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.