Clinical Efficacy of Single Application Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis.

Oi Leng Tan,Syarida Hasnur Safii,Masfueh Razali

doi:10.3390/pharmaceutics12111086

Oi Leng Tan, Syarida Hasnur Safii + Show 1 more

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https://doi.org/10.3390/pharmaceutics12111086

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Abstract

This review aimed to rank the clinical efficacy of commercially available single-application local drug delivery and adjunctive agents (LDAs) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Randomized controlled clinical trials that compared LDAs against SMD alone or with placebo in adults (aged at least 18 years) diagnosed with periodontitis with a minimum of 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented. The efficacies of the LDAs measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were reported as mean difference (MD) with 95% confidence intervals (CIs). The treatments were ranked according to their P-score. Four network meta-analyses suggested that sulfonic/sulfuric acid gel (PPD MD −1.13 mm, 95% CI −1.74 to −0.53, P-score 0.91; CAL MD −1.09 mm, 95% CI −1.58 to −0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD −0.90 mm, 95% CI −1.50 to −0.30, P-score 0.93; CAL MD −0.84 mm, 95% CI −1.40 to −0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence). LDAs have differing efficacies, but they present with possible clinical significance over SMD alone in NSPT.

Highlights

According to the 2019 Global Burden of Disease Study [1], periodontal disease has affected an estimated 1.06 billion people worldwide and can be an economic burden to a nation [2,3,4]
Our findings suggest that based on a single local drug delivery and adjunctive agents (LDAs) application, SA gel and DH gel were the most effective in probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain with a probable superiority over subgingival mechanical debridement (SMD) alone
The other LDAs that were probably superior compared with SMD alone and had possible clinical importance when used as adjuncts in nonsurgical periodontal therapy (NSPT) were MINO gel, MINO microspheres, antimicrobial PDT MB 1% and antimicrobial PDT ICG

Summary

Introduction

According to the 2019 Global Burden of Disease Study [1], periodontal disease has affected an estimated 1.06 billion people worldwide and can be an economic burden to a nation [2,3,4]. The incidence of periodontitis is likely to increase with the rising prevalence of diabetes, which is projected to affect 578 million people (10.2%) by 2030 [5] and tobacco smoking, in which 18.9% of the global population are current tobacco smokers [6]. Both factors are established risks for periodontitis [7]. Nonsurgical mechanical periodontal debridement has been established as the gold standard in treating periodontitis with probing depth reductions and attachment level gains of up to 2 mm in moderate to deep pockets [10]. Restricted access to furcation areas, deep pockets, and irregular surfaces complicate the removal of bacterial deposits, and the procedure is vastly dependent on the skills of the clinician [11]

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