Int J Oral Implantol (Berl). 2024 Nov 19;17(4):359-380.
To evaluate the additional benefits of the adjunctive use of systemic antibiotics in the non-surgical and surgical treatment of peri-implantitis.
A systematic search following the population, intervention, comparison, outcome and study design framework was conducted across the MEDLINE (via PubMed), Embase and Web of Science databases. The primary outcome was probing depth reduction, and the secondary outcomes were bleeding on probing, clinical attachment level, radiographic bone level changes, suppuration and clinical success. Data on outcome variables were pooled through random effects meta-analyses.
Eight articles (seven studies) were included. For non-surgical interventions, systemic antibiotics reduced probing depth significantly after 1 year (n = 4; mean difference 1.33, 95% confidence interval 0.84 to 1.82; P 0.01), and also led to significant benefits in probing depth reduction at 3 and 6 months, clinical attachment level gain at 1 year (n = 3; mean difference 1.31, 95% confidence interval 0.68 to 1.95; P 0.01) and suppuration reduction at 3 months; however, no significant differences were found in bleeding on probing at 3 and 6 months, or clinical success at 1 year. For surgical treatment, antibiotics reduced probing depth significantly after 6 months, but no significant differences were noted after 1 year. Systemic antibiotics resulted in a significant increase in radiographic bone level after 1 year (n = 2; mean difference 0.96, 95% confidence interval 0.31 to 1.61; P 0.01) and a higher chance of clinical success (n = 2; odds ratio 2.16, 95% confidence interval 1.04 to 4.50; P = 0.009). In the combined analysis of non-surgical and surgical treatments for probing depth reduction at 1 year, systemic antibiotics showed a significant advantage (n = 5; mean difference 0.98, 95% confidence interval 0.56 to 1.40; P 0.01). Benefits extended to clinical attachment level gain, bone gain and increased likelihood of clinical success at 1 year.
Non-surgical treatment of peri-implantitis with adjunctive systemic antibiotics led to significant benefits in probing depth reduction, clinical attachment level gain and suppuration reduction at 1 year. Surgical treatment with adjunctive systemic antibiotics showed significant benefits in terms of bone gain and clinical success at 1 year. Nevertheless, the variability in antibiotic protocols should be considered. The adjunctive use of systemic antibiotics should be evaluated with caution, as the benefits may not outweigh the risks of antibiotic resistance in less severe cases of peri-implantitis.
评估在种植体周围炎的非手术和手术治疗中辅助使用全身抗生素的额外益处。
按照人群、干预、比较、结局和研究设计框架，对 MEDLINE（通过 PubMed）、Embase 和 Web of Science 数据库进行了系统检索。主要结局为探诊深度减小，次要结局为探诊出血、临床附着水平、影像学骨水平变化、溢脓和临床成功率。通过随机效应荟萃分析汇总了结局变量的数据。
纳入了 8 篇文章（7 项研究）。对于非手术干预，全身抗生素在 1 年后显著降低了探诊深度（n=4；平均差值 1.33，95%置信区间 0.84 至 1.82；P<0.01），并且在 3 个月和 6 个月时也显著改善了探诊深度减小、1 年时的临床附着水平增加（n=3；平均差值 1.31，95%置信区间 0.68 至 1.95；P<0.01）和 3 个月时的溢脓减少；然而，在 3 个月和 6 个月时的探诊出血和 1 年时的临床成功率方面未发现显著差异。对于手术治疗，抗生素在 6 个月后显著降低了探诊深度，但在 1 年后未发现显著差异。全身抗生素在 1 年后显著增加了影像学骨水平（n=2；平均差值 0.96，95%置信区间 0.31 至 1.61；P<0.01）和增加了临床成功率（n=2；比值比 2.16，95%置信区间 1.04 至 4.50；P=0.009）。在 1 年时探诊深度减小的非手术和手术联合治疗的综合分析中，全身抗生素显示出显著优势（n=5；平均差值 0.98，95%置信区间 0.56 至 1.40；P<0.01）。益处还扩展到了 1 年时的临床附着水平增加、骨增加和临床成功率提高。
在种植体周围炎的非手术治疗中辅助使用全身抗生素可显著降低探诊深度、增加临床附着水平和减少溢脓，在 1 年时。在手术治疗中辅助使用全身抗生素可显著提高骨水平和临床成功率。然而，应考虑抗生素方案的变异性。辅助使用全身抗生素应谨慎评估，因为在不太严重的种植体周围炎病例中，抗生素的益处可能并不超过抗生素耐药的风险。
