Non‐surgical peri‐implantitis treatment with or without systemic antibiotics: a randomized controlled clinical trial

Abstract

Objectives: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI). Materials and methods:Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment.The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient). Results:All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD < 5 mm, and absence of BoP and SoP.Conclusions: Non-surgical treatment was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants.

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

“…Smoking habits were described in all studies and two of them included only no smokers [ 25 ] or light smokers [ 16 ]. History of periodontal disease was recorded in three studies [ 17 , 26 , 27 ] and the groups were comparable at baseline. Implant type was not described in two studies [ 17 , 25 ].…”

“…Implant type was not described in two studies [ 17 , 25 ]. One study reported the use of implants with rough surfaces [ 28 ]; other types of implants were included in the other three studies, where implant brand, but not the implant surface, was specified [ 16 , 26 , 27 ].…”

“…Non-surgical treatment followed different protocols for debridement and metallic instruments, including stainless steel curettes, which were used in two studies [ 17 , 26 ], while dedicated ones, such as Teflon curettes, were used in the other three [ 25 , 27 , 28 ] and one study did not report the type of instrumentation employed [ 16 ]. In two studies, chlorhexidine was additionally applied during the treatment [ 17 , 28 ] and, in two other studies, during the maintenance phase [ 26 , 27 ]. Air-polishing was employed in one study [ 26 ].…”

“…Two studies were judged at low [ 17 , 26 ], two at moderate [ 16 , 28 ], and two at high risk of bias [ 25 , 27 ] ( Table 3 ).…”

Clinical, Microbiological, and Biochemical Impact of the Surgical Treatment of Peri-Implantitis—A Prospective Case Series

“…This added value of adjunctive systemic antibiotics has also been demonstrated in periimplantitis regenerative interventions [ 53 ], with beneficial effects maintained up to 5 years postoperatively in patients with adequate supportive therapy [ 33 , 52 ]. There is only one randomized clinical trial demonstrating that this adjunctive application has a significant short-term advantage versus the placebo when used on moderately rough surface implants [ 36 ], and its real impact on the peri-implant microbiota is presently unknown [ 18 , 54 , 55 , 56 ].…”