Clinical Efficacy Of Traditional Chinese Medicine As An Adjuvant Therapy For The Treatment Of Peri-implantitis With Western Medicine:A Systematic Review And Meta-analysis

Objective: Peri-implantitis is one of the main causes of implant failures.At present,the topical strategy often predominates in peri-implantitis.It is difficult to achieve good therapeutic effects,which is likely due to the lack of consideration of entire organism regulation.As an adjuvant therapy to Western medicine,traditional Chinese medicine(TCM)may help deregulate the pathogenesis by regulating organism homeostasis,thus achieving anti-microbial and anti-inflammationas well as enhancing therapeutic stability.This paper aims to assess the clinical effectiveness of TCM as an adjuvant therapy to Western medicine therapy for the treatment of peri-implantitis systematically,demonstrating scientific evidence for the applicability advantages of this approach.Methods: Clinical trials about TCM as an adjuvant therapy to Western medicine therapy for the treatment of peri-implantitis were retrieved through computer and manual methods from databases including China National Knowledge Infrastructure(CNKI),VIP,Wan Fang,China Biomedical Literature Database(CBM),Pub Med,The Cochrane Library,Web of Science,and Ovid.The retrieval covered the period from database construction to January 2023.The quality of the included randomized controlled trials(RCTs)and non-randomized controlled trials(n RCTs)were evaluated according to the bias risk assessment tool recommended by Cochrane manual 5.1.0and methodological items for nonrandomized studies(MINORS),and the data of the included documents were extracted and cross-checked.Statistical analysis was performed using Rev Man 5.4 software and Stata 17.0 software.Results: In this study,10 kinds of literature involving 8 RCTs and 2 n RCTs,all of which were in Chinese,with 624 patients enrolled.The rate of effectiveness,probing depth(PD),sulcus bleeding index(SBI),plaque index(PLI),interleukin-6(IL-6),and interleukin-1(IL-1β)were used in the analysis as outcome indicators.Meta-analysis results showed that,compared with Western medicine therapy alone,TCM adjuvant therapy was able to improve the rate of effectiveness[RR=1.21(95%CI: 1.11,1.31),P<0.00001],reduce PD [WMD=0.62(95%CI: 0.44,0.80),P<0.00001],IL-6 [SMD=0.38(95%CI: 0.15,0.61),P=0.001],and IL-1β[SMD=0.64(95%CI: 0.40,0.88),P<0.00001],and improve SBI [SMD=0.64(95%CI:0.45,0.82),P<0.00001],and PLI [SMD=0.81(95%CI: 0.53,1.08),P<0.00001].Conclusion: The current evidence indicates that,compared with Western medicine therapy alone,TCM adjuvant therapy for the treatment of peri-implantitis effectiveness is significantly increased,while periodontal indexes are significantly reduced such as PD,SBI,and PLI,as well as the levels of proinflammatory cytokines such as IL-6 and IL-1β.Due to the limited quality and quantity of the included studies,more randomized controlled clinical trials with high quality,large sample sizes,and long follow-up times are required in the future to verify the above findings.