Adjunctive antibiotics in peri-implantitis surgery reduce bleeding on probing but not other outcomesAntibiotics with surgery reduced gum bleeding around dental implants in small study

Journal of clinical periodontology Published April 3, 2026 Study authors: Hakkers Jarno, de Waal Yvonne C M, Gareb Barzi, Meijer Henny J A, Raghoebar Gerry M PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Interpret isolated BOP reduction with adjunctive antibiotics cautiously; no broader clinical benefit was demonstrated.

This single-blind randomized controlled trial evaluated 59 patients with peri-implantitis and no, one-wall, or two-wall bony defects. Patients were randomized to receive either access-flap peri-implantitis surgery supplemented with systemic amoxicillin and metronidazole (n=29) or the same surgery without systemic antibiotics (n=30), with follow-up at 3, 6, 9, and 12 months postoperatively.

The primary outcomes were mean peri-implant probing pocket depth and mean peri-implant bleeding on probing. The test group showed significantly lower bleeding on probing at 9 months (β = -10.57%, 95% CI: -20.17 to -0.97, p=0.03) and 12 months (β = -14.47%, 95% CI: -25.9 to -3.04, p=0.01). However, no statistically significant differences were found between groups for probing pocket depth, disease resolution (composite outcome of residual probing depths ≤5 mm, no BOP in one or more sites, and no suppuration), suppuration on probing, or radiographic marginal bone levels at any timepoint.

Safety and tolerability data were not reported. Key limitations include the single-blind design, short-term 1-year follow-up, and the isolated effect on BOP that did not translate into broader or sustained clinical benefit. The clinical implications should be interpreted with caution, as the isolated short-term BOP reduction must be weighed against the risks associated with systemic antibiotic use without evidence of improvement in other important clinical parameters.

Researchers studied whether adding antibiotics to surgery helps treat peri-implantitis, a gum infection around dental implants. They followed 59 patients for one year. Half received surgery plus antibiotics (amoxicillin and metronidazole), while the other half received surgery alone.

The study found that patients who received antibiotics had less bleeding when their gums were probed at 9 and 12 months after treatment. However, the antibiotics did not lead to significant improvements in other key outcomes. There was no meaningful difference between groups in how deep the pockets around the implants were, whether the disease resolved, or in bone levels around the implants.

The main reason for caution is that the benefit was limited to just one measure (bleeding) and was observed over a relatively short time. The study did not report on side effects or safety concerns from the antibiotics, which are important to consider. For patients, this means that while antibiotics might reduce some bleeding in the short term, they did not show broader benefits in this study, and the decision to use them should be made carefully with a dentist, weighing potential risks.

What this means for you:

In a small study, antibiotics reduced gum bleeding after implant surgery but did not improve other outcomes. The benefit was limited.

Study Details

Study typeRct

Sample sizen = 29

EvidenceLevel 2

Follow-up12.0 mo

PublishedApr 2026

PMID41531146

View Original Abstract ↓

AIM: To analyse the effect of systemic amoxicillin and metronidazole on surgical peri-implantitis treatment with a follow-up period of 1 year. MATERIALS AND METHODS: Fifty-nine patients were randomly assigned to receive peri-implantitis surgery supplemented with (29 patients; test) or without (30 patients; control) systemic amoxicillin and metronidazole, in cases with no, one-wall or two-wall bony defects. Primary outcomes were mean peri-implant probing pocket depth (PPD) and mean peri-implant bleeding on probing (BOP); secondary outcomes included disease resolution (composite treatment outcome: residual probing depths ≤ 5 mm; no BOP in one or more probing site; no suppuration on probing), suppuration on probing (SOP) and radiographic marginal bone levels (MBLs), evaluated 3, 6, 9 and 12 months postoperatively (T3, T6, T9, T12). Linear and logistic mixed-effects models were employed. RESULTS: Between-group analyses showed that BOP was significantly lower in the test group compared to the control group at T9 (β = -10.57%, 95% CI: -20.17 to -0.97, p = 0.03) and T12 (β = -14.47%, 95% CI: -25.9 to -3.04, p = 0.01). No other parameters in the mixed-effects models showed statistically significant differences between groups at any timepoint. CONCLUSION: Access-flap peri-implantitis surgery supplemented with systemic amoxicillin and metronidazole led to a statistically significant reduction in peri-implant BOP after 1 year, whereas no other parameters showed statistically significant differences between groups at any timepoint. The clinical implications of these differences should be interpreted with caution, as the isolated short-term effect does not translate into broader or sustained clinical benefit and must be weighed against the risks associated with systemic antibiotic use.

Adjunctive antibiotics in peri-implantitis surgery reduce bleeding on probing but not other outcomesAntibiotics with surgery reduced gum bleeding around dental implants in small study

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Adjunctive antibiotics in peri-implantitis surgery reduce bleeding on probing but not other outcomesAntibiotics with surgery reduced gum bleeding around dental implants in small study

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