Antioxidants as Adjuvants in Periodontitis Treatment: A Systematic Review and Meta-Analysis

Abstract

This systematic review with meta-analysis aimed to evaluate the effect of antioxidants as an adjuvant in periodontitis treatment. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane, Lilacs, OpenGrey, and Google Scholar. Based on the PICO strategy, the inclusion criteria comprised interventional studies including periodontitis patients (participants) treated with conventional therapy and antioxidants (intervention) compared to patients treated only with conventional therapy (control) where the periodontal response (outcome) was evaluated. The risk of bias was evaluated using the Cochrane RoB tool (for randomized studies) and ROBINS-I tool (for nonrandomized studies). Quantitative data were analyzed in five random effects meta-analyses considering the following periodontal parameters: clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing depth (PD). After all, the level of certainty was measured with the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool. Among the 1884 studies identified, only 15 interventional studies were according to the eligibility criteria and they were included in our review. From them, 4 articles presented a high risk of bias. The meta-analysis showed a statistically significant difference for CAL (SMD 0.29 (0.04, 0.55), p=0.03, I2=13%), PI (SMD 0.41 (0.18, 0.64), p=0.0005, I2=47%), and BOP (SMD 0.55 (0.27, 0.83), p=0.0001, I2=0%). The GRADE tool showed a moderate to high certainty in the quality of evidence depending on the clinical parameter and antioxidants used. These results suggest that the use of antioxidants is an adjunct approach to nonsurgical periodontal therapy which may be helpful in controlling the periodontal status.

Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

“…Seventeen articles met the criteria and were included for qualitative analysis. Thirteen studies reported subgingival application of CHX gel adjunct to SRP at selected sites with a moderate to deep probing depth (at least 4 mm in all studies) [8][9][10][25][26][27][28][29][30][31][32][33][34]. Nine studies were split-mouth RCTs [10,12,[27][28][29][32][33][34][35], four were parallel RCTs [11,26,30,31] and three studies used a placebo in the control [12,31,33].…”

“…In regards to this issue, adjunctive systemic and localized antibiotics have been applied to compensate for the limitation of mechanical therapy. Despite the rapid development of a variety of adjunctive local periodontal treatments in recent years, such as metformin, antioxidants, photodynamic treatment and so on [7][8][9], chlorhexidine (CHX) remains one of the most effective local antimicrobial agents, and is widely used for the local treatment of periodontitis [10][11][12][13]. Through the rapid attraction of the negatively charged bacterial cell surface to the cationic CHX molecule, CHX shows strong antibacterial activity in the periodontal pocket, along with a lack of toxicity, incompliance from patients and an emergence of resistance microorganisms.…”

Evaluation of Efficacy of Coenzyme Q10 as an Adjunct to Nonsurgical Periodontal Therapy and Its Effect on Crevicular Superoxide Dismutase in Patients with Chronic Periodontitis

“…9 SOD is a primary enzyme which scavenges oxygen free radical, hence it is an important antioxidant enzyme that protects tissues against oxidative injury resulting from oxidative stress. 10 Antioxidant therapy for treatment of periodontitis has given positive results as stated in a systemic review by Castro et al 11 CoQ10, which is also known as ubiquinone, because of its ubiquitous presence, is an antioxidant enzyme and has been studied widely for its effect in treatment of periodontal disease. [12][13][14][15][16][17][18][19][20] In the present study, an attempt had been made to evaluate the efficacy of CoQ10 in reduction of clinical parameters (GI, PI, PPD, and CAL) and its effect on SOD in GCF as an adjunct to Phase 1 periodontal therapy.…”

Adjunctive Subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: A systematic review and meta-analysis

“…Seventeen articles met the criteria and were included for qualitative analysis. Thirteen studies reported subgingival application of CHX gel adjunct to SRP at selected sites with a moderate to deep probing depth (at least 4mm in all studies) [8][9][10][25][26][27][28][29][30][31][32][33][34] . Nine studies were split-mouth RCTs 10,12,[27][28][29][32][33][34][35] , four were parallel RCTs 11,26,30,31 and three studies used a placebo in the control 12,31,33 .…”