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) (pvalue <.05) in comparison with placebo. The test treatment also resulted in additional radiographic bone gain (2.33 vs. 1.13 mm) compared with placebo (pvalue <.05). There was a significantly greater decrease inPorphyromonas gingivalis,Tannerella forsythia, andCampylobacter rectuscounts compared with the control group (pvalue <.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 inClinicalTrials.gov(NCT03564301).

Objectives: The aim of this study was to comprehensively assess the literature in terms of the effect of peri‐implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes.Material and methods: Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant‐supported fixed prosthesis, what is the influence of thin as compared to thick peri‐implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri‐implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri‐implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions.Conclusions: There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness.

Blanco C, et al. J Periodontal Implant Sci. 2021 Oct;51(5):342-351. https://doi.org/10.5051/jpis.2100920046