Scaling and root planning (SRP) is the main therapeutic approach to treating periodontitis. The adjunctive use of local antimicrobials has demonstrated some improvement in outcomes.  The aim of this review was to assess the effect on clinical outcomes of local antimicrobials as adjuncts to SRP, compared to SRP alone or plus placebo, in chronic periodontitis patients.

Medline, Embase and the Cochrane Oral Health Groups trials register were searched together with hand searches of the Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research. Study selection and data abstraction was conducted by two reviewers and quality assessment and risk of bias was carried out according to Cochrane recommendations.

• 56 papers were included, reporting data from 52 different investigations. There was a high degree of heterogeneity among the studies.
• The overall effect of the subgingival application of antimicrobials was statistically significant (p=0.000) for both changes in probing pocket depth (PPD) and clinical attachment level (CAL) with a weighted mean difference (WMD) of -0.407 mm and -0.310 mm, respectively.
• No significant differences occurred for changes in bleeding on probing (BOP) and plaque index (PlI).
• Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5-0.7 mm).
• The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1-0.4 mm).

The authors concluded

The scientific evidence supports the adjunctive use of local antimicrobials to SRP in deep or recurrent periodontal sites, mostly when the vehicle has shown pharmakodynamic properties assuring the sustained release of the antimicrobial. This evidence must be interpreted with caution, since the reported data were highly heterogeneous and most of the selected studies were categorized with a high degree of bias.

Comment

This is an extensive review of the area but it is of note that all but two of the 56 included studies were considered to be of high or moderate risk of bias. This together with the marked heterogeneity in the studies needs to be taken into consideration in considering the use of these agents. The other issue to take into account is the small magnitude of the overall effect.  The authors also highlight that few studies report any side effects although some studies did report some adverse effects for example headache, diarrhoea, smarting, periodontal abscesses, root sensitivity, caries, taste disturbances and stomatitis.  It is also worth noting that systematic reviews of the use of systematic antibiotics have been conducted  (Dental Elf May 25^th 2012)

Links

Matesanz-PérezP, García-GargalloM, FigueroE, Bascones-MartínezA,  Mariano Sanz M, Herrera D. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared to subgingival debridement alone, in the treatment of chronic periodontitis.  Journal of Clinical Periodontology . Sept 2012 Accepted article

Dental Elf May 25^th 2012