Antimicrobial adjuncts in the management of periodontal and peri-implant diseases and conditions: a narrative review

Abstract

Periodontal and peri-implant diseases are of rising concern due to their increasing prevalence, potential complications and financial consequences. Etiologic factors primarily are putative microorganisms while therapy involves mechanical debridement of the dental plaque biofilm. This treatment is performed non-surgically or surgically. Due to the diversity of periodontal and peri-implant diseases and conditions, practitioners seek adjuvants to improve therapeutic outcomes and limit the likelihood of residual or refractory disease. Antimicrobials may improve therapeutic success by altering the local pathogenic microflora and limiting the systemic spread of opportunistic infections. The use of antimicrobial adjuncts in dentistry is controversial, and there is a need to assess their validity in order to improve the success rates of periodontal and implant therapy whilst minimizing complications or adverse effects. This review aims to provide a summary of the current status of antimicrobial use for periodontal and peri-implant disease management. Adjunctive therapy may include systemic antibiotics, local antimicrobials, supra and subgingival antimicrobial irrigants, antimicrobial oral rinses, antiplaque and anti-calculus agents, photodynamic and laser therapies. Periodontal and peri-implant conditions are detailed, and adjunct antimicrobial options are summarized and their benefits are weighed against their potential side-effects. We proposed a standardized protocol for the adjunctive use of local and systemic antimicrobials in the management of periodontal or peri-implant diseases and conditions.