Impact and efficacy of systemic antibiotics for peri‐implant diseases treatment: A systematic review and meta‐analysis on clinical and microbiological outcomes

Abstract Aim To evaluate the adjunctive effects of systemic antibiotics (SA) on clinical and microbiological outcomes in the treatment of peri‐implant diseases. Materials and Methods A systematic review and meta‐analysis were conducted following PRISMA guidelines and registered on PROSPERO (CRD420251059056). Randomized and non‐randomized clinical trials evaluating SA as adjuncts to non‐surgical treatment of peri‐implant mucositis (PM) and to non‐surgical or surgical therapy of peri‐implantitis (PI) were included. Rob2 and MINORS tools were used to assess the risk of bias of included articles. Results Eighteen studies were included in the qualitative analysis, of which only nine randomized clinical trials met the criteria for quantitative analysis. For PM treatment, SA did not significantly affect any assessed clinical outcomes (p>0.05). For PI treatment, the meta‐analysis showed that, in both non‐surgical and surgical PI treatment, adjunctive SA resulted in a significant bleeding on probing reduction at 12 months (p=0.007) and a significant probing pocket depth reduction at 12 months (p=0.004). However, no significant improvements in marginal bone level (MBL) were observed. For antimicrobial outcomes, only 2 studies reported significant effects of metronidazole as an adjunct to treatment on reductions in P. gingivalis and T. forsythia up to 12 months. Conclusions SA do not provide additional clinical or microbiological benefits in the treatment of PM. In PI, adjunctive systemic antibiotics may offer only limited improvements in selected clinical outcomes and specific peri‐implant pathogens for up to 12 months, without consistent benefits on MBL. However, given the heterogeneity of the available evidence, further high‐quality, long‐term studies are needed.