Systemic antibiotic therapy as an adjunct to non‐surgical peri‐implantitis treatment: A single‐blind RCT

Abstract

Aim The aim of this single‐blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non‐surgical treatment of peri‐implantitis. Material and methods Patients (N = 62) with peri‐implantitis were randomly assigned to receive full‐mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T0) to 3‐month follow‐up (T3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis. Results 57 patients with 122 implants completed 3‐month follow‐up. Both groups showed major clinical improvements at T3 in both peri‐implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters. Conclusions Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non‐surgical peri‐implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full‐mouth non‐surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri‐implantitis treatment phase.

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

“…Secondary outcomes were also determined in the present research ( Table 3 ). Eleven papers [ 6 , 17 , 22 , 24 , 30 , 49 , 50 , 51 , 52 , 53 , 54 ] reported bone loss. A generalized reduction of approximately 0.75 mm was obtained after 12 months of follow-up ( Table 3 ) when systemic antibiotics were administrated in conjunction with other therapies, such as mechanical debridement, bone graft plus membrane or even titanium granulates.…”

“…A generalized reduction of approximately 0.75 mm was obtained after 12 months of follow-up ( Table 3 ) when systemic antibiotics were administrated in conjunction with other therapies, such as mechanical debridement, bone graft plus membrane or even titanium granulates. Plaque score was also analyzed in eleven studies [ 1 , 6 , 16 , 22 , 47 , 48 , 50 , 52 , 54 , 56 , 57 ]. Plaque scores in all groups were significantly reduced from baseline to successive follow-up periods when systemic antibiotics were used in combination with complementary therapies.…”

“…Plaque scores in all groups were significantly reduced from baseline to successive follow-up periods when systemic antibiotics were used in combination with complementary therapies. Suppuration was determined in eight articles [ 6 , 24 , 47 , 48 , 50 , 52 , 53 , 57 ], and most showed a significant reduction after systemic antibiotic administration. Eight articles [ 1 , 6 , 16 , 24 , 30 , 55 , 56 , 57 ] also reported total bacterial counts, and Prevotella intermedia / nigrescens , Porphyromonas gingivalis , and Aggregatibacter actinomycetemcomitans were some of the most common bacteria associated with peri-implantitis.…”

“…Peri-implant biofilm contains a complex array of bacterial species that trigger the infection and cause the beginning of the disease [ 5 ]. The microbiota in peri-implantitis seems to be mainly composed of anaerobic Gram-negative species and is not linked to a uniform microbial profile, contrary to periodontitis [ 6 ]. A marked difference has not been detected in the bacterial species between periodontal and peri-implant sites [ 7 , 8 ].…”

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

“…A recently published study (De Waal et al, 2021) investigated the effect of chlorhexidine or amoxicillin/metronidazole as an adjunct to non-surgical therapy in bleeding scores and other clinical and microbiological parameters over a 3-month follow-up period. In contrast to the present study, although they found differences in clinical parameters favouring the use of adjunctive antibiotics, these differences did not reach statistical significance.…”