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Available evidence
Ethical considerations There are no perceived ethical considerations.
Number and design of included studies The SR (Gennai et al., 2023) included six RCTs evaluating the effect of systemic probiotic used by the patient, adjunctively to sub-marginal instrumentation, compared with sub-marginal instrumentation alone or combined with a negative control or a placebo, in terms of BOP reduction at 3 months in patients with peri-implant mucositis. Risk of bias The overall risk of bias of the included studies was judged as ‘ low ’ (RoB 2 tool), with three studies with a low risk of bias and three with a moderate risk of bias.
Economic considerations There are no perceived economic considerations, although an extra economic cost is derived from the prescription of the probiotics.
Legal considerations There are no perceived legal considerations.
R6.13. In patients with peri-implant mucositis, what is the efficacy of the oral administration of systemic antibiotics when used adjunctively to PMPR?
Effect sizes and their clinical relevance At 3 months, results revealed:
PICOS question addressed by an SR
R6.13: Evidence-based recommendation Due to concerns about patient's health and the impact of systemic antibiotic use to public health, in patients with peri-implant mucositis we recommend not to use Supporting literature (Gennai et al., 2023; Sanz et al., 2020) and antibiotic stewardship. Quality of evidence Low (three RCTs) Grade of recommendation GradeA — ## Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
• Statistically significant greater reduction in BOP (%) for antiseptics than controls ( n studies = 6; n patients = 260; weighted mean differ- ence [WMD] = 12.11%; 95% CI [3.20; 21.03]; p = .008; I 2 = 93.3%). • Statistically significant greater reduction in plaque (%) for antisep- tics than controls ( n studies = 6; n patients = 260; WMD = 14.20%; 95% CI [3.46; 29.94]; p = .01; I 2 = 92.4%). • No statistically significant differences in PD reductions. • Complete disease resolution was only reported in one study (32% after 135 days, without differences between test and control groups). At 6 months, no statistically significant differences were found when comparing probiotics versus control groups for any study out- come. No adverse events were reported due to the adjunctive use of L. reuteri tablets.
Background
Intervention
Consistency All studies reported the same tendency.
The following systemic antibiotics (prescribed as oral administration) as adjuvants to sub-marginal instrumentation have been tested in the treatment of peri-implant mucositis: • Azithromycin (500 mg the first day and 250 mg from the second to fourth day). • Amoxicillin (500 mg, thrice daily for 1 week).
Balance of benefit and harm No adverse events have been reported. Clear benefits observed at 3 months, although they were not sustained at 6 months.
Overall certainty of the evidence Moderate.
Available evidence
From evidence to recommendation — additional considerations
Number and design of included studies The SR (Gennai et al., 2023) included three RCTs evaluating the effect of systemic antibiotics prescribed as oral administration adjunctively to sub-marginal instrumentation. In one study, amoxi- cillin was compared with sub-marginal instrumentation combined with probiotics. In another study, the adjunctive administration of azithromycin was compared with instrumentation alone. In the third study, the adjunctive use of azithromycin plus a 0.12% CHX
Acceptability Systemic probiotics are still not widely accepted by the population.
Feasibility There are no perceived barriers.
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