Adjunctive Antibiotics with Nonsurgical Periodontal Therapy Improve the Clinical Outcome of Chronic Periodontitis in Current Smokers

Abstract

A systematic review was performed to identify randomized, controlled, clinical trials designed to study the efficacy of adjunctive antimicrobial therapy with periodontal treatment of chronic periodontitis in smokers. A search was carried out using the databases PubMed (using MeSH terms and free text), EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials, and a manual search of 4 periodontal journals, bibliographies, review articles, and consensus statements. The databases were searched from their earliest records until December 31, 2009. The inclusion criteria of studies were as follows: (1) randomized, controlled clinical studies of ≥6 months study duration; (2) application of a systemic or local adjunctive antimicrobial agent for the treatment of chronic periodontitis in current smokers; (3) measurement of clinical attachment level, probing depth, and bleeding on probing as primary outcomes; (4) no periodontal treatment or use of systemic antibiotics within 6 months of the start of the trial; and (5) publication in an English-language, peer-reviewed journal. The key intervention was the use of antibiotics as an adjunct to nonsurgical or surgical periodontal treatment of chronic periodontitis in current smokers. There were no limitations on the type of antibiotics used, regimen, or the route of administration. The change in clinical attachment level and probing depth ≥6 months postoperatively following periodontal treatment. Five clinical trials met the inclusion criteria and their findings were used in this systematic review. Nine additional studies were excluded: 8 because smokers were not randomized, and 1 because the follow-up was only 3 months. The age of subjects in the included studies ranged from 42 to 52 years, and the sample size ranged from 30 to 181 subjects. Three studies used nonsurgical periodontal therapy (scaling and root planing) (Table 1). The first study used doxycycline 10% gel delivered locally and reported a gain in attachment level 24 months postoperatively. The second study used minocycline 1-mg microspheres delivered locally and reported a reduction in probing depth 9 months postoperatively. In the third study, the experimental group was administered azithromycin 250 mg systemically, and reported a gain in clinical attachment level and a reduction in probing depth 6 months postoperatively. The fourth study used a pocket reduction surgery and adjunctive use of systemic azithromycin 500 mg, and found no significant reduction in probing depth or gain in attachment level 6 months postoperatively. The fifth study used surgical therapy consisting of guided tissue regeneration (GTR) supplemented with local application of metronidazole 25% gel for the treatment of Class II furcation defects. The latter study reported a statistically significant gain in vertical attachment level but no significant change in horizontal attachment level or probing depth during a 12-month follow-up period. The risk of bias in all studies was estimated as high. The authors of the systematic review stated that the reviewed data were inadequate and inconsistent, and therefore meta-analyses were not performed. There is no sufficient evidence in the literature to support or refute that adjunctive antibiotic therapy would lead to a significant reduction in probing depth or gain in clinical attachment level when treating periodontitis in smokers.