Abstract
Background
Periodontitis
is microbially-associated, host-mediated inflammatory condition that
results in loss of periodontal attachment. The goals of periodontal
therapy include arresting the disease progression, establishing healthy,
stable, maintainable periodontal conditions. A fundamental strategy of
treating periodontitis is scaling and root planning (SRP), however its
efficacy may be restricted in areas inaccessible for mechanical
instrumentation. As periodontitis is infectious in nature, it might be
helpful to use additional antimicrobial adjuncts, in order to eliminate
or inactivate pathogenic microflora. The aim of this study is to
evaluate the current evidence regarding the potential clinical benefits
of using additional antiseptics for SRP in nonsurgical periodontal
therapy.
Methods
An
electronic literature search was conducted in the MEDLINE (Ovid) and
Cohrane Central Register of Controlled Trials (CENTRAL) databases for
articles published between January 1, 2000 and September 22, 2019.
Randomized controlled clinical trials in English that compare the
effectiveness of one or more antiseptic agents as adjuncts to SRP with a
follow-up of ≥6 months were included. A meta-analysis using the
random-effects model was performed on the selected qualifying articles.
Results
The
search resulted in 12 articles that met the inclusion criteria. Based
on the vehicle employed to deliver the antiseptic agent, studies were
divided into adjunctive sustained-release antiseptics (gels, chips and
varnish) and adjunctive irrigation with antiseptics. The meta-analysis
demonstrated significant improvements in probing depth (PD) reduction (p = 0.001), clinical attachment level (CAL) gain (p = 0.001), and bleeding on probing (BOP) values (p = 0.001)
following the adjunctive subgingival application of sustained-release
antiseptics. Additional subgingival irrigation with antiseptics failed
to show significant improvements in PD (p = 0.321), CAL (p = 0.7568), or BOP values (p = 0.3549) over SRP alone.
Conclusions
Adjunctive
subgingivally delivered antiseptics with a sustained-release delivery
have significant clinical benefits compared to SRP alone.
Comments