A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis.

AIMS To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. MATERIAL AND METHODS Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. RESULTS The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). CONCLUSIONS The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.

[1]  D. E. Slot,et al.  Effect of socket preservation therapies following tooth extraction in non-molar regions in humans: a systematic review. , 2011, Clinical oral implants research.

[2]  G. Perinetti,et al.  Clinical, microbiologic, and biochemical effects of subgingival administration of a Xanthan-based chlorhexidine gel in the treatment of periodontitis: a randomized multicenter trial. , 2009, Journal of periodontology.

[3]  Vijayalakshmi.,et al.  Effect of a controlled release device containing minocycline microspheres on the treatment of chronic periodontitis: A comparative study , 2009, Journal of Indian Society of Periodontology.

[4]  David J Spiegelhalter,et al.  A re-evaluation of random-effects meta-analysis , 2009, Journal of the Royal Statistical Society. Series A,.

[5]  A. Verma,et al.  Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis. , 2008, The journal of contemporary dental practice.

[6]  S. Sagar,et al.  Clinical and Microbiologic Effects of Subgingivally Delivered 0.5% Azithromycin in the Treatment of Chronic Periodontitis , 2008 .

[7]  M. Sanz,et al.  Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. , 2008, Journal of clinical periodontology.

[8]  W. Teughels,et al.  Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology. , 2008, Journal of clinical periodontology.

[9]  S. Socransky,et al.  Locally delivered doxycycline during supportive periodontal therapy: a 3-year study. , 2008, Journal of periodontology.

[10]  S. Paraskevas,et al.  A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. , 2008, Journal of clinical periodontology.

[11]  G. Perinetti,et al.  Clinical and Microbiologic Effects of Subgingival Controlled-Release Delivery of Chlorhexidine Chip in the Treatment of Periodontitis: A Multicenter Study , 2008 .

[12]  B. Willershausen,et al.  The adjunctive use of a controlled-release chlorhexidine chip following treatment with a new ultrasonic device in supportive periodontal therapy: a prospective, controlled clinical study. , 2007, International journal of dental hygiene.

[13]  J. Gunsolley,et al.  Minocycline HCl microspheres reduce red-complex bacteria in periodontal disease therapy. , 2007, Journal of periodontology.

[14]  M. J. Novak,et al.  Evaluation of the effect of subgingival placement of chlorhexidine chips as an adjunct to scaling and root planing. , 2007, Journal of periodontology.

[15]  J. Cosyn,et al.  Subgingival chlorhexidine varnish administration as an adjunct to same-day full-mouth root planing. II. Microbiological observations. , 2007, Journal of periodontology.

[16]  M. Serdar,et al.  The effect of topical doxycycline usage on gingival crevicular fluid MMP-8 levels of chronic and aggressive periodontitis patients: a pilot study. , 2006, International journal of dental hygiene.

[17]  J. Cosyn,et al.  Clinical benefits of subgingival chlorhexidine varnish application as an adjunct to same-day full-mouth root planing: a pilot study. , 2006, Journal of periodontology.

[18]  M. Casati,et al.  Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a 2-year follow-up. , 2006, Journal of periodontology.

[19]  G. Güncü,et al.  Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid. , 2006, Journal of periodontology.

[20]  J. Cosyn,et al.  A systematic review on the effects of the chlorhexidine chip when used as an adjunct to scaling and root planing in the treatment of chronic periodontitis. , 2006, Journal of periodontology.

[21]  K. Lohr,et al.  Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. , 2005, Journal of periodontology.

[22]  J. Cosyn,et al.  A chlorhexidine varnish implemented treatment strategy for chronic periodontitis: short-term clinical observations. , 2005, Journal of clinical periodontology.

[23]  E. Feres-Filho,et al.  Antibiotic resistance profile of the subgingival microbiota following systemic or local tetracycline therapy. , 2004, Journal of clinical periodontology.

[24]  Marcelo Diniz Carvalho,et al.  Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a clinical study. , 2004, Journal of periodontology.

[25]  E. Baltacıoğlu,et al.  A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis. , 2004, Journal of oral science.

[26]  D. Cirillo,et al.  Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months. , 2004, Journal of clinical periodontology.

[27]  P. Hanes,et al.  Local anti-infective therapy: pharmacological agents. A systematic review. , 2003, Annals of periodontology.

[28]  S. Socransky,et al.  Systemic anti-infective periodontal therapy. A systematic review. , 2003, Annals of periodontology.

[29]  M. Sanz,et al.  A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. , 2002, Journal of clinical periodontology.

[30]  D. Kinane,et al.  Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births? , 2002, Journal of clinical periodontology.

[31]  C. Douglass,et al.  Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. , 2002, Journal of clinical periodontology.

[32]  J. Slots,et al.  Initial effect of controlled release chlorhexidine on subgingival microorganisms. , 2002, Journal of periodontal research.

[33]  S. Salvador,et al.  Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters of periodontal syndrome. , 2002, Journal of clinical periodontology.

[34]  J. Lessem,et al.  Enhancing the value of scaling and root-planing: Arestin clinical trial results. , 2002, Journal of the International Academy of Periodontology.

[35]  J. Boyens,et al.  Scaling and root-planing treatment with adjunctive subgingival minocycline. A clinical pilot study over six months, of sites adjacent to and remote from the antibiotic application. , 2002, Journal of the International Academy of Periodontology.

[36]  T. Sorsa,et al.  The effect of subgingival controlled-release delivery of chlorhexidine chip on clinical parameters and matrix metalloproteinase-8 levels in gingival crevicular fluid. , 2002, Journal of periodontology.

[37]  W. Killoy.  The clinical significance of local chemotherapies. , 2002, Journal of clinical periodontology.

[38]  R. Reinhardt,et al.  Comparison of conventional periodontal maintenance versus scaling and root planing with subgingival minocycline. , 2002, Journal of periodontology.

[39]  R. Holle,et al.  Non-surgical periodontal therapy with adjunctive topical doxycycline: a double-blind randomized controlled multicenter study. , 2002, Journal of clinical periodontology.

[40]  G. K. Johnson,et al.  Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. , 2001, Journal of periodontology.

[41]  H. Newman,et al.  Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative multi-centre trial of 2 treatment approaches. , 2001, Journal of clinical periodontology.

[42]  H. Newman,et al.  Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel. , 2000, Journal of clinical periodontology.

[43]  G. Greenstein.  Nonsurgical periodontal therapy in 2000: a literature review. , 2000, Journal of the American Dental Association.

[44]  L. Flores-de-Jacoby,et al.  Topical metronidazole application as an adjunct to scaling and root planing. , 2000, Journal of clinical periodontology.

[45]  M. Jeffcoat,et al.  Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings. , 2000, Journal of periodontology.

[46]  J. Bernimoulin,et al.  Repeated local metronidazole-therapy as adjunct to scaling and root planing in maintenance patients. , 1999, Journal of clinical periodontology.

[47]  J. Matthews,et al.  Non-surgical periodontal treatment with and without adjunctive metronidazole in smokers and non-smokers. , 1999, Journal of clinical periodontology.

[48]  W. A. Soskolne,et al.  An in vivo study of the chlorhexidine release profile of the PerioChip in the gingival crevicular fluid, plasma and urine. , 1998, Journal of clinical periodontology.

[49]  M. Tonetti,et al.  A controlled multicenter study of adjunctive use of tetracycline periodontal fibers in mandibular class II furcations with persistent bleeding. , 1998, Journal of clinical periodontology.

[50]  D. Fine,et al.  Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. , 1998, Journal of periodontology.

[51]  L. Hou,et al.  Clinical response of localized recurrent periodontitis treated with scaling, root planing, and tetracycline fiber. , 1998, Journal of the Formosan Medical Association = Taiwan yi zhi.

[52]  T. Lie,et al.  Effects of topical metronidazole and tetracycline in treatment of adult periodontitis. , 1998, Journal of periodontology.

[53]  J. Matthews,et al.  Adjunctive systemic and locally delivered metronidazole in the treatment of periodontitis: a controlled clinical study , 1998, British Dental Journal.

[54]  C. Jarrold,et al.  Clinical and microbiological effects of topical minocycline in the treatment of elderly patients with periodontitis. , 1997, British dental journal.

[55]  S. Socransky,et al.  The effect of SRP on the clinical and microbiological parameters of periodontal diseases. , 1997, Journal of clinical periodontology.

[56]  R. Palmer,et al.  A randomized controlled trial of a 2% minocycline gel as an adjunct to non-surgical periodontal treatment, using a design with multiple matching criteria. , 1997, Journal of clinical periodontology.

[57]  T. Kadir,et al.  A clinical and microbiological evaluation of systemic and local metronidazole delivery in adult periodontitis patients. , 1997, Journal of clinical periodontology.

[58]  D. Kinane,et al.  Comparison of 3 periodontal local antibiotic therapies in persistent periodontal pockets. , 1996, Journal of periodontology.

[59]  M. Timmerman,et al.  Evaluation of the long-term efficacy and safety of locally-applied minocycline in adult periodontitis patients. , 1996, Journal of clinical periodontology.

[60]  J. M. Goodson,et al.  Evaluation of periodontal treatments using controlled-release tetracycline fibers: microbiological response. , 1995, Journal of periodontology.

[61]  K. Kornman,et al.  Clinical and microbiological effects of controlled-release locally delivered minocycline in periodontitis. , 1994, Journal of periodontology.

[62]  S. Jeong,et al.  Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy. , 1994, Journal of periodontology.

[63]  K. Kornman,et al.  A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjunction with scaling and root planing in maintenance patients: clinical results. , 1994, Journal of periodontology.

[64]  C. Walker,et al.  A Role for Antibiotics in the Treatment of Refractory Periodontitis. , 1993, Journal of periodontology.

[65]  D. van Steenberghe,et al.  Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study. , 1993, Journal of periodontology.

[66]  A. Saito,et al.  Clinical and microbiological study of local minocycline delivery (Periocline) following scaling and root planing in recurrent periodontal pockets. , 1991, The Bulletin of Tokyo Dental College.

[67]  T. Umemoto,et al.  Therapeutic effects of combined treatment using tetracycline-immobilized collagen film and root planing in periodontal furcation pockets. , 1991, Journal of clinical periodontology.

[68]  R. Caffesse,et al.  Scaling and root planing with and without periodontal flap surgery. , 1986, Journal of clinical periodontology.

[69]  D. Sakellari,et al.  Clinical and microbiological effects of adjunctive, locally delivered chlorhexidine on patients with chronic periodontitis. , 2010, Journal of the International Academy of Periodontology.

[70]  J. Gunsolley,et al.  Association of antimicrobial and clinical efficacy: periodontitis therapy with minocycline microspheres. , 2010, Journal of the International Academy of Periodontology.

[71]  D. Moher,et al.  METHODS OF SYSTEMATIC REVIEWS AND META-ANALYSIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009 .

[72]  W. Teughels,et al.  Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. , 2002, Periodontology 2000.

[73]  K. Williams,et al.  Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis. , 2002, Journal of periodontology.

[74]  P. Heasman,et al.  Local delivery of chlorhexidine gluconate (PerioChipTM) in periodontal maintenance patients , 2001 .

[75]  D. Kinane,et al.  A six-month comparison of three periodontal local antimicrobial therapies in persistent periodontal pockets. , 1999, Journal of periodontology.

[76]  U. Onan,et al.  Evaluation of adjunctive tetracycline fiber therapy with scaling and root planing: short-term clinical results. , 1999, Periodontal clinical investigations : official publication of the Northeastern Society of Periodontists.

[77]  H. Newman,et al.  Sustained local delivery of chlorhexidine in the treatment of periodontitis: a multi-center study. , 1997, Journal of periodontology.