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

## TL;DR

This study reviews the effectiveness of different tools for cleaning around dental implants to reduce inflammation, finding that while some tools help, evidence is limited.

## Contribution

The study systematically evaluates and compares the efficacy of various interproximal cleaning devices for managing peri-implant mucositis.

## Key findings

- Oral irrigators and interdental brushes showed higher but not significant improvement in reducing inflammation compared to dental floss.
- Meta-analysis found no significant difference between toothbrushing alone and toothbrushing with an oral irrigator in reducing BOP and PI.
- All devices showed some effectiveness in controlling biofilm and inflammation, but evidence remains limited.

## Abstract

A well-defined protocol for self-performed interproximal oral hygiene around implant-supported restorations is currently lacking.

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.

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.

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.

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.