Comparative Effectiveness of Local Antimicrobial Strategies for Peri-implantitis: A Network Meta-analysis

The study conducted a network meta-analysis to compare local antimicrobial strategies used as adjuncts to nonsurgical peri-implantitis therapy, including chlorhexidine, minocycline, doxycycline, and photodynamic therapy. Twenty-three controlled trials involving 1,248 implants with a minimum follow-up of 6 months were included based on systematic searches of MEDLINE, Embase, and the Cochrane Library. Primary outcomes were changes in probing pocket depth (PPD) and bleeding on probing (BOP), while secondary outcomes included radiographic bone fill and disease resolution rate. A random-effects network model was applied, and consistency was assessed using node-splitting. At 12 months, adjunctive local antibiotics achieved the greatest PPD reduction (−1.4 mm, 95% CI −1.9 to −0.9) compared with debridement alone, followed by chlorhexidine (−0.9 mm, 95% CI −1.3 to −0.5) and photodynamic therapy (−0.8 mm, 95% CI −1.2 to −0.4). However, none of the adjunctive approaches consistently improved radiographic bone levels across studies. SUCRA rankings indicated that minocycline microspheres had the highest probability of clinical superiority, although heterogeneity in defect morphology and debridement protocols limited definitive conclusions. Overall, local antimicrobials provide modest improvements in clinical parameters, while long-term disease control remains primarily dependent on adequate mechanical access and supportive maintenance.