The amount of CAL obtained was not statistically significant at 1-3 months of followup[WMD=0.026,95%CI(-0.419,0.472),P=0.907],but there was statistically significant difference at 6-12 months of follow-up[WMD=0.488,95%CI(0.009,0.966),P=0.046).3.There was no statistical significance in PLI reduction at 1-3 months of follow-up[WMD=-0.024,95%CI(-0.080,0.032),P=0.401]or at 6-12 months of follow-up[WMD=0.003,95%CI(-0.330,0.337),P=0.985].GPAP was not superior to MD in improving plaque index.4.The decrease in BOP was statistically significant at 1-3 months[WMD=8.33,95%CI(5.34,11.32),P<0.0001]and 6-12 months[WMD=21.72,95%CI(10.51,32.92),P<0.0001].GPAP has a significant advantage over MD in improving BOP.5.Egger’s test showed publication bias in PLI reduction at 6-12 months follow-up(P=0.029<0.05).Conclusion:Compared with traditional mechanical debridement,GPAP can improve the clinical efficacy of peri-implantitis,mainly in the reduction of probing depth,improvement of probing bleeding,and improvement of clinical attachment level during 6-12 months of follow-up but has no advantage in the improvement of plaque index.