Clinical efficacy of chlorhexidine chips and tetracycline fibers as an adjunct to non surgical periodontal therapy

The aim of this systematic review is to compare the clinical efficacy of repeated applications of local drug delivery and adjunctive agents (LDAs) in nonsurgical periodontal therapy (NSPT) compared to subgingival mechanical debridement (SMD) alone. The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Web of Science, hand-searched literature and grey literature databases were searched for randomized controlled clinical trials (RCTs) with a minimum of 6-month follow-up. The outcomes of interest were changes in probing pocket depth and clinical attachment level as well as patient-centred outcomes. Of 1094 studies identified, 16 RCTs were included in the qualitative analysis. Across 11 different adjuncts analysed, only two studies utilizing minocycline gel/ointment and antimicrobial photodynamic therapy (aPDT) with indocyanine green photosensitizer had statistically significant differences in primary outcomes when compared to their control groups. Only one study on aPDT methylene blue 0.005% had compared single versus multiple applications against its control group. A mean range of 0.27–3.82 mm PD reduction and −0.09–2.82 mm CAL gain were observed with repeated LDA application. Considerable clinical heterogeneity and methodological flaws in the included studies preclude any definitive conclusions regarding the clinical efficacy of repeated LDA applications. Future RCTs with a direct comparison between single and repeated applications should be conducted to confirm or refute the clinical advantages of repeated LDA application in the nonsurgical management of periodontitis.

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Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis

BMC Oral Health ◽

10.1186/s12903-021-01695-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yu Huang ◽

Zheng Zhang ◽

Youli Zheng ◽

Zhulan Zhao ◽

Yang Zhong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Publication Bias ◽

Clinical Efficacy ◽

Clinical Data ◽

Random Effect ◽

Random Effect Model ◽

Periodontal Therapy ◽

Sensitivity Analyses ◽

Controlled Trials ◽

Cochrane Central Register

Abstract Backgrounds To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients. Methods We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method. Results Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs. Conclusions SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice.

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Effects of Non-surgical Periodontal Therapy on Periodontal Clinical Data in Periodontitis Patients With Rheumatoid Arthritis: a Meta-analysis

10.21203/rs.3.rs-173708/v1 ◽

2021 ◽

Author(s):

Yu Huang ◽

Zheng Zhang ◽

Youli Zheng ◽

Zhulan Zhao ◽

Yang Zhong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Publication Bias ◽

Clinical Efficacy ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Periodontal Therapy ◽

Sensitivity Analyses ◽

Cochrane Central Register ◽

Randomized Controlled Clinical Trials

Abstract Backgrounds: To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the overall aim of this study was to summarize available data regarding the clinical efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to patients with periodontitis alone.Methods: A meta-analysis of existing randomized controlled clinical trials (RCTs) was conducted. The eligible RCTs were selected through Embase, PubMed and Cochrane Central Register of Controlled Trials and manual retrieval from the earliest records to March 15, 2020 to extract data. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. The authors applied sensitivity analysis for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method.Results: Eight RCTs eventually met the inclusion criteria for the study. The overall outcomes concerned PI, GI, PD, Al and BOP were 0.42(95% CI 0.02, 0.81), 0.03(95% CI -0.03, 0.10),-0.06mm (95% CI -0.18, 0.06), 0.16mm (95% CI-0.03, 0.36) and 4.15(95% CI -0.26, 8.55), respectively. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested.Conclusions: The authors conclude that SRP is equally effective in patients with periodontitis and RA than in periodontitis ones. This result suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy.

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Clinical Efficacy of 25% Potassium Oxalate Solution of Dentin Hypersensitivity after Periodontal Therapy.

Nihon Shishubyo Gakkai Kaishi (Journal of the Japanese Society of Periodontology) ◽

10.2329/perio.35.162 ◽

1993 ◽

Vol 35 (1) ◽

pp. 162-171

Author(s):

Hiroshi ITO ◽

Takashi YOSHIHAMA ◽

Hiroshi NAKAYA ◽

Kyuichi KAMOI

Keyword(s):

Clinical Efficacy ◽

Periodontal Therapy ◽

Dentin Hypersensitivity ◽

Potassium Oxalate ◽

Oxalate Solution

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Clinical efficacy of local application of sustained-release metronidazole in periodontal therapy

Dentistry Review ◽

10.1016/j.dentre.2021.100006 ◽

2021 ◽

pp. 100006

Author(s):

Niroshani Surangika Soysa ◽

Hansani Waidyarathne ◽

Madushani Ranaweera ◽

Chrisman Neil Roshan Alexander Alles

Keyword(s):

Sustained Release ◽

Clinical Efficacy ◽

Periodontal Therapy ◽

Local Application

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Clinical Efficacy of Single Application Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis

Pharmaceutics ◽

10.3390/pharmaceutics12111086 ◽

2020 ◽

Vol 12 (11) ◽

pp. 1086

Author(s):

Oi Leng Tan ◽

Syarida Hasnur Safii ◽

Masfueh Razali

Keyword(s):

Drug Delivery ◽

Clinical Efficacy ◽

Meta Analysis ◽

Periodontal Therapy ◽

Local Drug Delivery ◽

Single Application ◽

Doxycycline Hyclate ◽

Pocket Depth ◽

Probing Pocket Depth ◽

Nonsurgical Periodontal Therapy

This review aimed to rank the clinical efficacy of commercially available single-application local drug delivery and adjunctive agents (LDAs) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Randomized controlled clinical trials that compared LDAs against SMD alone or with placebo in adults (aged at least 18 years) diagnosed with periodontitis with a minimum of 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented. The efficacies of the LDAs measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were reported as mean difference (MD) with 95% confidence intervals (CIs). The treatments were ranked according to their P-score. Four network meta-analyses suggested that sulfonic/sulfuric acid gel (PPD MD −1.13 mm, 95% CI −1.74 to −0.53, P-score 0.91; CAL MD −1.09 mm, 95% CI −1.58 to −0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD −0.90 mm, 95% CI −1.50 to −0.30, P-score 0.93; CAL MD −0.84 mm, 95% CI −1.40 to −0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence). LDAs have differing efficacies, but they present with possible clinical significance over SMD alone in NSPT.

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