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Peri-ImplantitisPhase 4NCT03564301

Metronidazole as an Adjunct of Non- Surgical Treatment of Peri-implantitis

A Phase 4 study testing Metronidazole 250 MG in people with Peri-Implantitis, run by Juan Blanco Carrión at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The use of systemic antibiotics as and adjunct to non-surgical peri-implant therapy may be an improvement in comparison to these therapies alone. The primary objective is the evaluation of significant changes in probing pocket depth between non-surgical with or without antibiotics. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Peri-Implantitis
What is being tested?
Metronidazole 250 MG
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
20 participants
Where
1 siteSpain
Study dates
3 Mar 2018to 22 Dec 2020
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Older than 18 years.
  • Presence of at least 1 implant diagnosed with peri-implantitis (Presence of BOP and/or suppuration, with 2 mm of detectable bone loss after initial remodeling, and PD≥ 4 mm as defined by Daubert et al. 2015).
  • Absence of implant mobility.
  • History of taking systemic antibiotics in the preceding 3 months.
  • No systemic pathology that contraindicated the completion of treatment.
  • The patient understands the treatment and willing to comply.
  • The patient is willing to give written informed consent and can do

Who cannot join

  • Pregnant.
  • Metronidazole allergies
  • Patients on treatment with bisphosphonates.
  • Uncontrolled periodontal disease.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Department of periodontology, faculty of Odontology

    Santiago de Compostela, Coruña, 15782

Other trials in Spain

About this study

Official title: Metronidazole as an Adjunct of Non- Surgical Treatment of Peri-implantitis : a 6-months Placebo- Controlled Clinical Trial in Humans

The use of systemic antibiotics as and adjunct to non-surgical peri-implant therapy may be an improvement in comparison to these therapies alone. The primary objective is the evaluation of significant changes in probing pocket depth between non-surgical with or without antibiotics.

This is a controlled-placebo clinical trial design. Patients with osseointegrated oral implants will be selected and recruited from a university clinic. Oral hygiene instruction and non-surgical debridement at implants will be provided with ultrasonic devices and immediately after, patients will be prescribed:

Group Control: A placebo with the same characteristics as the antibiotic Group Test: Systemic antibiotics (Metronidazole 250mg, 2 capsules three times a day, for 7 days Three and six months after non-surgical treatment, clinical parameters will be registered and radiographs compared using reproducible landmarks. Any adverse event will be also recorded.

Read the detailed description

Microbial colonization of implant surface is the main causative factor of periimplantitis. Non-surgical treatment have been shown to be ineffective in bacterial control. The capacity of certain bacteria to invade soft tissues in periodontal lesions and a possible invasion in peri-implant diseases, could also be a good reason. Mombelli and Lang in a case-series study observed a significant reduction on probing depths and microbial parameters after non-surgical treatment and systemic antimicrobial therapy (ornidazole) of implants affected by marked loss of bone.

The rationale for conducting this research is to demonstrate that there may be significant differences in clinical, radiographic and microbiological parameters if systemic metronidazole is prescribed in conjunction with non-surgical treatment of peri-implantitis lesions. If there are differences, and a further improvement is observed in evaluated parameters, treatment protocols for these prevalent lesions could have been modified.

The objective of this research is to check whether there are differences in clinical, radiographic and microbiological parameters when performing non-surgical treatment to treat peri-implantitis with adjunctive administration of systemic metronidazole or a placebo.

Design: This research is designed as a parallel group, placebo-controlled, randomized, double-blind clinical study.

Population: Patients who come to the Periodontology Department, Faculty of Dentistry, University of Santiago de Compostela with dental implants presenting pathology.

Treatment Groups: Study group: patients treated by non-surgical treatment in conjunction with systemic metronidazole.Control group: patients treated by non-surgical treatment in conjunction with a placebo.

Randomization:After checking the inclusion criteria, signing the informed consent and included in the study. All subjects will be randomly assigned a number and one of the treatment group. The randomization will be done by a computer program for a simple randomization assignment.

Treatment: Non-surgical treatments will be performed under local anaesthesia . In cases where the prosthesis is screwed and screw access is possible, it will be removed during treatment and re-placed once completed. The patient will rinse with a mouthwash of chlorhexidine digluconate 0.12% and then implants affected will be debrided by ultrasound and manual curettes with the objective of removing deposits of plaque and calculus that are attached to the surface of the implant or prosthesis. Once the debridement is finished, pockets will be irrigated with chlorhexidine for 2 minutes and the surface of the prostheses polished using rubber cups and polishing paste.Immediately after the end of treatment and depending on the result of randomization, the exact number of tablets of the antibiotic or placebo to be taken during the following days will be given to the patient. The patient will be instructed in oral hygiene with either manual or electric toothbrush and interdental hygiene at the time of the completion of treatment. Subsequently, at 4 weeks, motivation and hygiene instructions will be strengthened by modifying brushing technique when deemed necessary.

Being tested
Placebo oral capsule, Metronidazole 250 MG
Keywords
Peri-implantitis, antibiotics, Metronidazole, non- surgical treatment
Medical subject headings
Peri-Implantitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Placebo oral capsuleDrug

    Immediately after the end of non surgical treatment of periimplantitis and depending on the result of randomization, the exact number of tablets of the placebo to be taken during the following days will be given to the patient.

  • Metronidazole 250 MGDrug

    Immediately after the end of non surgical treatment of periimplantitis and depending on the result of randomization, the exact number of tablets of the antibiotic to be taken during the following days will be given to the patient.

Study groups in NCT03564301
Study groupRoleWhat they receive
Metronidazole 250mgActive comparatorSystemic antibiotic: Metronidazole 250mg , 2 capsules three times a day, for 7 days.
Receives: Drug: Metronidazole 250 MG
PlaceboPlacebo comparatorPlacebo: same shape, size and dosis as test
Receives: Drug: Placebo oral capsule

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in probing depth

    Probing depth is the distance from the gingival margin to the bottom of the periodontal pocket (junctional epithelium). It is measured with a millimetric probe CP15 Hu-Friedy UNC at six points in each implant (mesial, distal and medial in buccal and lingual).

    Measured: baseline, 2 and 6 months after treatment

Secondary outcomes (6)
  1. Recession

    the distance is measured from the free gingival margin (more coronal portion of the free gingiva) to the cement enamel junction. The following values are obtained:

    • Zero: if the level of the cement enamel junction.
    • Negative: the free gingival margin is apical to the cement enamel junction.
    • Positive: when the free gingival margin is coronal to the cement enamel junction.

    Measured: baseline, 2 and 6 months after treatment

  2. Attachment level

    Distance from the cement enamel junction to the bottom of the periodontal pocket (probing depth + recession).

    Measured: baseline, 2 and 6 months after treatment

  3. Bleeding Index

    it will be recorded in six locations per tooth. It will be registered as presence or absence. If bleed- ing occured within 10-15 s, a positive score will be given.

    Measured: baseline, 2 and 6 months after treatment

  4. Peri-implant bone loss.

    Distance from the implant shoulder to the first bone-implant contact in mesial and distal aspects of each implant.. The extent of peri-implant bone loss will be performed with Kodak® software and a correction of the vertical distortion of the x- rays will be done by the technique described by Tonetti et al. (1993).

    Measured: baseline, 2 and 6 months after treatment

  5. Microbiological variable

    in terms of presence of periodontal pathogens and bacterial load. Deeper locations around each implant will be selected. The samples will be analyzed by real-time PCR. It will be recorded as the total percentage of each bacterium

    Measured: baseline and 6 months after treatment

  6. plaque index

    it will be recorded in four locations per tooth. It will be registered as presence or absence. Plaque present along the gingival margin that could be easily removed with the tip of a probe was recorded. Percentage scores for the presence of plaque over all examined sites will be calculated for each patient.

    Measured: baseline, 2 and 6 months after treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jun 2018
  2. Study start3 Mar 2018
  3. Primary completion1 Mar 2020
  4. Study completion22 Dec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
PLACEBO-CONTROLLED CLINICAL TRIAL IN HUMAN
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03564301
Sponsor's protocol ID
APB-MET-2017-01
Status last verified
Mar 2020
First submitted
19 May 2018
Last updated
28 Apr 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Carcuac O, Derks J, Charalampakis G, Abrahamsson I, Wennstrom J, Berglundh T. Adjunctive Systemic and Local Antimicrobial Therapy in the Surgical Treatment of Peri-implantitis: A Randomized Controlled Clinical Trial. J Dent Res. 2016 Jan;95(1):50-7. doi: 10.1177/0022034515601961. Epub 2015 Aug 18.

    PubMed 26285807
  • Mombelli A, Lang NP. Antimicrobial treatment of peri-implant infections. Clin Oral Implants Res. 1992 Dec;3(4):162-8. doi: 10.1034/j.1600-0501.1992.030402.x.

    PubMed 1298430
  • Renvert S, Samuelsson E, Lindahl C, Persson GR. Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study. I: clinical results. J Clin Periodontol. 2009 Jul;36(7):604-9. doi: 10.1111/j.1600-051X.2009.01421.x.

    PubMed 19538334
  • Renvert S, Roos-Jansaker AM, Claffey N. Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review. J Clin Periodontol. 2008 Sep;35(8 Suppl):305-15. doi: 10.1111/j.1600-051X.2008.01276.x.

    PubMed 18724858
  • Persson GR, Samuelsson E, Lindahl C, Renvert S. Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results. J Clin Periodontol. 2010 Jun;37(6):563-73. doi: 10.1111/j.1600-051X.2010.01561.x.

    PubMed 20507380
  • Linares A, Dopico J, Blanco C, Pico A, Sobrino T, Blanco J, Leira Y. The systemic impact of non-surgical treatment of peri-implantitis with or without adjunctive systemic metronidazole: Secondary analysis of a randomized clinical trial. Clin Oral Implants Res. 2024 Dec;35(12):1519-1530. doi: 10.1111/clr.14339. Epub 2024 Aug 2.

    PubMed 39093380
  • Blanco C, Pico A, Dopico J, Gandara P, Blanco J, Linares A. Adjunctive benefits of systemic metronidazole on non-surgical treatment of peri-implantitis. A randomized placebo-controlled clinical trial. J Clin Periodontol. 2022 Jan;49(1):15-27. doi: 10.1111/jcpe.13564. Epub 2021 Oct 28.

    PubMed 34713471

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Metronidazole 250 MG in people with Peri-Implantitis, run by Juan Blanco Carrión at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Apr 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in probing depth (time frame: baseline, 2 and 6 months after treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03564301, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Apr 2021.

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