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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

  1. Paula Matesanz-Pérez1,
  2. María García-Gargallo1,
  3. Elena Figuero1,
  4. Antonio Bascones-Martínez1,3,
  5. Mariano Sanz2,
  6. David Herrera2,*

Article first published online: 16 JAN 2013

DOI: 10.1111/jcpe.12026

Issue

Journal of Clinical Periodontology

Journal of Clinical Periodontology

Volume 40, Issue 3, pages 227–241, March 2013

Additional Information

How to Cite

Matesanz-Pérez P, García-Gargallo M, Figuero E , Bascones-Martínez A , Sanz M , Herrera D. 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. J Clin Periodontol 2012; 00:000–000. doi: 10.1111/jcpe.12026.

Author Information

  1. 1

    Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain

  2. 2

    ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain

  3. 3

    “Host Response in Oral and Periodontal Pathology” Research Group, University Complutense, Madrid, Spain

* Address:
David Herrera
Facultad de Odontología
Universidad Complutense
Plaza Ramón y Cajal s/n, Ciudad Universitaria
28040 Madrid, Spain
E-mail: davidher@odon.ucm.es

  1. Conflict of interest and sources of funding statement The authors declare that they have no conflict of interests.

  2. This research was self-supported by the ETEP Research group.

Publication History

  1. Issue published online: 5 FEB 2013
  2. Article first published online: 16 JAN 2013
  3. Accepted manuscript online: 28 SEP 2012 07:35AM EST
  4. Manuscript Accepted: 21 SEP 2012

Funded by

  • ETEP Research group

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Keywords:

  • chronic periodontitis;
  • local antimicrobials;
  • meta-analysis;
  • scaling and root planing;
  • systematic review

Abstract

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.

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