Antibiotics as Adjunctive Therapy in the Non-Surgical Treatment of Peri-Implantitis: A Systematic Review and Meta-Analysis

Abstract

The role of antibiotics as adjunctive therapy in the non-surgical treatment of peri-implantitis is uncertain. The aim of this systematic review of randomized controlled trials was to assess the efficacy of antibiotic therapy, local or systemic, as an adjunctive to the non-surgical therapy of peri-implantitis. Primary outcomes were: implant success rate and complications, changes in radiographic bone level, probing pocket depth (PPD), probing attachment level (PAL), bleeding on probing (BOP) and peri-implantitis resolution. Six studies were included: two using topical and four systemic antibiotics. Adjunctive local antibiotics improved PPD (mean difference (MD) = 0.6 mm; 95% CI 0.42–0.78), BOP (MD = 0.15% (95% CI 0.10, 0.19)) and the success rate (risk ratio = 9.89; 95% CI 2.39–40.84). No significant difference in bone level and success rate were found with the use of systemic antibiotics, although they appeared to improve PPD (MD = 1.15 mm; 95% CI 0.31–1.99) and PAL (MD = 1.10 mm; 95% CI 0.13–2.08). Within the limitations of this review, the adjunctive local antibiotics showed improved outcomes in terms of success rate, PPD and BOP, while adjunctive systemic antibiotics improved PPD and PAL only. Peri-implantitis resolution was about 20–30% using adjunctive local antibiotics, whilst it ranged from 2% to 65% with adjunctive systemic antibiotics. Findings are still controversial, since they are based on few studies with high heterogeneity, at the uncertain or high risk of bias and involve few patients. Non-surgical debridement and maintenance periodontal support therapy remain pivotal and the adjunctive use of antibiotics for peri-implantitis cannot be routinely recommended, even considering the increasing concern on antibiotic resistance.

Unraveling the effectiveness of antibiotics for peri‐implantitis treatment: A scoping review

“…Most of these reviews included the same RCTs, with only slight variation of the focused question among different studies. Overall, these systematic reviews included from 4 to 26 studies 16,57–69 and showed contradictory conclusions in terms of recommending 65 or not 66 the use of adjunctive antimicrobials to treat peri‐implantitis. In this sense, a scoping review such as this one critically discussing the literature on this topic is helpful to guide clinical decision and future studies.…”

“…The main strength of this study was that for the first time, it provided a thorough evaluation of the clinical and microbiological outcomes of locally and systemically delivered antibiotics as adjuncts to the surgical and nonsurgical debridement of implants affected by periimplantitis. While recent systematic reviews have assessed the benefits of antibiotics for the treatment of peri-implantitis, 16,58,63,65,66,84 none of them provided data for different types of antibiotic delivery or for the effects of these agents in changing the submucosal microbiome. We have recently highlighted that the scoping reviews assessing laboratory data are useful scientific tools still underused in dentistry.…”

Non-Surgical Treatment of Peri-Implantitis Using Air Abrasive Device With or Without Adjunctive Use of Systemic Antibiotics

“…Aj z tohto dôvodu sa použitie MAP s obľubou kombinuje s ďalšou, podpornou terapiou. Antibiotiká ako doplnková terapia pri liečbe peri-implantitídy ukazujú veľmi sľubné výsledky a je popísané výraznejšie zlepšenie hodnôt klinických indexov v porovnaní s mechanickou terapiou samotnou [24][25][26].…”