Efficacy of adjuvant metronidazole therapy on peri-implantitis: a systematic review and meta-analysis of randomized clinical studies

Abstract

Peri-implant diseases are pathological conditions that affect the survival of dental implants. Etiological studies are limited, accepting a prevalence of 20% at the implant level and 24% at the patient level. The benefits of adjuvant metronidazole are controversial. A systematic review and meta-analysis of RCTs according to PRISMA and PICOS was performed with an electronic search over the last 10 years in MEDLINE (PubMed), WOS, Embase, and Cochrane Library. The risk of bias was measured using the Cochrane Risk of Bias tool and the methodological quality using the Jadad scale. Meta-analysis was performed with RevMan version 5.4.1, based on mean difference and standard deviation, with 95% confidence intervals; the random-effects model was selected, and the threshold for statistical significance was defined as p < 0.05. A total of 38 studies were collected and five were selected. Finally, one of the studies was eliminated because of unanalyzable results. All studies reached a high methodological quality. A total of 289 patients were studied with follow-up periods from 2 weeks to 1 year. Statistical significance was only found, with respect to the use of adjunctive metronidazole, in the pooled analysis of the studies (p = 0.02) and in the analysis of the radiographic values reported on peri-implant marginal bone levels, in the studies with a 3-month follow-up (p = 0.03). Discrepancies in the use of systemic metronidazole require long-term randomized clinical trials (RCTs) to determine the role of antibiotics in the treatment of peri-implantitis.

A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis

“…Nevertheless, systemic antibiotics use remains a controversial issue, as currently there are many reviews stating that systemic antibiotics do not improve the surgical treatment of peri-implantitis in terms of PPD or BoP [26,28], statements that are consistent with that observed in our systematic review and meta-analysis.…”

“…This same prospective study, in which they performed a debridement of the implant surface in conjunction with a systemic administration of amoxicillin and metronidazole, observed a mean reduction in PPD of 2.14 mm; however, they are aware of its limitations, including the absence of a control group that made it impossible to evaluate the efficacy of the treatment [25]. Furthermore, a recent systematic review of the efficacy of metronidazole as an adjuvant in the therapy of periimplantitis [26] warned that the combination of amoxicillin together with metronidazole should be limited to patients with specific microbiological profiles, as in the case of patients testing positive for A. actinomycetemcomitans. Since it is well known that most prescribers do not perform a bacteriological examination [8,27], in addition to the fact that combined management can contribute substantially to the advancement of antibiotic resistance, as already shown by many species [8], the routine use of this therapy arouses significant disagreement among researchers.…”

Antioxidant, anti-inflammatory and antimicrobial activity of natural products in periodontal disease: a comprehensive review

“…In fact, a meta-analysis of clinical studies, recently carried out by us, on the use of metronidazole as an adjuvant treatment for peri-implantitis (a pathology with certain similarities to periodontitis), found no definitive conclusions on its effect. (López-Valverde et al, 2023).…”

Antibiofilm peptides enhance the corrosion resistance of titanium in the presence of Streptococcus mutans

“…However, owing to implant design, it is unlikely to completely remove the biofilms by nonsurgical mechanical therapy alone ( Renvert et al, 2008 ). The adjunctive application of antimicrobials, including chemical agents and antibiotics, is therefore considered a promising strategy to alleviate microbial burden ( Patil et al, 2022 ; López-Valverde et al, 2023 ). The past few years have witnessed a variety of antimicrobial agents for use in implant disinfection ( Malheiros et al, 2023 ).…”