Efficacy of adjunctive antibiotics compared to non-antibiotic therapies following mechanical debridement for peri-implantitis: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the efficacy of antibiotic therapy as an adjunct to mechanical debridement in peri-implantitis. METHOD: PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched (inception to 15 January, 2026). Additionally, clinical trials were searched on ClinicalTrials.gov. Meta-analyses were performed to evaluate bone level (BL), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), modified plaque index (mPLI), plaque score (PS). RESULTS: Twenty-two RCTs were included. Adjunctive antibiotics with mechanical debridement demonstrated significant advantages in improving PPD (WMD = -0.69; 95% CI: [-1.04, -0.33]; P = 0.0001; heterogeneity:I2 = 91%, P < 0.00001), CAL (WMD = -0.55; 95% CI: [-1.07, -0.04]; P = 0.04; heterogeneity:I2 = 95%, P < 0.00001), PS (WMD = -4.07; 95% CI: [-6.80, -1.33]; P = 0.004; heterogeneity:I2 = 0%, P = 0.94), and BOP (WMD = -12.45; 95% CI: [-24.13, -0.77]; P = 0.04; heterogeneity:I2 = 94%, P < 0.00001). In the subgroup analysis comparing mechanical debridement plus antibiotics versus mechanical debridement alone, statistically significant improvements were observed for CAL (WMD = -0.84; 95% CI: [-1.55, -0.13]; P = 0.02) and PS (WMD = -3.94; 95% CI: [-7.14, -0.74]; P = 0.02), confirming clinical necessity of antibiotics as an adjunct to debridement. In the comparison of local versus systemic antibiotic administration, comparable efficacy in reducing PPD was observed for both local (WMD = -0.68; 95% CI: [-1.14, -0.22]; P = 0.004) and systemic (WMD = -0.70; 95% CI: [-1.25, -0.15]; P = 0.01) routes, with no significant difference between subgroups (P = 0.95, I² = 0%). For PS, local antibiotics (WMD = -6.57; 95% CI: [-11.10, -2.04]; P = 0.004) demonstrated significantly greater improvement compared to systemic antibiotics (WMD = -2.63; 95% CI: [-6.07, 0.80]; P = 0.13). CONCLUSION: As an adjunct to mechanical debridement, antibiotics may provide modest benefits for peri-implantitis, demonstrating efficacy in improving probing pocket depth, clinical attachment level, plaque score, bleeding on probing, and other parameters related to soft tissue health and plaque control. PROSPERO: CRD420261328879. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328879.