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

Abstract

Background Antibiotics are the most effective adjuncts in the treatment of periodontitis. However, the benefits of these agents in treating peri‐implantitis are still debatable and demand further analysis. Purpose The aim of this review was to critically appraise the literature on the use of antibiotics to treat peri‐implantitis, with the ultimate goal of supporting evidence‐based clinical recommendations, defining gaps in knowledge and guiding future studies on this topic. Methods A systematized literature search was conducted in MEDLINE/PubMed and Cochrane Library databases for randomized clinical trials (RCTs) on patients with peri‐implantitis treated by mechanical debridement‐only or with adjunctive use of local or systemic antibiotics. Clinical and microbiological data were extracted from the RCTs included. The findings were critically reviewed, interpreted, and discussed. An overview of antibiotic‐loaded dental implant materials in peri‐implantitis treatment was also provided. Results Twelve RCTs testing local/systemic antibiotics were included. Although not always statistically significant, all antibiotic‐treated groups had greater reductions in mean PD than those treated by mechanical debridement‐only. The only clinically relevant antibiotic protocol supported by one RCT with low risk of bias and long‐lasting benefits was systemic metronidazole (MTZ). Studies using ultrasonic debridement reported better outcomes. No RCTs to date have tested MTZ‐only or with amoxicillin (AMX) as adjuncts to open‐flap implant debridement. In vitro/animal studies suggested that biomaterials with antimicrobial properties are promising to treat peri‐implantitis. Conclusion There are insufficient data to support a particular evidence‐based antibiotic protocol to treat peri‐implantitis using surgical or nonsurgical therapy, but some conclusions may be drawn. Systemic MTZ adjunct to ultrasonic debridement is an effective protocol to improve the outcomes of nonsurgical treatment. Future studies should assess the clinical and microbiological effects of MTZ and MTZ + AMX as adjuncts to optimal nonsurgical implant decontamination protocols or open‐flap debridement. In addition, new locally delivered drugs and antibiotic‐loaded surfaces should be assessed by RCTs.

Do systemic amoxicillin and metronidazole during the non‐surgical peri‐implantitis treatment phase prevent the need for future surgical treatment? A retrospective long‐term cohort study

“…Whether this therapy is a form of non-surgical treatment can be debated. In short, these findings seem to confirm the notion that there are insufficient data present to support a specific antibiotic protocol to treat peri-implantitis using non-surgical therapy (Feres et al, 2023).…”

Antibiotic prescribing patterns among dentists in Italy and Albania: A comparative questionnaire analysis

“…However, AWaRe's book provides no indication for antibiotic treatment for this clinical condition. A recent review states that there is still no specific antibiotic protocol for the treatment of periimplantitis, but the systemic use of metronidazole plus ultrasonic debridement may improve non-surgical treatment [ 26 ]. However, De Waal et al affirm that amoxicillin + metronidazole systemic antibiotic therapy does not improve clinical or microbiological outcomes of non-surgical peri-implantitis treatment and should not be used frequently [ 27 ].…”

An antibacterial conjugate of carbon nanohorns for NIR-light mediated peri-implantitis treatment

“…However, there is concern about allergic reactions and increased antibiotic resistance. 17–19 In this regard, photodynamic therapy (PDT) is considered a practical approach for oral treatment, including peri-implantitis, because light illumination is easily accessible to the affected area. 20,21…”