Non-Cochrane · intervention · PM41923333
Impact and efficacy of systemic antibiotics for peri-implant diseases treatment: A systematic review and meta-analysis on clinical and microbiological outcomes.
Isola Gaetano, Polizzi Alessandro, Angjelova Angela, et al. · Periodontology 2000 · 2025 · PubMed · doi:10.1111/prd.70033
Findings
19 findings
| Population | ||||
|---|---|---|---|---|
| Patients with peri-implant mucositis | Adjunctive systemic antibiotics (azithromycin or amoxicillin) to non-surgical mechanical debridement | Non-surgical mechanical debridement alone | Probing pocket depth (PPD) reduction 3 months · Clinical trials of implant patients | MD 0.24 [-0.11, 0.6] GRADE not reported 2 studies · 76 participants |
| Patients with peri-implant mucositis | Adjunctive systemic antibiotics (azithromycin or amoxicillin) to non-surgical mechanical debridement | Non-surgical mechanical debridement alone | Bleeding on probing (BOP) reduction 3 months · Clinical trials of implant patients | MD 1.34 [-0.86, 3.55] GRADE not reported 2 studies · 76 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Marginal bone gain 3 months · Clinical trials of implant patients | MD 0.04 [-0.05, 0.13] GRADE not reported 2 studies · 86 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Tannerella forsythia load reduction 12 months · Clinical trials of implant patients | MD 0.48 [0.05, 0.92] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Fusobacterium nucleatum load reduction 3 months · Clinical trials of implant patients | MD 0.33 [-0.07, 0.73] GRADE not reported 2 studies · 88 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Porphyromonas gingivalis load reduction 3 months · Clinical trials of implant patients | MD 0.17 [-0.62, 0.95] GRADE not reported 2 studies · 86 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Marginal bone gain 12 months · Clinical trials of implant patients | MD 0.6 [-0.3, 1.51] GRADE not reported 3 studies · 122 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Tannerella forsythia load reduction 3 months · Clinical trials of implant patients | MD 0.34 [-0.18, 0.86] GRADE not reported 2 studies · 86 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Marginal bone gain 6 months · Clinical trials of implant patients | MD 0.42 [-0.13, 0.98] GRADE not reported 2 studies · 49 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Probing pocket depth (PPD) reduction 12 months · Clinical trials of implant patients | MD 0.84 [0.26, 1.41] GRADE not reported 4 studies · 123 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Bleeding on probing (BOP) reduction 3 months · Clinical trials of implant patients | MD 8.38 [-6.8, 23.55] GRADE not reported 3 studies · 117 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Bleeding on probing (BOP) reduction 6 months · Clinical trials of implant patients | MD 9.27 [-10.79, 29.32] GRADE not reported 2 studies · 60 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Probing pocket depth (PPD) reduction 3 months · Clinical trials of implant patients | MD 0.97 [0.44, 1.49] GRADE not reported 3 studies · 89 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Tannerella forsythia load reduction 6 months · Clinical trials of implant patients | MD 0.51 [0.09, 0.93] GRADE not reported 2 studies · 84 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Suppuration on probing (SOP) reduction 3 months · Clinical trials of implant patients | MD 4.71 [0.54, 8.88] GRADE not reported 2 studies · 97 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Porphyromonas gingivalis load reduction 12 months · Clinical trials of implant patients | MD 2.74 [2.11, 3.36] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Porphyromonas gingivalis load reduction 6 months · Clinical trials of implant patients | MD 1.64 [1.04, 2.25] GRADE not reported 2 studies · 81 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Probing pocket depth (PPD) reduction 6 months · Clinical trials of implant patients | MD 0.74 [0.27, 1.22] GRADE not reported 4 studies · 123 participants |
| Patients with peri-implantitis | Adjunctive systemic antibiotics (amoxicillin, metronidazole, azithromycin; single or combined) to non-surgical or surgical treatment | Non-surgical or surgical treatment alone or with placebo | Bleeding on probing (BOP) reduction 12 months · Clinical trials of implant patients | MD 14.05 [3.77, 24.33] GRADE not reported 2 studies · 60 participants |
Included primary studies 18
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Almohareb 2020 Clinical efficacy of photodynamic therapy as an adjunct to mechanical debridement in the treatment of per-implantitis with abscess. PMID:32545150 | 2020 | 1 other review | not stated | not extracted yet |
| Blanco 2022 Adjunctive benefits of systemic metronidazole on non-surgical treatment of peri-implantitis. A randomized placebo-controlled clinical trial. PMID:34713471 | 2022 | 1 other review | not stated | not extracted yet |
| De Waal 2021 Systemic antibiotic therapy as an adjunct to non-surgical peri-implantitis treatment: A single-blind RCT. PMID:33939193 | 2021 | 1 other review | not stated | not extracted yet |
| Polymeri 2022 Non-surgical peri-implantitis treatment with or without systemic antibiotics: a randomized controlled clinical trial. PMID:35238084 | 2022 | 1 other review | not stated | not extracted yet |
| Shibli 2019 Microbiological and clinical effects of adjunctive systemic metronidazole and amoxicillin in the non-surgical treatment of… PMID:31576959 | 2019 | 1 other review | not stated | not extracted yet |
| Al Deeb 2020 Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation. PMID:31689510 | 2020 | this review only | not stated | not extracted yet |
| Alqahtani 2022 Efficacy of Antibiotic Versus Probiotics As Adjuncts to Mechanical Debridement for the Treatment of Peri-Implant Mucositis. PMID:33450748 | 2022 | this review only | not stated | not extracted yet |
| Carcuac 2016 Adjunctive Systemic and Local Antimicrobial Therapy in the Surgical Treatment of Peri-implantitis: A Randomized Controlled Clinical Trial. PMID:26285807 | 2016 | this review only | not stated | not extracted yet |
| Carcuac 2017 Surgical treatment of peri-implantitis: 3-year results from a randomized controlled clinical trial. PMID:28902426 | 2017 | this review only | not stated | not extracted yet |
| Gershenfeld 2018 Randomized clinical trial of the effects of azithromycin use in the treatment of peri-implantitis. PMID:29679488 | 2018 | this review only | not stated | not extracted yet |
| Gomi 2015 Full-mouth scaling and root planing combined with azithromycin to treat peri-implantitis. PMID:25439282 | 2015 | this review only | not stated | not extracted yet |
| Hallstrom 2012 Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial. PMID:22571225 | 2012 | this review only | not stated | not extracted yet |
| Hallstrom 2017 Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial. PMID:28836279 | 2017 | this review only | not stated | not extracted yet |
| Heitz-Mayfield 2012 Anti-infective surgical therapy of peri-implantitis. A 12-month prospective clinical study. PMID:22092831 | 2012 | this review only | not stated | not extracted yet |
| Irshad 2021 Effects of Implant Surface Debridement and Systemic Antibiotics on the Clinical and Microbiological Variables of Periimplantitis. PMID:33553428 | 2021 | this review only | not stated | not extracted yet |
| Ramanauskaite 2024 Systemic Antibiotic Prophylaxis Adjunctive to Surgical Reconstructive Peri-Implantitis Treatment: A Retrospective Study. PMID:39676072 | 2025 | this review only | not stated | not extracted yet |
| Riben Grundstrom 2024 Systemic antibiotics in the surgical treatment of peri-implantitis: A randomized placebo-controlled trial. PMID:38699828 | 2024 | this review only | not stated | not extracted yet |
| Tada 2018 The effects of Lactobacillus reuteri probiotics combined with azithromycin on peri-implantitis: A randomized placebo-controlled study. PMID:28756115 | 2018 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Humans with peri-implant mucositis or peri-implantitis | Peri-implant mucositis (n=3 studies) and peri-implantitis (n=15 studies); sample sizes 18 to 100 |
| Intervention | Adjunctive systemic antibiotics (single or combined) | Amoxicillin plus metronidazole (n=9), azithromycin (n=5), metronidazole alone (n=1), amoxicillin, phenoxymethylpenicillin plus metronidazole, as adjunct to nonsurgical (n=12) or surgical (n=6) debridement |
| Comparison | Placebo, mechanical debridement or surgery alone, or alternative regimens | Debridement alone or with placebo or chlorhexidine |
| Outcomes | Clinical (BOP, PPD, SOP, plaque score, MBL, recession) and microbiological outcomes (bacterial load or concentration) | BOP, PPD, SOP, marginal bone level, plaque score, recession, and F. nucleatum, P. gingivalis, T. forsythia counts |
| Study designs | RCTs, nonrandomized clinical trials, prospective/retrospective cohort or case-control studies published in English up to May 31, 2025 | 18 studies: 15 parallel-arm RCTs, 1 prospective cohort, 2 retrospective comparative series; 9 RCTs in meta-analysis |
| Timing | Not specified | Follow-up 12 weeks to 36 months; pooled at 3, 6 and 12 months |