Clinical Efficacy of Repeated Applications of Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review.

Oi Leng Tan,Masfueh Razali,Syarida Hasnur Safii

doi:10.3390/antibiotics10101178

Abstract

The aim of this systematic review is to compare the clinical efficacy of repeated applications of local drug delivery and adjunctive agents (LDAs) in nonsurgical periodontal therapy (NSPT) compared to subgingival mechanical debridement (SMD) alone. The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Web of Science, hand-searched literature and grey literature databases were searched for randomized controlled clinical trials (RCTs) with a minimum of 6-month follow-up. The outcomes of interest were changes in probing pocket depth and clinical attachment level as well as patient-centred outcomes. Of 1094 studies identified, 16 RCTs were included in the qualitative analysis. Across 11 different adjuncts analysed, only two studies utilizing minocycline gel/ointment and antimicrobial photodynamic therapy (aPDT) with indocyanine green photosensitizer had statistically significant differences in primary outcomes when compared to their control groups. Only one study on aPDT methylene blue 0.005% had compared single versus multiple applications against its control group. A mean range of 0.27–3.82 mm PD reduction and −0.09–2.82 mm CAL gain were observed with repeated LDA application. Considerable clinical heterogeneity and methodological flaws in the included studies preclude any definitive conclusions regarding the clinical efficacy of repeated LDA applications. Future RCTs with a direct comparison between single and repeated applications should be conducted to confirm or refute the clinical advantages of repeated LDA application in the nonsurgical management of periodontitis.

Highlights

The 2019 Global Burden of Disease Study ranked oral disorders as first in prevalence globally with 30% of the 3.48 billion people affected having some form of periodontal disease [1]
The American Association of Periodontology suggested the use of sustained- or controlled-release local delivery antimicrobial agents when there is the presence of a localized probing pocket depth (PD) of more than 4 mm and gingival inflammation following conventional therapies in the absence of anatomical defects [12], whereas the American Dental Association Clinical Practice Guidelines [13] recommended the use of doxycycline hyclate (DH) gel and minocycline (MINO) microspheres as an “expert opinion for” adjunctive use, which does not imply endorsement but signified that there was a lack of good evidence
Some studies concluded that repeated local drug delivery and adjunctive agents (LDAs) applications offered more advantages to the overall outcomes of periodontal therapy [40,43,45,47,49,50,52,53], our findings found limited clinical improvements compared with subgingival mechanical debridement (SMD) alone whereby the majority of the studies exhibited no significant differences between SMD alone and SMD with an adjunct

Summary

Introduction

The 2019 Global Burden of Disease Study ranked oral disorders as first in prevalence globally with 30% of the 3.48 billion people affected having some form of periodontal disease [1]. The latest Clinical Practice Guideline developed by the European Federation of Periodontology recommended that locally administered antiseptics and antibiotics may be considered as an adjunct to subgingival instrumentation for treatment of Stage I–III periodontitis with consideration of its cost and availability of products [10]. These evidence-based recommendations have been adopted by the British Society of Periodontology for clinical application in the United Kingdom dental community [11]. The recommendation for chlorhexidine (CHX) chips and antimicrobial photodynamic therapy (aPDT) to be used as an adjunct in nonsurgical periodontal therapy was ‘weak’, albeit a with moderate level of certainty, and the authors proposed that the interventions should be implemented only after other alternatives have been considered

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Discussion

Conclusion