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Adjunctive therapies in non-surgical periodontal treatment II
PD Dr. Kristina Bertl, PhD MSc MBA
In the recently presented systematic review by Donos et al. (‘Adjunctive therapies in non-surgical periodontal treatment I’), local and systemic adjunctive therapies were discussed in the context of non-surgical periodontal treatment. However, as part of the Perio Workshop 2019, the possibilities offered by local antibiotics were also assessed.
Local antibiotics have several advantages over systemic ones, namely a low number of unwanted side effects; a higher rate of compliance, because the method does not rely on the patient actually taking all their tablets; and a very low risk of antibiotic resistance.
As part of the Perio Workshop 2019, Herrera et al. (2020) pooled current knowledge regarding the application of local antibiotics in non-surgical periodontal treatment in a systematic review. Studies about the following local antibiotics and antiseptics were found and analyzed:
- Tetracycline (e.g. Actisite, Aureomycin)
- Minocycline (e.g. Arestin, Dentomycin)
- Doxycycline (e.g. Ligosan, Atridox)
- Metronidazole (e.g. Elyzol)
- Chlorhexidine (e.g. Chlosite, Periochip)
Based on the data from 50 individual studies, the authors came to the following conclusions:
- Local antibiotics do not produce any significant side effects and in most cases (in 34 of the 50 studies) only one application was required.
- For all local antibiotics combined, the post-treatment probing pocket depth was approximately 0.4 mm smaller for the groups given local antibiotics than for the control groups – both in the short and long term.
- In the short term (six–nine month follow-up), use of Atridox (two studies), Actisite (seven studies), Ligosan (three studies) and Arestin (six studies) resulted in a statistically significant improvement with regard to probing pocket depth. Periochip (nine studies) also led to a significant improvement in probing pocket depth, but the included studies also exhibited significant heterogeneity.
Because of the substantial heterogeneity of the studies involved, it is generally difficult to compare the various products. The final conclusion remains that local antibiotics as a whole can lead to an improvement in probing pocket depth in the range of approximately 0.5 mm.
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Reference
- Herrera D, Matesanz P, Martín C, Oud V, Feres M, Teughels W. Adjunctive effect of locally delivered antimicrobials in periodontitis therapy. A systematic review and meta-analysis. J Clin Periodontol. 2020 Jan 8. doi: 10.1111/jcpe.13230.
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