Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis

Abstract

The aim of this study was to perform a systematic review and meta-analysis to examine the effect of systemic antibiotics in the periodontal treatment of smokers. The selection criteria were as follows: controlled randomized clinical trials; studies published in English; studies with smoker patients diagnosed with chronic periodontitis; patients without systemic diseases; studies that used systemic antibiotic therapy associated with periodontal treatment; studies that presented results for the test and control groups and assessments of clinical periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). The differences in average weights were calculated with a confidence interval (CI) of 95% for PD reduction, CAL gain and BOP. The means of the periodontal clinical parameters were compared between the baseline and post-treatment periods between the test groups and the control groups. The heterogeneity was assessed using the Cochran Q test (Q (df = 3), α = 5%). A total of 67 articles were found, and after the selection process, three randomized controlled trials were included in the meta-analysis. The results indicate that SRP associated with systemic antibiotics promoted additional benefits when compared to SRP alone, with a greater reduction of PD (p = 0.0359, CI = -0.42, -0.01) and a gain of CAL (p = 0.0161, CI = -0.39, -0.04). There was a modest PD reduction (PD, DM -0.21) and a modest CAL gain (CAL, DM -0.22). The results of our meta-analysis reveal the clinical benefits of systemic antibiotics as an adjunct to the non-surgical periodontal treatment of smokers. These clinical improvements, although statistically significant, appeared to be of little clinical relevance.

Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial

“…In line with the findings of the present work, other studies have shown that the use of an adjunctive therapy with MTZ or MTZ + AMX has clinical and microbiological treatment benefits in non-smoking patients with chronic periodontitis [2,[32][33][34] as well as in patients who smoke [22,30]. There is still no consensus on antibiotic protocol in smokers [35], although certain studies have used the combination of MTZ + AMX for a period of 7 [30] or 14 [22,25] days. Another study suggested that smokers may specifically benefit from being treated with a combination of MTZ + AMX in the non-surgical phase, and that this reduces the need for surgery [8].…”

Is Antimicrobial Photodynamic Therapy Effective as an Adjunct to Scaling and Root Planing in Patients with Chronic Periodontitis? A Systematic Review

“…Residual pockets during SRP present similar challenges and additional therapeutic approaches to achieving periodontal health are required. To improve the results of mechanical debridement, antibiotics are widely used [ 3 , 4 ]. Limitations of drug resistance associated with the use of local and systemic medications have led to the popularity of antimicrobial photodynamic therapy (aPDT) in the management of chronic periodontitis.…”

Methylene Blue-Mediated Photodynamic Therapy Induces Macrophage Apoptosis via ROS and Reduces Bone Resorption in Periodontitis

“…The standard management of periodontal diseases focuses on infection control, detoxification of dental surfaces, regeneration of lost tissues, and plaque-control regimens via mechanical debridement (such as scaling and root planning (SRP)) [7]. Other therapeutic modalities, such as antiseptics and/or antibiotics, laser therapy, guided bone regeneration, and air-polishing, have also been proposed [8–11]. However, the outcomes of clinical treatment remain less than ideal.…”