Does Patient Adherence Influence the Ability of Supportive Periodontal Therapy to Maintain Stability Around Teeth and Dental Implants - A Systematic Review

Purpose: After completion of active periodontitis and/or peri-implantitis therapy, patients transition to an individualised follow-up maintenance phase to maintain periodontal and peri-implant stability. This systematic review aims to assess whether patient adherence to supportive periodontal care(SPC) and supportive peri-implant care (SPIC) influences long-term clinical outcomes, particularly probing depth, to maintain periodontal and/or peri-implant health.

Materials and methods: Using the PECO method, the following specific question was addressed: Among successfully treated periodontitis patients with or without dental implants (P), does non-adherence (E) compared to adherence (C) to supportive periodontal or peri-implant care (SPC/SPIC) affect clinical outcomes associated with maintenance of periodontal or peri-implant health(O), based on comparative longitudinal studies (S) with a minimum follow-up of one year (T)? The following electronic databases were systematically searched: MEDLINE, Embase, Cochrane Library, Google Scholar. This was supplemented by additional manual search strategies. Due to heterogeneity in adherence definitions and outcome measures, a structured narrative synthesis was carried out (PROSPERO CRD42022371423).

Results: A total of 3891 articles were selected in a primary search. Subsequently, seven studies were deemed eligible for inclusion in this review. Across these, adherence to supportive care was consistently associated with improved clinical outcomes, including reduced probing depths, lower bleeding on probing, and reduced tooth or implant loss. Due to the heterogeneity of the data, no meta-analysis was performed.

Conclusions: Adherence to SPT/SPIC was consistently associated with more favorable clinical outcomes in the included studies. Future studies are necessary and should consider (i) applying consistent definitions for adherence/non-adherence based on clinical status in relation to need for intervention, (ii) time interval between SPT/SPIC intervention, (iii) consistency in data collection protocols during interventions.