Objective: To answer the following PICO question: “In patients requiring surgical treatment of peri‐implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?”Methods: Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri‐implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full‐text analysis, extracted data, and performed the risk‐of‐bias assessment. Whenever possible, results were summarized through random effects meta‐analyses.Results: Twenty‐two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta‐analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = −0.24 mm, 95% confidence interval [CI] [−1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [−0.69; 2.55], p = .26), even if with substantial heterogeneity.Conclusions: No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short‐term clinical benefits in terms of treatment success (CRD42020182303).

Aim: To analyse the efficacy of non‐surgical therapy (NST) in terms of pocket closure (PC) and changes in percentage and number of pockets.Materials and Methods: Three databases (PubMed, EMBASE, and Scopus) were searched up to January 2020. Prospective studies with a minimum follow‐up of 12 months and presenting data in terms of PC or number or percentage of pocket depths (PDs) before and after NST on systemically healthy patients were included. Random‐effect meta‐analyses were performed.Results: After screening 4610 titles and abstracts, 27 studies were included. Of these, 63.9% of PC was reported by one study. The percentage of PDs ≤3 mm changed from 39.06% to 64.11% with a weighted mean difference (WMD) of 26.14% (p < .001). This accounted for a relative increase of healthy sites of 64.13%. The mean percentage of PD ≥5 mm was 28.23% and 11.71% before and after treatment, respectively, with a WMD of 15.50% (p < .001). The WMD in the number of PDs ≥5 mm before and after treatment was 24.42 (p = .036). The mean number of residual PPD ≥5 after NST was 14.13.Conclusions: NST is able to eradicate the majority of the pockets. However, residual pockets after NST may remain and should be considered cautiously for further treatment planning.