Adjunctive benefits of systemic metronidazole on non-surgical treatment of peri-implantitis. A randomized placebo-controlled clinical trial.

AIM: To study clinical, radiographic, and microbiological outcomes after non-surgical therapy of peri-implantitis with or without adjunctive systemic metronidazole. MATERIALS AND METHODS: A randomized placebo-controlled clinical trial was carried out in 32 subjects (62 implants) diagnosed with peri-implantitis. Implants received a mechanical non-surgical debridement session and systemic metronidazole or placebo. Clinical, radiographic, and microbiological outcomes were evaluated at baseline, 3, 6, and 12 months. RESULTS: After 12 months, the test treatment resulted in significantly greater PPD reduction (2.53 vs. 1.02 mm) and CAL gain (2.14 vs. 0.53 mm) (p value <.05) in comparison with placebo. The test treatment also resulted in additional radiographic bone gain (2.33 vs. 1.13 mm) compared with placebo (p value <.05). There was a significantly greater decrease in Porphyromonas gingivalis, Tannerella forsythia, and Campylobacter rectus counts compared with the control group (p value <.05). At the end of follow-up, 56.3% of patients met the success criteria in the test group and 25% in the control group. CONCLUSIONS: The use of systemic metronidazole as an adjunct to non-surgical treatment of peri-implantitis resulted in significant additional improvements in clinical, radiographic, and microbiological parameters after 12 months of follow-up. This study is registered in ClinicalTrials.gov (NCT03564301).

Peri-implantitis, systemic inflammation, and dyslipidemia: a cross-sectional biochemical study.

PURPOSE: The aim of this study was to compare the inflammatory and lipid profile of patients with and without peri-implantitis. METHODS: A cross-sectional biochemical study was carried out in which blood samples were collected from 16 patients with peri-implantitis and from 31 subjects with healthy implants. Clinical peri-implant parameters were obtained from all subjects. Levels of tumor necrosis factor-alpha and interleukin-10 (IL-10) were measured in serum. Lipid fractions, glucose and creatinine levels, and complete blood count were also assessed. RESULTS: After controlling for a history of periodontitis, statistically significant differences between peri-implantitis patients and controls were found for total cholesterol (estimated adjusted mean difference, 76.4 mg/dL; 95% confidence interval [CI], 39.6, 113.2 mg/dL; P<0.001), low-density lipoprotein (LDL) cholesterol (estimated adjusted mean difference, 57.7 mg/dL; 95% CI, 23.8, 91.6 mg/dL; P<0.001), white blood cells (WBC) (estimated adjusted mean difference, 2.8×103/µL; 95% CI, 1.6, 4.0×103/µL; P<0.001) and IL-10 (estimated adjusted mean difference, -10.4 pg/mL; 95% CI, -15.8, -5.0 pg/mL; P<0.001). The peri-implant probing pocket depth (PPD) was modestly positively correlated with total cholesterol (r=0.512; P<0.001), LDL cholesterol (r=0.463; P=0.001), and WBC (r=0.519; P<0.001). A moderate negative correlation was observed between IL-10 and PPD (r=0.609; P<0.001). CONCLUSIONS: Otherwise healthy individuals with peri-implantitis showed increased low-grade systemic inflammation and dyslipidemia.

Adjunctive Systemic Metronidazole to Nonsurgical Therapy of Peri-implantitis with Intrabony Defects: A Retrospective Case Series Study.

PURPOSE: To show the clinical and radiographic results of intrabony peri-implantitis lesions treated nonsurgically with adjunctive systemic metronidazole with a mean follow-up of 50 months. MATERIALS AND METHODS: Subjects diagnosed with peri-implantitis (probing depth ≥ 5 mm with concomitant bleeding on probing and/or suppuration) with radiographic evidence of intrabony defects > 2 mm were included in this study. Implants affected received one session of nonsurgical mechanical debridement with ultrasonic and steel curettes. Systemic metronidazole was immediately prescribed for 7 days. Clinical and radiographic variables were registered at baseline and at the end of follow-up. RESULTS: Eighteen patients and 25 implants were included in this investigation. At baseline, the mean radiographic bone level and intrabony component were 4.52 ± 2.14 mm and 3.93 ± 1.51 mm, respectively. After a mean follow-up of 54 (range: 12 to 108) months, the mean radiographic bone level reduction was 2.6 ± 0.21 mm, and the intrabony component reduction was 2.85 ± 0.37 mm (P < .05). A mean probing depth reduction of 4.66 ± 1.33 mm was observed (P < .05). CONCLUSION: Within the limits of this study, nonsurgical treatment of peri-implantitis with the adjunctive administration of systemic metronidazole has shown potential effectiveness in terms of probing depth and radiographic defect reduction after a mean follow-up of 54 months.