Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery—A Systematic Review with Meta-Analysis

Abstract

Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.

Minimal invasiveness in the surgical treatment of intraosseous defects: A systematic review

“…| 27 • seven articles (five parallel-arm randomized controlled trials, one split-mouth randomized controlled trial, one parallel-arm, quasi-randomized controlled trial) performed a comparative evaluation of regenerative periodontal treatment based on combination therapies vs monotherapies in terms of intraoperative and postoperative pain and morbidity, chair time, and/or costs 39,42,[47][48][49][50][51] ;…”

“…[24][25][26] Also, the use of systemic antibiotic therapies in the postoperative phase has been considered to improve clinical outcomes and prevent postoperative infections. 27 Several systematic reviews have evaluated the impact of flap design 2,[28][29][30] and regenerative technology, 3,31,32 as well as perioperative and postoperative protocols, 27 on the clinical outcomes of a periodontal regenerative procedure. Differently, the relevance of the same factors on invasiveness (as derived from a systematic review comprehensively considering the pertinent literature) currently remains unknown.…”

“…In this respect, technologies (eg, low‐level laser therapy) have been proposed to improve the biocompatibility of the exposed root surface and enhance wound healing 24–26 . Also, the use of systemic antibiotic therapies in the postoperative phase has been considered to improve clinical outcomes and prevent postoperative infections 27 …”

Antibiotika in der parodontalen Therapie

“…Die aktuelle S3-Leitlinie empfiehlt diese Verfahren in der Therapiestufe 3 in bestimmten vertikalen Defekten und in Furkationen 33 , äußert sich aber nicht zu einer begleitenden systemischen Antibiotikagabe. Erstmals wurde nun auch diese Frage unter Einschluss von über einhundert randomisierten Studien zur regenerativen Parodontalchirurgie ganz aktuell analysiert 43 . Zwar zeigten Meta-Regressionsanalysen im indirekten Vergleich geringfügig bessere Ergebnisse für diejenigen Studienarme, bei denen Antibiotika gegeben worden waren, aber bei Analyse der vergleichenden Studien (direkter Vergleich: regenerative Therapie mit versus ohne adjuvante AB-Therapie) fanden sich keine klinischen Vorteile 44 – 47 .…”

“…erkennbar. Basierend auf diesen Daten folgerten die Autoren, dass der Einsatz adjuvanter systemischer Antibiotika bei regenerativer Parodontalchirurgie auch im Sinne von Antibiotic Stewardship 34 in Frage gestellt werden sollte 43 . Die oben erwähnten Studien machten zumeist leider keine Angaben über unerwünschte Nebenwirkungen in Verbindung mit der Antibiotikagabe.…”