Local/Topical Antibiotics for Peri-Implantitis Treatment: A Systematic Review

Abstract

Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.

Antibiotic Resistance in Patients with Peri-Implantitis: A Systematic Scoping Review

“…As seen in Table 1 , most of the investigations used different culture methodologies to identify the microorganisms studied. Two studies used the same methodology to evaluate antimicrobial resistance [ 17 , 18 , 33 , 34 ], while one investigation used the E-test [ 35 ] and another implemented the minimum inhibitory concentration [ 36 ] based on previously established standards [ 37 ].…”

“…This review evaluated the prevalence of antimicrobial-resistant species in PI patients. Although the management of adjunctive antimicrobials in the therapy of patients with PI is controversial, some systematic reviews have evaluated different clinical trials carried out recently [ 17 , 24 ]. This means that clinicians currently use antibiotics for the treatment of PI.…”

“…Mechanical management alone has presented uncertain treatment results, whereas effects following surgical therapy present just a slight increase in bone level [ 14 , 15 ]. Notably, several systematic reviews have indicated that most surgical PI procedures recommend the adjunctive implementation of systemic antimicrobials to target putative microorganisms [ 15 , 16 , 17 , 18 ]. Moreover, a recent systematic review found that in healthful subjects’ antimicrobial prophylaxis is prescribed to avoid early implant failure [ 19 ].…”

Considerations on the Controlled Delivery of Bioactive Compounds through Hyaluronic Acid Membrane

“…Local or topical treatment is preferred over systemic treatment due to significantly lower side effects and less patient compliance [ 10 ]. The commonly used topical antimicrobial agents are chlorhexidine, metronidazole, tetracycline, ciprofloxacin, doxycycline and minocycline [ 16 , 17 , 18 , 19 ]. One of the active antimicrobial agents, MZ, is already used for local periodontal treatment, alone or in combination with other antibiotics, such as tetracycline.…”

Tetracycline impregnated bone grafts in the management of peri-implantitis and guided bone regeneration around dental implants: A systematic review

“…The local action of antibiotics is expected to prevent the growth of pathogenic microflora and provide optimum conditions for bone regeneration. Broad spectrum antibiotics such as tetracycline and its derivatives doxycycline, and minocycline have commonly been used for local delivery around dental implants ( Mombelli et al, 2001 , Passarelli et al, 2021 ).…”