Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis

Teughels, Wim; Feres, Magda; Oud, Valèrie; Martín, Conchita; Matesanz, Paula; Herrera, David

doi:10.1111/jcpe.13264

Cited by 203 publications

(228 citation statements)

References 83 publications

Supporting

Mentioning

184

Contrasting

Unclassified

Order By: Relevance

“…This antibiotic has shown significant reductions in a global inflammatory score comprised by hs-CRP, IL-1β, IL-6 and TNF-α, at 6 months, but not on CRP alone [51], and hence, the cardiovascular effect shown in this study could be attributed to the antibiotic rather than the periodontal therapy. However, the adjunctive use of systemic antimicrobials to subgingival instrumentation is clearly justified by the periodontitis severity in the selected sample, since this modality of therapy has demonstrated a significant added effect on clinical and microbiological outcomes when compared to subgingival debridement alone in severe periodontitis patients [52], as well as in randomized clinical trials evaluating the impact of intensive periodontal therapy in cardiovascular risk outcomes [40,46].…”

Section: Discussionmentioning

confidence: 99%

Impact of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a randomized clinical trial

Montero

López

Vidal

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Although there is evidence of positive effect of periodontal therapy on systemic inflammation, this response is highly variable among subjects. It was the aim of this clinical investigation to determine the impact of periodontal treatment on systemic markers of inflammation in patients with metabolic syndrome (MetS) and periodontitis. Methods In this parallel-arm, double blind, randomized controlled clinical trial, 63 patients with MetS and severe periodontitis were randomly assigned to receive intensive periodontal treatment (IPT; scaling and root planing plus azithromycin 500 mg, q.d., for three days) or minimal periodontal treatment (MPT; supragingival professional mechanical plaque removal plus a placebo). The primary outcome was the impact of the tested interventions on hs-CRP serum levels at 6 months. As secondary outcomes, differences in the levels of cytokines, markers of prothrombotic states, carbohydrate and lipids metabolism, as well as blood pressure, were measured at 3 and 6 months after therapy. Results The ITT population consisted on 63 subjects randomly assigned to either MPT (n = 31) or IPT (n = 32) groups. At baseline, mean hs-CRP was 3.9 mg/L (standard deviation, SD = 2.9) and 3.9 mg/L (SD = 3.4), respectively, and no significant differences in their cardiometabolic risk profiles were detected between groups. After 6 months, unadjusted mean hs-CRP were 2.9 mg/L (standard error, SE = 0.4) and 4.0 (SE = 0.8), respectively. Adjusting for baseline hs-CRP, sex, age, smoking status and body mass index, hs-CRP was 1.2 mg/L (95% confidence interval, [CI 0.4; 2.0]; p = 0.004) lower in the IPT group than in the MPT group. In the secondary outcomes, significant reductions in IL-1β, TNF-α, HbA1c and blood pressure were observed in the IPT group at 3 months, when compared to the MPT group. Conclusion Effective periodontal treatment significantly reduced hs-CRP after 6 months in patients with MetS and severe periodontitis. Periodontal therapy might be useful to reduce cardiovascular risk in these patients. Trial registration: ClinicalTrials.gov Registration Number: NCT03960216.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a randomized clinical trial

Montero

López

Vidal

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Changes or delta (∆) in clinical parameters (at subject level) from baseline to 3, 6, 9 and 12 months were determined. "Pocket" closure was de ned as mean and SD of percentage of sites going from PPD ≥ 4 mm to PPD ≤ 3 mm at 3-and 12-months follow up [7]. "Risk for disease progression" was de ned at the patient level according to Land and Tonetti (2003).…”

Section: Outcome Variablesmentioning

confidence: 99%

“…Systemic antibiotics have the advantage of reaching all oral surfaces and uids, in addition to having the potential to reach periodontal pathogens that eventually invade the host's tissue [7]. Azithromycin is a broad-spectrum bacteriostatic antibiotic [8] with immunomodulatory properties [9].…”

Section: Introductionmentioning

confidence: 99%

“…Due to its pharmacological properties azithromycin allows a once a day administration during 3 or 5 days, thus increasing patient compliance [8] and limiting the side effects. Azithromycin as an adjunct to SRP signi cantly improves the e cacy of non-surgical periodontal therapy in terms of probing pocket depth (PPD) and bleeding on probing (BOP) reduction along with clinical attachment level gain [5,7]. SRP in conjunction with antibiotics is nevertheless not always associated with superior clinical results.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Effects of Probiotic or Azithromycin as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis Stage III: A Pilot Randomized Controlled Clinical Trial

Morales¹,

Contador²,

Bravo³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The aim of this triple- blind placebo- controlled parallel- arm randomized clinical trial was to evaluate the clinical effects of Lactobacillus rhamnosus SP1 or azithromycin as an adjunct to scaling and root planing (SRP) in patients with periodontitis stage III. Methods Forty-seven systemically healthy participants with periodontitis stage III were recruited. Following SRP, the participants were randomly assigned to one of three treatment modalities; 1) placebo (n = 15), 2) probiotics (n = 16) and 3) antibiotics-azithromycin (n = 16). The participants were monitored at baseline, 3, 6, 9 and 12 months after therapy. Probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment loss (CAL) and plaque accumulation (PI) were evaluated. Results All 47 participants completed the study. At 12 months, all groups showed significant improvements of PPD and PI (p < 0.012) irrespective of the treatment modality and without significant differences between the groups. Probiotics and azithromycin showed no added benefit in terms of CAL. While the placebo (p = 0.002) and the antibiotic-azithromycin (p = 0.002) group showed a significant reduction of BOP, only the placebo group revealed a significant reduction of CAL at 12 months follow-up (p = 0.003). The number of sites and teeth with PPD ≥ 5, ≥6 and ≥ 7 mm were significantly reduced in all groups at 12 months follow-up (p < 0.025) irrespective of the treatment regime and without significant differences between the groups. Conclusion The use of probiotics or azithromycin as an adjunct to SRP failed to provide additional benefits in the treatment of periodontitis stage III. The benefits of these two treatment regimes as an adjunct to SRP remain unclear.

show abstract

“…Due to its pharmacological properties azithromycin allows a once a day administration over 3 or 5 days, thus increasing patient compliance [8] and limiting the side effects. Azithromycin as an adjunct to SRP signi cantly improves the e cacy of non-surgical periodontal therapy in terms of probing pocket depth (PPD) and bleeding on probing (BOP) reduction along with clinical attachment level gain [5,7]. SRP in conjunction with antibiotics is nevertheless not always associated with superior clinical results.…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planing in the treatment of periodontitis stage III: A pilot randomized controlled clinical trial

Morales

Contador

Bravo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The aim of this triple- blind placebo- controlled parallel- arm randomized clinical trial was to evaluate the clinical effects of Lactobacillus rhamnosus SP1 or azithromycin as an adjunct to scaling and root planing (SRP) in patients with stage III periodontitis.Methods: Forty-seven systemically healthy participants with stage III periodontitis were recruited. Following SRP, the participants were randomly assigned to one of three treatment modalities; 1) placebo (n=15), 2) probiotics (n=16) and 3) antibiotics-azithromycin (n=16). The participants were monitored at baseline, 3, 6, 9 and 12 months after therapy. Probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment loss (CAL) and plaque accumulation (PI) were evaluated. Results: All 47 participants completed the study. At 12 months, all groups showed significant improvements of PPD and PI (p<0.012) irrespective of the treatment modality and without significant differences between the groups. Probiotics and azithromycin showed no added benefit in terms of CAL. While the placebo (p=0.002) and the antibiotic-azithromycin (p=0.002) group showed a significant reduction of BOP, only the placebo group revealed a significant reduction of CAL at 12 months follow-up (p=0.003). The number of sites and teeth with PPD ≥5, ≥6 and ≥7mm were significantly reduced in all groups at 12 months follow-up (p<0.025) irrespective of the treatment regime and without significant differences between the groups. Conclusion: The use of probiotics or azithromycin as an adjunct to SRP failed to provide additional benefits in the treatment of stage III periodontitis. The benefits of these two treatment regimes as an adjunct to SRP remain unclear.

show abstract

Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis

Cited by 203 publications

References 83 publications

Impact of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a randomized clinical trial

Impact of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a randomized clinical trial

Clinical Effects of Probiotic or Azithromycin as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis Stage III: A Pilot Randomized Controlled Clinical Trial

Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planing in the treatment of periodontitis stage III: A pilot randomized controlled clinical trial

Contact Info

Product

Resources

About