Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions

Abstract

Objective: To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up.

Materials and methods: A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities.

Results: The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group.

Conclusion: Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions.

Trial registration: This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO.

Keywords: Metanalysis; Non-surgical periodontal therapy; Periodontal medicine; RCT.

Fig. 1

Risk of bias assessment for all included studies and summarized based on the intention-to-treat and per-protocol criteria

Fig. 2

Forest plot showing the mean differences of mean probing depth (in mm) sorted according to risk of bias assessment (low/some concerns vs. high) at 3 and 6 months

Fig. 3

Forest plot showing the mean differences of mean clinical attachment loss (in mm) sorted according to risk of bias assessment (low/some concerns vs. high) at 3 and 6 months

Fig. 4

Forest plot showing the mean differences of the percentage of sites with bleeding on probing (%BOP) sorted according to risk of bias assessment (low/some concerns vs. high) at 3 and 6 months

Fig. 5

Forest plot showing the mean differences of the percentage of sites with probing depths ≤ 3 mm (%PD ≤ 3 mm) sorted according to risk of bias assessment (low/some concerns vs. high) at 3 months; a including the studies where missing standard deviations were imputed; b only studies with complete information

Fig. 6

Irrespective of the comorbidity status, baseline values of mean PD and mean CAL were strongly associated with the corresponding measures at 3-months after NSPT. Study groups with higher mean PD at baseline exhibited a higher mean PD after therapy, whereas higher values of mean PD at baseline were concomitantly associated with greater reductions in mean PD over 3 months. Regarding the shape of the association, no significant differences between systemically healthy and diabetes groups were observed. In analyses of mean CAL, analogous results were obtained. The circle sizes represent the respective study sizes. For detailed information about the studies included in the arm with healthy subjects, please refer to Kocher et al. 2018. [66]