Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis

Abstract

Objective: The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) compared to SRP alone in patients with untreated aggressive periodontitis.

Background: In patients with aggressive periodontitis, SRP is often combined with the use of systemic antibiotics. However, the effectiveness of these antibiotics over time and differences in effectiveness between different antibiotics are hardly known.

Material and methods: The MEDLINE-PubMed database was searched from their earliest records until January 20, 2014. Several journals were hand searched and some authors were contacted for additional information. The following outcome measures were analysed: mean probing pocket depth reduction, mean clinical attachment level gain and mean bleeding on probing change. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed.

Results: The search yielded 296 abstracts. Ultimately, 101 articles were selected of which 14 articles met the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (0.36 ± 0.22 mm at 3 mo, 6 mo 0.42 ± 0.22 mm and 12 mo 0.88 ± 0.27 mm) and deep pockets (0.74 ± 0.36 mm at 3 mo, 6 mo 0.85 ± 0.55 mm and 12 mo 1.26 ± 0.81 mm) and a significant clinical attachment gain for moderate (0.26 ± 0.18 at 3 mo, 6 mo 0.52 ± 0.15 and 12 mo 0.83 ± 0.38) and deep pockets (0.59 ± 0.18 at 3 mo, 0.96 ± 0.21 at 6 mo and 1.00 ± 0.80 at 12 mo).

Conclusion: For the treatment of patients with aggressive periodontitis, systemic antibiotics combined with non-surgical periodontal therapy resulted in a significant additional effect compared to non-surgical therapy alone. There is a visible trend that showed metronidazole + amoxicillin is the most potent antibiotic combination.

Keywords: aggressive periodontitis; non-surgical periodontal therapy; systemic antibiotics.