Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review

Abstract

Aims: The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis.

Methods: Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model.

Results: Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I² = 87.38%), CAL (Q value = 13.65, P = 0.008, I² = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I² = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone.

Conclusions: Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable.

Keywords: Bisphosphonates; periodontal disease; scaling and root planning; systematic review.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Review and Meta‐Analysis) flow diagram for studies retrieved through the searching and selection process

Figure 2

Forest plot presenting post‐therapy probing depth reduction by comparing adjunctive bisphosphonate therapy vs. scaling and root planing (SRP)

Figure 3

Forest plots presenting post‐therapy clinical attachment level gain by comparing adjunctive bisphosphonate therapy vs. scaling and root planing (SRP)

Figure 4

Forest plots presenting post‐therapy bone defect fill by comparing adjunctive bisphosphonate therapy vs. scaling and root planing (SRP)