Do Systemic Antibiotics Offer Benefits to the Surgical Treatment of Peri-Implantitis? A Systematic Review With Meta-Analyses.

Aim To assess the potential benefit of using adjunct systemic antibiotics in surgical peri-implantitis treatment. Materials And Methods Six databases were searched (December 2024) for randomised/non-randomised clinical studies. After duplicate study selection, data extraction and risk-of-bias assessment, random-effects meta-analyses of odds ratios (ORs) or mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by the analysis of certainty of evidence. Results Seven studies (three randomised and four non-randomised, comprising 595 patients and 1388 implants) were included. Systemic antibiotics were associated with greater short-term treatment success (n = 5; OR = 2.33; 95% CI: 1.29-4.21), bone gain (n = 4; MD = 0.37 mm; 95% CI: -0.68 to -0.07), increased bone level stability (n = 3; OR = 2.73; 95% CI: 1.50-4.99), reduced bleeding on probing (n = 6; OR = 0.49; 95% CI: 0.31-0.78), reduced suppuration on probing (n = 3; OR = 0.33; 95% CI: 0.18-0.61) and increased gingival recession (n = 3; MD = 0.18 mm; 95% CI: 0-0.36 mm) (p < 0.05). Systemic antibiotics seem to benefit only implants with modified surfaces (ORs: modified 4.10 vs. turned 0.79), and event that, without long-term benefits (≥ 3 years). Finally, one trial found that antibiotics probably increased diarrhoea risk. Conclusions Evidence from randomised/non-randomised studies seems to indicate that systemic antibiotics benefit surgical peri-implantitis treatment, in the short term (1-2 years), especially for implants with a modified surface, while data on adverse effects is scarce. No substantial long-term benefits are seen (≥ 3 years). Uncertainty still exists regarding the potential benefit of systemic antibiotics as adjunct to surgical management of peri-implantitis.