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

Abstract

Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [-0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance.

Keywords: antibacterial agents; antibiotic resistance; antibiotics; bleeding on probing; peri-implantitis; probing pocket depth.

Figure 1

PRISMA flow diagram for the studies inclusion process.

Figure 2

Quality evaluation of the RCTs using the Robins-II Tool. The risk of bias of the included studies was judged as low (green), some concerns (yellow) or high (red) [1,6,24,30,48,51,54,55,56].

Figure 3

Quality evaluation of the non-RCTs using The Joanna Briggs Institute Critical Appraisal tool. The risk of bias of the included studies was contemplated as low (green), unclear (yellow) or high (red) [16,17,22,47,49,50,52,53,57].

Figure 4

(a) Forest plot for no systemic antibiotic (control group) versus adjunct systemic antibiotic (test group) when comparing the bleeding on probing (BoP). (b) Funnel plot graph illustrating the publication bias and the systematic heterogeneity of the included studies. The standard error (SE) is represented in the vertical axis and the bleeding on probing (MD) in the horizontal axis [1,6,24,30,48,52,54,55,56,57].

Figure 5

Forest plot for no systemic antibiotic (control group) versus adjunct systemic antibiotic (test group) when comparing the bleeding on probing (BoP) after (a) three months or less of follow-up, (b) more than 3 months of follow-up, (c) performing an implant exposure surgery or open flat debridement, (d) performing non-surgical subgingival debridement, (e) azithromycin as adjunct systemic antibiotic, (f) metronidazole plus amoxicillin as adjunct systemic antibiotic, (g) amoxicillin as adjunct systemic antibiotic, (h) less of 7 days of antibiotic administration, and (i) more than 7 days of antibiotic administration. Weighted mean is presented at CI 95%. Heterogeneity was determined using Higgins (I²). In all the analyses, a random-effects model was applied. Statistical significance was set at 0.05 [1,6,24,30,48,52,54,55,56,57].

Figure 6

(a) Forest plot for no systemic antibiotic (control group) versus adjunct systemic antibiotic (test group) when comparing peri-implant probing pocket depth (PPD). (b) Funnel plot graph illustrating the publication bias and the systematic heterogeneity of the included studies. The standard error (SE) is represented in the vertical axis and the probing pocket depth (MD) in the horizontal axis [1,6,17,24,30,48,52,54,55,56,57].

Figure 7

Forest plot for no systemic antibiotic (control group) versus adjunct systemic antibiotic (test group) when comparing peri-implant probing pocket depth (PPD) after (a) three months or less of follow-up, (b) more than 3 months of follow-up, (c) performing an implant exposure surgery or open flat debridement, (d) performing non-surgical subgingival debridement, (e) azithromycin as adjunct systemic antibiotic, (f) metronidazole plus amoxicillin as adjunct systemic antibiotic, (g) amoxicillin as adjunct systemic antibiotic, (h) less of 7 days of antibiotic administration, and (i) more than 7 days of antibiotic administration. Weighted mean is presented at CI 95%. Heterogeneity was determined using Higgins (I²). A random-effects model was applied in all the analyses. Statistical significance was set at 0.05 [1,6,17,24,30,48,52,54,55,56,57].