Adjunctive benefits of systemic metronidazole on non‐surgical treatment of peri‐implantitis. A randomized placebo‐controlled clinical trial

Abstract

Aim To study clinical, radiographic, and microbiological outcomes after non‐surgical therapy of peri‐implantitis with or without adjunctive systemic metronidazole. Materials and Methods A randomized placebo‐controlled clinical trial was carried out in 32 subjects (62 implants) diagnosed with peri‐implantitis. Implants received a mechanical non‐surgical debridement session and systemic metronidazole or placebo. Clinical, radiographic, and microbiological outcomes were evaluated at baseline, 3, 6, and 12 months. Results After 12 months, the test treatment resulted in significantly greater PPD reduction (2.53 vs. 1.02 mm) and CAL gain (2.14 vs. 0.53 mm) (p value <.05) in comparison with placebo. The test treatment also resulted in additional radiographic bone gain (2.33 vs. 1.13 mm) compared with placebo (p value <.05). There was a significantly greater decrease in Porphyromonas gingivalis, Tannerella forsythia, and Campylobacter rectus counts compared with the control group (p value <.05). At the end of follow‐up, 56.3% of patients met the success criteria in the test group and 25% in the control group. Conclusions The use of systemic metronidazole as an adjunct to non‐surgical treatment of peri‐implantitis resulted in significant additional improvements in clinical, radiographic, and microbiological parameters after 12 months of follow‐up. This study is registered in https://clinicaltrials.gov (NCT03564301).

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial

“…Thirdly, the importance of giving the patient a course of antibiotics in order to eliminate the aerobic and anaerobic microbes that may activate in cases of periosteal injuries [ 1 , 5 , 28 ]. Fourth, emphasizing to the patient the importance of adherence to the postoperative instructions [ 28 , 29 , 30 ]. By following these steps and adopting them in dental clinics, the chances of developing alveolitis and infection can be reduced to the minimum.…”

“…Clavulanic acid is irreversible inhibitor of β-lactamase enzymes, well absorbed orally, and combined with amoxicillin [ 1 , 7 , 30 ].…”

“…The second possible account for the superiority of metronidazole over amoxicillin and co-amoxiclav could be as a result of the involvement of anaerobic bacteria in early dissolution of the blood clot formed after surgical extraction, and metronidazole is the unique antibiotic that kills such an infection [ 1 , 2 , 17 , 29 , 30 ].…”

“…Furthermore, antibiotics will be useful for elderly patients or those with impaired immune response because they are susceptible to dry socket after dental extraction [ 8 ]. However, the mechanical factors that lead to dissolving the formed blood clot such as frequent mouth rinses, smoking, surgical techniques or surgeons with poor experience are still happening and causing a number of postoperative complications in dentoalveolar surgery [ 27 , 28 , 29 , 30 ].…”

Peri-Implantitis: Application of a Protocol for the Regeneration of Deep Osseous Defects. A Retrospective Case Series

“…Antibiotic prophylaxis, especially that based on a mix of amoxicillin and metronidazole, is widely used by clinicians for the treatment of peri-implantitis with excellent results [ 37 ], and in a retrospective clinical study, it has been shown to have superior results in terms of BoP and mucosal recession compared to the group of patients who did not receive systemic antibiotics [ 38 ]. Moreover, in a randomized clinical trial, the use of systemic metronidazole elicited excellent results in clinical, radiographic, and microbiological parameters in the non-surgical treatment of peri-implantitis [ 39 ]. The vitamin supplement has been shown, both in vitro and in clinical studies, to be a very useful support in the healing of surgical wounds [ 40 ]; moreover, a retrospective clinical study has shown how the vitamin supplement has proved useful in countering antibiotic-associated pseudomembranous colitis [ 41 ].…”