Therapeutics Advances
Copyright ©2014 Baishideng Publishing Group Inc.
World J Stomatol. Nov 20, 2014; 3(4): 38-51
Published online Nov 20, 2014. doi: 10.5321/wjs.v3.i4.38
Table 1 Summary of the systematic reviews for mechanical non surgical periodontal therapy
Systematic reviewNo. of studiesTreatment modalitiesTested clinical parametersConclusion
Mechanical therapy
Tunkel et al[17]27Machine driven vs subgingival debridementTooth loss, CAL, PPD, BOPNo difference between ultrasonic/sonic and manual debridement in the treatment of chronic periodontitis for single-rooted teeth. Ultrasonic/sonic subgingival debridement requires less time than hand instrumentation
Van der Weijden et al[25]26Subginigval debridement + supragingival plaque controlBOP, PPD, CALImprovement in PPD and CAL by subgingival debridement (with supragingival plaque control)
Slots et al[19]15Vector® ultrasonic scaler vs conventional ultrasonic instruments and/or hand instrumentationCalculus removal, time of instrumentation, root surface aspects, patients' perception, BOP, PPD, CAL and microbiological effectsComparable clinical and microbiological effect of all 3 modalities. Vector® ultrasonic system is more time consuming
Laser therapy
Schwarz et al[29]11Laser monotherapy vs mechanical debidementClinical data Laser safety dataEr:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and long term compared with mechanical debridement. Insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode lasers
Karlsson et al[32]4Laser therapy + SRPBOP, PPD, CALNo consistent evidence for efficacy of laser as an adjunct to NSPT in adults with chronic periodontitis
Slots et al[30]8Nd:YAG Laser monotherapy vs Laser + SRPPlaque, BOP, gingivitis, PPD, CAL, and GRNo beneficial effect of a pulsed Nd:YAG laser compared to ultrasonics and/or hand instrumentation in the initial periodontitis
Sgolastra et al[31]5Er:YAG laser vs SRPCAL, PPD and GRNo evidence of effectiveness of Er:YAG laser compared to SRP
Photodynamic therapy
Azarpazhooh et al[40]5Monotherapy or adjunctive PDTPPD, CAL, GR, Full mouth plaque and bleeding scoresRoutine use of PDT for clinical management of periodontitis cannot be recommended
Sgolastra et al[39]4PDT used alone or adjunctive to scaling root planningCAL, PPD, GRPDT adjunctive to conventional treatment provides short-term benefits, but microbiological outcomes are contradictory. No evidence of effectiveness for the use of PDT as alternative to SRP
Table 2 Summary of systematic reviews on adjunctive chemothrerapeutic agents
Systematic reviewNo. of studiesTreatment modalitiesTested clinical parametersConclusion
Systemic antimicrobial therapy
Herrera et al[50]25SRP + systemic antibiotics vs SRP alone or SRP + placeboPPD, CALSystemic antimicrobials in conjunction with SRP can offer an additional benefit over SRP alone in the treatment of periodontitis
Haffajee et al[51]29SRP + systemic antibiotics vs SRP alone or SRP+ placeboCALThe use of systemically administered adjunctive antibiotics with and without SRP and/or surgery appeared to provide a greater clinical improvement in CAL
Goodson et al[52]RCT# (187 Patients)SRP + systemic antibiotics vs SRP + local antibiotic therapy and/or periodontal surgeryCAL, PPDAdjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with SRP alone
Sgolastra et al[54]6AMX/MET + SRP vs full mouth SRP aloneCAL, PPD, secondary outcomes, and adverse eventsSignificant CAL gain and PPD reduction in favor of full mouth SRP + AMX/MET; no significant risk difference in the occurrence of adverse events
Sgolastra et al[55]4AMX/MET + SRP vs SRP aloneCAL, PPD, secondary outcomes, and adverse eventsSignificant CAL gain and PPD reduction in favor of SRP + AMX/MET; no significant difference in BOP or suppuration. Supports effectiveness of SRP with AMX/MET in chronic periodontitis
Zandbergen et al[53]28Adjuvant AMX/MET + SRPCAL, PPD, plaque index, BOPAMX/MET as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in adults who are otherwise healthy
Keestra et al[56]43Different systemic antibiotics + SRP vs SRP aloneBOP, CAL, PPDSystemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. For initially moderate and deep pockets, MET or MET + AMX, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Clinical benefit became smaller over time (1 yr)
Local antimicrobial therapy
Hanes et al[60]32Local controlled-release anti-infective drug therapy with or without SRP vs SRP alonePPD, CALLocal anti-infective agents resulted in significant adjunctive PPD reduction or CAL gain for minocycline gel, microencapsulated minocycline, CHX chip and doxycycline gel during SRP compared to SRP alone. The decision to use local anti-infective adjunctive therapy remains a matter of individual clinical judgment, the phase of treatment, and the patient’s status and preferences
Bonito et al[61]3Local antimicrobials with SRP vs SRP aloneCAL, PPDOnly modest improvements in PPD reductions
Matesanz-Pérez et al[62]52Local antimicrobials with SRP vs SRP aloneCAL, PPD, plaque index, BOPScientific 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
Full mouth disinfection
Eberhard et al[78]7FMD with or without antiseptics vs quadrant scalingTooth loss, BOP, PPD, CALOnly minor differences in treatment effects between the treatment strategies
Eberhard et al[79]7FMD with or without antiseptics vs quadrant scalingTooth loss, BOP, PPD, CALSlightly more favourable, but modest outcomes were found following FMD in moderately deep pockets. Very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection
Lang et al[80]12FMD with or without antiseptics vs conventional staged debridementBOP, PPD, CAL microbial changesDespite the significant differences of modest magnitude, FMD with or without antiseptics do not provide clinically relevant advantages over conventional staged debridement. Hence, all three treatment modalities may be recommended for debridement in the initial treatment of chronic periodontitis
Farman et al[81]7Full mouth debridement vs FMD with antiseptics vs quadrant scalingBOP, PPD, CALTraditional quadrant approach and full-mouth debridement could be equally effective
Table 3 Recommended systemic antibiotic dosing regimens
Single agent regimen dosage/duration
Amoxicillin500 mg, three times per day × 8 d
Azithromycin500 mg, once daily × 4-7 d
Ciprofloxacin500 mg, twice daily × 8 d
Clindamycin300 mg, three times daily × 10 d
Doxycycline or minocycline100-200 mg, once daily × 21 d
Metronidazole500 mg, three times daily × 8 d
Combination therapy
Metronidazole + amoxicillin250 mg, of each three times daily × 8 d
Metronidazole + ciprofloxacin500 mg of each twice daily × 8 d
Table 4 Summary of systematic reviews on host modulation therapy
Systematic reviewNo. of studiesTreatment modalitiesTested clinical parameters Conclusion
Reddy et al[89]7 (SDD), 10 (NSAIDs), 3 (BPs)Adjuntive efficacy of anti-proteinases, anti-inflammatory agents, and anti-resorptiveBone changes, CAL, PPD, plaque index, gingivitisUse of SDD+ SRP‡ is statistically more effective than SRP alone in reducing PPD and achieving CAL gain Insufficient data for NSAIDs and BPs may have potential adjunctive role in periodontal therapy
Preshaw et al[92]2SDD + SRP vs SRP + placeboCAL, PPDAdjunctive SDD enhances therapeutic outcomes compared with SRP alone, resulting in clinical benefit in both smokers and non-smokers with chronic periodontitis
Sgolastra et al[91]3SDD + SRP vs SRP + placeboCAL, PPD, Plaque Index, Gingival Index, and gingival crevicular fluid levelsSupports long-term effectiveness of adjunctive SDD therapy
Moreno Villagrana et al[90]9SDD + SRP vs SRP + placeboCAL, PPDStatistically significant results in patients with aggressive or chronic periodontitis under periodontal treatment