Antiseptics As Adjuncts To Scaling And Root Planing In The Treatment Of Periodontitis: A Systematic Literature Review

Abstract

Background: Periodontitis is microbially-associated, host-mediated inflammatory condition that results in loss of periodontal attachment. The goals of periodontal therapy include arresting the disease progression, establishing healthy, stable, maintainable periodontal conditions. A fundamental strategy of treating periodontitis is scaling and root planing (SRP), however its efficacy may be restricted in areas inaccessible for mechanical instrumentation. As periodontitis is infectious in nature, it might be helpful to use additional antimicrobial adjuncts, in order to eliminate or inactivate pathogenic microflora. The aim of this study is to evaluate the current evidence regarding the potential clinical benefits of using additional antiseptics for SRP in nonsurgical periodontal therapy. Methods: An electronic literature search was conducted in the MEDLINE (Ovid) and Cohrane Central Register of Controlled Trials (CENTRAL) databases for articles published between January 1, 2000 and September 22, 2019. Randomized controlled clinical trials in English that compare the effectiveness of one or more antiseptic agents as adjuncts to SRP with a follow-up of ≥ 6 months were included. A meta-analysis using the random-effects model was performed on the selected qualifying articles. Results: The search resulted in 12 articles that met the inclusion criteria. Based on the vehicle employed to deliver the antiseptic agent, studies were divided into adjunctive sustained-release antiseptics (gels, chips and varnish) and adjunctive irrigation with antiseptics. The meta-analysis demonstrated significant improvements in probing depth (PD) reduction (p = 0.001), clinical attachment level (CAL) gain (p = 0.001), and bleeding on probing (BOP) values (p = 0.001) following the adjunctive subgingival application of sustained-release antiseptics. Additional subgingival irrigation with antiseptics failed to show significant improvements in PD (p = 0.321), CAL (p = 0.7568), or BOP values (p = 0.3549) over SRP alone. Conclusions: Adjunctive subgingivally delivered antiseptics with a sustained-release delivery have significant clinical benefits compared to SRP alone.

Efficacy of Isolated and Combined Application of Topical Metronidazole and Chlorhexidine in the Treatment of Periodontal Inflammation a Randomized Controlled Trial

“…Treatment option for periodontal problems starts by the removal of bacterial deposits by supra-and sub gingival scaling and root planning (SRP) (10) . There is also a well-known fact that SRP may not efficaciously removal of sub gingival debris, where there is barrier to access such as deep pockets and root fraction's (11) .It may be assumed that chemical agents having the ability to reach deeper structures on probing resulting in greater improvement, (12) an advantage of this is that a concentrated amount of drug is incorporated deeper on sub gingival site (13) ,with having no adverse effect on micro flora of the mouth (14).…”

Clinical efficacy of single and multiple applications of antimicrobial photodynamic therapy in periodontal maintenance: A systematic review and network meta-analysis

“…In particular, bacterial biofilm cannot be efficiently eliminated from deep pockets, intrabony defects, or furcation areas. It is also dependent on the operators' manual skills and various patient-related factors (e.g., patients' smoking status and systemic diseases) [4]. Several studies have shown that adjunctive aids to SD (e.g., local antibiotics, antiseptics, lasers) may substantially improve the clinical outcomes following nonsurgical periodontal treatment [4][5][6][7].…”