title: Systemic antibiotics and the risk of superinfection in peri-implantitis.
abstract: Peri-implantitis has emerged in the last few years as a complication difficult to resolve. The etiopathogenesis consensus is mainly attributed to bacteria. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, a PubMed/Medline literature search was performed using the US National Library of Medicine database up to 2015 to analyze available scientific data on the rationale and risk of superinfection associated to systemic antimicrobials in human peri-implant disease. A hand search was also conducted on relevant medical and microbiology journals. The methodological index for non-randomized studies (MINORS) was independently assessed for quality on the selected papers. Proposed combined therapies use broad-spectrum antibiotics to halt the disease progression. A major associated risk, particularly when prescribed empirically without microbiological follow-up, is the undetected development of superinfections and overgrowth of opportunistic pathogens difficult to eradicate. Peri-implant superinfections with opportunistic bacteria, yeast and viruses, are plausible risks associated to the use of systemic antibiotics in immunocompetent individuals. Lack of microbiological follow-up and antibiotic susceptibility testing may lead to ongoing microbial challenges that exacerbate the disease progression. The increased proliferation of antimicrobial resistance, modern implant surface topography and indiscriminative empiric antibiotic regimens may promote the escalation of peri-implant disease in years to come. A personalized 3-month supportive therapy may help prevent risks by sustaining a normal ecological balance, decreasing specific pathogen proportions and maintaining ideal plaque control.
authors.affiliation: Department of Periodontics, VA Hospital, Greater Los Angeles Healthcare System, USA. Electronic address: fverdugo@perio.org.
authors.forename: Fernando
authors.initials: F
authors.lastname: Verdugo
authors.affiliation: Advanced Periodontology, University of Southern California School of Dentistry, Los Angeles, CA, USA.
authors.forename: Theresia
authors.initials: T
authors.lastname: Laksmana
authors.affiliation: Department of Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: Agurne
authors.initials: A
authors.lastname: Uribarri
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018441:Biofilms / Q000187:drug effects; D015921:Dental Implants / Q000382:microbiology / Q000706:statistics & numerical data*; D003773:Dental Plaque / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D006801:Humans; D009894:Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D057873:Peri-Implantitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015163:Superinfection / Q000453:epidemiology* / Q000382:microbiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015921:Dental Implants
keywords: Anti-bacterial agents; Candidiasis; Enterobacteriaceae; Opportunistic infection; Peri-implantitis; Superinfection; herpesviridae