Reassessing the Use of Membranes in Peri-Implantitis Surgery: A Systematic Review and Meta-Analysis of In Vivo Studies

Peri-implantitis (PI) presents a growing challenge in implant dentistry, with regenerative surgical approaches often incorporating barrier membranes despite the uncertainty of their clinical value. This systematic review and meta-analysis of in vivo studies aimed to evaluate the efficacy of barrier membranes in the reconstructive surgical treatment of PI. A comprehensive electronic search was performed in PubMed, Scopus, Google Scholar, and the Cochrane Library, covering studies published from 1990 to 2024. The protocol followed PRISMA guidelines and was registered in PROSPERO (CRD42025625417). Eligible studies included in vivo investigations comparing regenerative procedures with and without membrane use, with a minimum follow-up of 6 months and at least 10 implants per study. Risk of bias (RoB) was assessed using the Cochrane RoB tool. The meta-analysis was conducted using a random-effects model and included 15 studies comprising 560 patients. Although not consistently statistically significant, the findings suggested that membrane use may offer enhanced outcomes in terms of probing pocket depth (PPD) reduction and marginal bone level (MLB) gain. The evidence was limited by high clinical heterogeneity, variability in outcome definitions, and short follow-up durations. While membranes are commonly utilized, current evidence does not justify their routine use. Further well-designed, long-term clinical trials are needed to establish specific indications and optimize treatment strategies.