Risk-based efficacy of systemic and local antibiotics in nonsurgical treatment of peri-implantitis: A systematic review and meta-analysis.

Background: Peri-implantitis is a prevalent inflammatory condition that compromises the long-term stability of dental implants. With its rising incidence, adjunctive therapies to nonsurgical mechanical debridement, particularly antibiotics, have gained attention. This systematic review evaluated the efficacy of systemic and local antibiotics as adjuncts to nonsurgical peri-implantitis treatment, focusing on probing depth (PD) reduction, bleeding on probing (BOP), and clinical attachment level (CAL). Methods: In accordance with the PRISMA 2020 guidelines, randomized controlled trials (RCTs) were screened. Data extraction and quality assessment were performed independently by two reviewers, and the quantitative synthesis was conducted using the CMA3 software. Results: Out of 93 screened records, six RCTs were included in this systematic review. Five studies investigated the effects of systemic treatment, and only one RCT reported the outcomes of topical antibiotic use. The quality of the studies was unclear in five studies and low in one study. Both systemic and local antibiotics demonstrated clinical benefits when combined with mechanical debridement. Reported adverse effects were generally mild. Overall, antibiotic therapy was associated with a greater decrease in PD (mean difference: -0.66, 95% confidence intervals: -1.014, -0.318, Conclusion: Based on the limited available evidence, antibiotics may offer adjunctive benefits in the nonsurgical management of peri-implantitis. Protocol heterogeneity and limited long-term data highlight the need for standardized regimens, assessment of antimicrobial resistance, high-quality long-term RCTs, and cost-effective studies in this regard.