The most effective treatments were metronidazole as adjunct to non-surgical treatment and combined with amoxicillin adjuncts to open flap debridement. While local antibiotic applications also enhance clinical parameters, they appear less effective than systemic regimens. Future well-designed clinical trials focusing on microbiological outcomes and standardized protocols are warranted to optimize periimplantitis management strategies.
Shibli et al. (2026) studied this question.