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HERRERA ET AL .
R8.14. Do adjunctive locally administered antibiotics improve clinical outcomes of surgical treatment of peri-implantitis?
day for 10 days, and starting 3 days prior to surgery (Carcuac et al., 2016); the other evaluated the systemic application of azithro- mycin, 500 mg at the day of surgery, and 250 mg, once per day, dur- ing 4 additional days (Hallstrom et al., 2017).
PICOS question addressed by an SR
R8.14: Evidence-based statement There is insufficient evidence to make any recommendation on the use of local antibiotics as adjuncts in the surgical treatment of peri- implantitis . Supporting literature (Teughels et al., 2023; Wilensky et al., 2023) Quality of evidence Very low Grade of recommendation Statement Strength of consensus Unanimous consensus (2.1% of the group abstained due to potential CoI)
Risk of bias Some concerns (Carcuac et al., 2016) and high risk (Hallstrom et al., 2017), as evaluated with RoB 2.
Effect sizes and their clinical relevance Disease resolution (based on <5 mm PDs, no BOP and no additional bone loss >5 mm) was consistent between studies and favoured sys- temic antibiotics: 56% test versus 29.2% control (Carcuac et al., 2016); 46.7% test versus 25% control group (Hallstrom et al., 2017). Two implant losses occurred in the control group of the first study (Carcuac et al., 2016).
Background
Intervention
Consistency See previous section.
Tissue destruction at peri-implantitis sites is more pronounced than periodontitis around teeth due to anatomical differences, larger size of the inflammatory lesion and extent of the lesion to the bone crest. Therefore, clinicians are tempted to use antibiotics in addition to the surgical treatment of peri-implantitis.
Balance of benefit and harm The potential benefit of the use of systemic antibiotics needs to be balanced with the overall risks, which include adverse events (e.g., allergic reactions) and antibiotic resistance.
Overall certainty of the evidence Low.
Available evidence
Number and design of included studies Two RCTs were identified: one assessing local minocycline application at the time of surgery in 50 patients (25 test and 25 control), and repeated at 1, 3 and 6 months, with all patients also receiving sys- temic amoxicillin thrice per day, 500 mg, for 3 days (Cha et al., 2019); and another evaluating local doxycycline application in 27 patients (14 test and 13 control), formulated in a bone graft, at the time of sur- gery (Emanuel et al., 2020).
From evidence to recommendation — additional considerations
Acceptability Due to concerns about patients' health and the impact of systemic antibiotic use on public health and inconsistent evidence, its use as adjunct to surgical therapy of peri-implantitis is not recommended.
Risk of bias High risk of bias for both RCTs.
Feasibility Not applicable.
Effect sizes and their clinical relevance Not applicable.
Ethical considerations Harms related to the intake of systemic antibiotics must be balanced with potential benefits.
Consistency Not applicable.
Economic considerations Not applicable.
Balance of benefit and harm The potential benefit of the use of local antibiotics needs to be bal- anced with the overall risks, which include adverse events (e.g., allergic reactions) and antibiotic resistance.
Legal considerations Not applicable.
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