Do adjunctive antimicrobials improve the outcome of non-surgical peri-implantitis treatment?

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Design This study was a single-centre, single-blind, controlled parallel group randomised control trial.Case selection Participants included those referred to The Hague Clinic for Periodontology in the Netherlands. The selection criteria included patients diagnosed with peri-implantitis, defined as marginal bone loss of >2 mm in addition to bleeding or suppuration on probing and a probing depth of >5 mm. The study was carried out over seven years and involved a control group (full mouth non-surgical peri-implantitis treatment) and a test group (non-surgical peri-implantitis treatment combined with systemic antimicrobials). Data analysis Sixty patients were recruited (30 allocated to each group) and 57 completed follow-up and were analysed according to the intention to treat principle. The patients were reviewed monthly and clinical data according to the parameters being measured were recorded. Microbiological analysis was also carried out. The power calculation was based upon the primary outcome measure of interest: bleeding on probing (BoP).Results The primary outcome parameter being measured was change in full mouth BoP and this study concluded that there were no significant differences in bleeding scores between the control and intervention at three months post-treatment. Secondary outcome parameters being measured included full mouth peri-implant and periodontal plaque scores (PS, %), clinical attachment levels, suppuration scores (SS, %), mean probing depths, mean peri-implant bone levels, change in detection frequency of periodontal pathogen species over the study duration, adverse event occurrence and need for additional surgical treatment. No significant differences were noted between the two groups for any clinical parameter.Conclusions Antimicrobial therapy does not lead to improved patient outcomes in terms of reducing microbial load and reducing pocket depth. Based on this study, there is inadequate evidence to support the use of adjunctive antimicrobials for the non-surgical treatment of peri-implantitis.