Abstract
Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.
Highlights
Introduction iationsThe use of systemic antimicrobials in periodontal therapy has been advocated for several decades, owing to the importance of microbes as triggers of the periodontal pathogenic process [1,2]
“In patients with periodontitis with ID or FI treated with regenerative surgery, what is the adjunctive benefit of systemic antimicrobials on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated with periodontal regenerative/reconstructive surgery?”
Studies: RCTs testing a regenerative technique at least in one arm and including at least 10 patients/arm and at least 1-year follow-up. For this systematic review (SR), we considered any type of regenerative surgery [guided tissue regeneration (GTR), enamel matrix derivative (EMD), bone filler or substitutes (BRG), growth factors (GF)] in patients with periodontal intra-bony defects ≥3 mm [7] or periodontitisrelated furcation defects of any type [8]
Summary
The use of systemic antimicrobials in periodontal therapy has been advocated for several decades, owing to the importance of microbes as triggers of the periodontal pathogenic process [1,2]. Several studies focused on the potential role of systemic antibiotics as adjuncts to mechanical non-surgical therapy, with the aim to improve pocket depth reduction and attachment level gain. A recent systematic review (SR) and meta-analysis concluded that the use of systemic antimicrobials as an adjunct to subgingival instrumentation results in statistically significant improvements in clinical outcomes. There is rising concern about the global emergence of antibiotic resistance [4,5]. A recent S3-level clinical guideline called for a restricted use of adjunctive systemic antibiotics during step 2 of periodontal therapy [6] There is rising concern about the global emergence of antibiotic resistance [4,5]. and a recent S3-level clinical guideline called for a restricted use of adjunctive systemic antibiotics during step 2 of periodontal therapy [6].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
