ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Local Antibiotic Use As An Adjunct To Scaling And Root Planning For Periodontitis
Clinical Question In an adult patient with chronic periodontitis, is local antibiotic therapy plus scaling and root planning more effective in improving attachment than scaling and root planning alone?
Clinical Bottom Line Adding local antibiotic therapy to scaling and root planning for patients with periodontitis may add modestly to improvements in probing depth and/or clinical attachment level, compared to scaling and root planning alone. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16101353Bonito / 2005Adults with chronic periodontitisSystematic review
Key resultsTetracycline, minocycline, metronidazole, and chlorhexidine gave the most positive results, improving on scaling and root planning by 0.1 mm to 0.5 mm. The incremental improvement gained by local antibiotics compared to scaling and root planning alone were very small and of questionable clinical significance, even when statistically significant.
Evidence Search "Periodontitis/drug therapy"[Mesh] AND "Anti-Bacterial Agents"[Mesh]
Comments on
The Evidence
Authors reported a systematic review of the literature from 1966 through December 2002. Following explicit criteria they included 50 controlled clinical studies of locally delivered agents (16 studies on tetracycline, 11 on minocycline, 10 on metronidazole, 17 on chlorhexidine, 2 on other antibiotics (doxycycline gel, ofloxacin inserts) and 5 on non-antibiotic anti-microbials (fluoride, hydrogen peroxide, etc). Meta-analysis was performed on most of the antibiotic studies for both probing depth and clinical attachment level outcomes, for at least 3 studies per agent of at least 6 month follow up. This systematic review covered research only until December 2002. Subsequent RCT’s have been published, but none on such a broad range of locally delivered antibiotics as are covered in this review and addressed by this clinical question. Readers who wish to have the latest good evidence on a particular antibiotic should review the literature on that agent, subsequent to 2002.
Applicability Included studies covered patients with chronic adult periodontitis but no serious comorbidities.
Specialty/Discipline (Periodontics)
Keywords periodontitis, antibiotics, antimicrobials
ID# 885
Date of submission: 05/06/2011spacer
E-mail coomes@uthscsa.edu
Author Angela Coomes
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail DEAHL@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Daniel Sabra (San Antonio, TX) on 10/03/2014
A PubMed search on local antibiotics and chronic periodontitis revealed a few more recent articles than the 2005 systematic review by Bonito. Ioannou published a cohort study in 2011 (PMID 24421978) which showed no significant significant difference resulting from local antibiotic delivery in chronic periodontitis patients undergoing initial therapy. However, the design of the study was poor; it compared two different treatments, a) scaling and root planing with hand instruments vs. b)ultrasonic debridement + localized doxycycline gel delivery. Jain’s 2012 study, PMID 23055582, was a randomized controlled trial, and it also found no significant difference in a split mouth design between sites having localized minocycline gel delivery after scaling and root planing vs. scaling and root planing alone. This research contradicts about Bonito’s findings, however his study is a meta-analysis/systematic review which is a higher level of evidence. Keep in mind that Bonito’s systematic review found that the administration of local antibiotics resulted in statistically significant however small improvements in pocket depths and clinical attachment level; this does not necessarily mean that the difference was clinically relevant or cost-effective.
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