Non-surgical periodontal therapy: An update on current evidence

Table 2 Summary of systematic reviews on adjunctive chemothrerapeutic agents

Systematic review	No. of studies	Treatment modalities	Tested clinical parameters	Conclusion
Systemic antimicrobial therapy
Herrera et al[50]	25	SRP + systemic antibiotics vs SRP alone or SRP + placebo	PPD, CAL	Systemic antimicrobials in conjunction with SRP can offer an additional benefit over SRP alone in the treatment of periodontitis
Haffajee et al[51]	29	SRP + systemic antibiotics vs SRP alone or SRP+ placebo	CAL	The 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 surgery	CAL, PPD	Adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with SRP alone
Sgolastra et al[54]	6	AMX/MET + SRP vs full mouth SRP alone	CAL, PPD, secondary outcomes, and adverse events	Significant 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]	4	AMX/MET + SRP vs SRP alone	CAL, PPD, secondary outcomes, and adverse events	Significant 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]	28	Adjuvant AMX/MET + SRP	CAL, PPD, plaque index, BOP	AMX/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]	43	Different systemic antibiotics + SRP vs SRP alone	BOP, CAL, PPD	Systemic 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]	32	Local controlled-release anti-infective drug therapy with or without SRP vs SRP alone	PPD, CAL	Local 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]	3	Local antimicrobials with SRP vs SRP alone	CAL, PPD	Only modest improvements in PPD reductions
Matesanz-Pérez et al[62]	52	Local antimicrobials with SRP vs SRP alone	CAL, PPD, plaque index, BOP	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
Full mouth disinfection
Eberhard et al[78]	7	FMD with or without antiseptics vs quadrant scaling	Tooth loss, BOP, PPD, CAL	Only minor differences in treatment effects between the treatment strategies
Eberhard et al[79]	7	FMD with or without antiseptics vs quadrant scaling	Tooth loss, BOP, PPD, CAL	Slightly 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]	12	FMD with or without antiseptics vs conventional staged debridement	BOP, PPD, CAL microbial changes	Despite 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]	7	Full mouth debridement vs FMD with antiseptics vs quadrant scaling	BOP, PPD, CAL	Traditional quadrant approach and full-mouth debridement could be equally effective

CAL: Clinical attachment level; PPD: Probing pocket depth; SRP: Scaling and root planing; BOP: Bleeding on probing; RCT: Randomized controlled clinical trial; AMX/MET: Amoxicillin plus metronidazole; FMD: Full mouth disinfection.