Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review

Abstract

Keywords Bisphosphonates, scaling and root planning, periodontal disease, systematic review AIMSThe aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis. METHODSDatabases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTSEight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I 2 = 87.38%), CAL (Q value = 13.65, P = 0.008, I 2 = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I 2 = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone. CONCLUSIONSAdjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2017) 83 444-454 444

Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta‐analysis

“…Treatment of periodontitis with adjuncts aims to facilitate manual debridement in reducing further disease progression. Studies have shown that SRP when performed with other existing adjunct therapies (such as bisphosphonates, statins, application of lasers and photodynamic therapy) is more effective in reducing periodontal inflammation in systemically healthy individuals compared with SRP alone. Similarly, locally delivered metformin should be used to compare the observed effects in periodontal inflammation.…”

“…Considering these difficulties, various adjunctive treatments have been investigated and proposed to supplement SRP. These include systemic and localized delivery of antibiotics, bisphosphonates, lasers and photodynamic therapy to reduce bacterial counts and improve clinical periodontal parameters such as probing depth reduction, gaining clinical attachment level and bone defect (BD) fill in periodontitis . Among these compounds, locally delivered metformin have recently been introduced for the treatment of periodontal bone defects in chronic periodontitis …”

“…These include systemic and localized delivery of antibiotics, bisphosphonates, lasers and photodynamic therapy to reduce bacterial counts and improve clinical periodontal parameters such as probing depth reduction, gaining clinical attachment level and bone defect (BD) fill in periodontitis. [6][7][8][9][10][11][12] Among these compounds, locally delivered metformin have recently been introduced for the treatment of periodontal bone defects in chronic periodontitis. 13,14 Metformin is an oral hypoglycemic drug categorized under biguanides and are considered the most efficient agents widely used in the treatment of type 2 diabetes mellitus.…”

Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis

“…Nonetheless, the existence of serious side effects to these drugs, such as MRONJ, requires for said risks to be carefully compared in a risk-benefit perspective. 17 The presented hypothesis is that there may be a relationship between PD and MRONJ. To the best of our knowledge, no previous systematic approach has been used to study the relationship between PD and MRONJ.…”

“…Overall, these reports challenge the concept that bisphosphonates have a negative effect in PD, representing an interesting avenue for its potential use as adjuvants or host modulation therapies for PD. Nonetheless, the existence of serious side effects to these drugs, such as MRONJ, requires for said risks to be carefully compared in a risk‐benefit perspective …”