The adjunctive use of host modulators in non‐surgical periodontal therapy. A systematic review of randomized, placebo‐controlled clinical studies

Abstract

Non-surgical periodontal therapy (NSPT) includes the improvement of oral hygiene and the use of subgingival scaling and root planing (SRP) for removing the soft and calcified biofilm deposits from the affected root surfaces. The ultimate goal of this mechanical treatment is to allow the diseased periodontal tissues to heal back to an inflammation-free status and restore periodontal health, as demarcated by the improvement of clinical indices. The sustainability and predictability of the outcome depends on various factors, including the efficient removal of

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

“…We recommend not to use locally delivered bisphosphonate (BP) gels or systemic BPs as an adjunct to subgingival instrumentation. Donos et al (2019) Quality of evidence Seven placebo-controlled RCTs (n = 348), on local delivery of 1% alendronate gel (six studies) and 0.5% zolendronate gel (one study); two placebo-controlled RCTs (n = 90) on systemic administration of BPs (alendronic acid and risedronate).…”

“…We recommend not to use local administration of statin gels (atorvastatin, simvastatin, rosuvastatin) as adjuncts to subgingival instrumentation.Supporting literatureDonos et al (2019) Quality of evidence Twelve placebo-controlled RCTs (n = 753), for 1.2% atorvastatin (six RCTs, n = 180), 1.2% simvastatin gel (5 RCTs, n = 118) and 1.2% rosuvastatin gel (four RCTs, n = 122)Grade of recommendation Grade A-↓↓Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)BackgroundInterventionStatins are known to have pleiotropic pharmacological effects in addition to their hypolipidemic properties. These include antioxidant and anti-inflammatory effects, the stimulation of angiogenesis, improvements in endothelial function and the positive regulation of bone formation pathways(Adam & Laufs, 2008;Mennickent, Bravo, Calvo, & Avello, 2008;Petit et al, 2019).Recent evidence suggests that statins may also attenuate periodontal inflammation, as reflected by decreases in pro-inflammatory and increases in anti-inflammatory mediators within the gingival crevicular fluid (GCF) of patients with periodontitis(Cicek Ari et al, 2016).…”

Metagenomic sequencing provides new insights into the subgingival bacteriome and aetiopathology of periodontitis

“…Further, antibiotics only alter the bacteriome for three months and may be a double‐edged sword as they suppress health‐associated species, potentially worsening dysbiosis 13 . The use of probiotics to improve non‐surgical periodontal outcomes through bacteriome modulation therapy could be a promising option, although the evidence available to date from randomized clinical studies indicate only limited clinical benefits 55 …”

Do Lasers Have an Adjunctive Role in Initial Non-Surgical Periodontal Therapy? A Systematic Review

“…For purposes of this manuscript, ‘adjunctive’ was defined when scaling and root planning (SRP) using either ultrasonic driven scalers and/or hand scaling instruments was performed together other treatments such as a laser. Other adjunctive modalities have been developed, such as antimicrobial photodynamic therapy [ 34 ] or systemic and locally delivered anti-microbial medications [ 35 ] but will not be discussed here.…”