Abstract
BackgroundMany systematic reviews and meta-analysis have indicated beneficial effects of adjunctive systemic antibiotics in periodontal therapy in specific situations. However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase. Material and MethodsSearches in the databases Medline, Scopus and Cochrane Library were conducted. The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all post-treatment phases. ResultsOf the 6209 records identified, two randomized clinical trials and two retrospective cohort studies were eligible according to inclusion criteria. Two studies suggested there were greater clinical benefits when systemic antibiotics were prescribed during the active phase of periodontal therapy than in the reevaluation phase while two other studies showed no significant difference in clinical outcomes at 6 months between these two different timing of administration. ConclusionsThe evidence available and evaluated in this systematic review is of heterogeneous quality and limited by the restricted number of studies and their dissimilarities in their study design and outcome reporting. Despite insufficient evidence to determine the ideal time to the adjunctive systemic antibiotic administration in the periodontal therapy, it seems that prescription of systemic antibiotic at the active phase of periodontal therapy leads to better clinical outcomes. Key words:Active phase; periodontal therapy, periodontitis, reevaluation, systemic antibiotics, timing.
Highlights
The use of systemic antimicrobials as adjunct to mechanical therapy has been indicated to potentiate the effects of non-surgical mechanical therapy in the cases of aggressive periodontitis, severe and progressive periodontitis and in periodontitis associated with specific microbiological profiles [1,2]
2 studies including 1 randomized control trials (RCT) [22] of high risk of bias and 1 retrospective cohort studies (RCS) [24] of good quality suggested there were greater clinical benefits when metronidazole and amoxicillin association was administered during the active phase of periodontal therapy than in the non-surgical re-treatment phase
The 2 others studies including 1 RCT [23] of unclear risk of bias and 1 RCS [25] of good quality, included in this systematic review showed that giving antibiotics in the first or second phase have had no influence on the long term outcome
Summary
The use of systemic antimicrobials as adjunct to mechanical therapy has been indicated to potentiate the effects of non-surgical mechanical therapy in the cases of aggressive periodontitis, severe and progressive periodontitis and in periodontitis associated with specific microbiological profiles [1,2]. This systematic review aims to determine which is the optimal time of systemic antibiotic administration as an adjunct to periodontal therapy, during the active non-surgical phase or the reevaluation phase. The purpose of this review is to answer the following question: “Would adjunctive systemic antibiotic administration in the active phase of periodontal therapy provides greater clinical benefits than in the reevaluation phase?” -Eligibility Criteria Studies were assessed for eligibility based on the following criteria: 1. Administrating adjunctive antibiotics in the first phase result in fewer patient requiring further therapy, a shorter treatment time and a lower mean number of surgical interventions. At 3 months after the initial therapy, the immediate administration of antibiotics resulted in significantly greater reductions in PD and RAL (for full- mouth means and for initially deep sites) and in the proportion of sites with PD >6mm compared to SRP alone in the late antibiotics group. SRP(b) (subgingival reinstrumentation at BOP positive sites with PD≥4mm and at all sites exhibiting PD≥5mm) +Late ATB (AMOX 500+MTZ250 every 8 h /10 days) after 3months (b) SRP by quadrant in 4 visits within 2 weeks
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