Gels As Adjuvant to Non-surgical Periodontal Therapy: A Systematic Review and Meta-analysis

Overview

Journal Heliyon

Specialty Social Sciences

Date 2023 Jul 17

PMID 37455970

Authors

Pierre-Yves Gegout

Celine Stutz

Olivier Huck

Affiliations

Soon will be listed here.

Abstract

Objective: This systematic review and meta-analysis evaluated the effect of the use of available drugs loaded gels used as adjunct to non-surgical periodontal therapy.

Methods: Systematic research on PubMed/MEDLINE, Cochrane Central register of Controlled Trials, and Embase databases up to December 2021 was performed. Randomized clinical trials (RCT) which compared the outcomes of scaling and root planing (SRP) + local adjuvant administration (gel) versus SRP + placebo or SRP alone in Humans were included. The primary outcome measures were PPD and CAL changes at 3 months.

Results: After articles screening, 77 articles were included and assessed for quality. Then, a meta-analysis was conducted in studies with at least 3 months of follow-up. Clinical improvements were found to be significant for tetracyclines (-0.51 [-0.71;-0.31] < 0.001), macrolides (-0.71 [-1.04;-0.38] p < 0.001), statins (-0.84 [-0.98;-0.70] < 0.001), metformin (-1.47 [-1.66;-1.29] < 0.001) and hyaluronan (-1.61 [-2.28;-0.94] < 0.001) loaded gels, but non-significant for chlorhexidine (-0.48 [-1.10; 0.14] = 0.13), metronidazole (-0.50 [-1.20; 0.20] = 0.16) and bisphosphonates (-0.42 [-1.39; 0.54] = 0.539) gels.

Conclusion: Adjunctive use of drugs loaded gels to non-surgical periodondal treatment could improve PPD reduction at 3 months. However, huge disparities remain when comparing the outcomes of the differents drugs used. Future comparative studies should be considered to determine precisely short and long term benefits of such treatments.

Citing Articles

Treatment of periodontal diseases: Latin America and the Caribbean Consensus 2024.

Fischer R, do Amaral G, Huaman-Mendoza A, Bueno L, Villar C Braz Oral Res. 2024; 38(suppl 1):e121.

PMID: 39607152 PMC: 11665977. DOI: 10.1590/1807-3107bor-2024.vol38.0121.

Comparative Study of Systemic vs. Local Antibiotics with Subgingival Instrumentation in Stage III-IV Periodontitis: A Retrospective Analysis.

Ilyes I, Boariu M, Rusu D, Iorio-Siciliano V, Vela O, Boia S Antibiotics (Basel). 2024; 13(5).

PMID: 38786158 PMC: 11117343. DOI: 10.3390/antibiotics13050430.

Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis.

Pardo A, Fiorini V, Zangani A, Faccioni P, Signoriello A, Albanese M J Clin Med. 2024; 13(8).

PMID: 38673451 PMC: 11050662. DOI: 10.3390/jcm13082179.

References

Chatterjee D, Kapoor A, Vijay S, Sobti G, Kara D, Thanvi J . Efficacy of Locally Administered 1.2% Rosuvastatin Gel in Patients with Periodontitis: A Randomized Placebo Controlled Clinical Trial. Eur J Dent. 2019; 13(1):29-35. PMC: 6635963. DOI: 10.1055/s-0039-1688522. View

Kadadasu R, Atchuta A, Palaparthy R, Reddy S, Sisinty V, Beeravolu M . Clinicomicrobiological evaluation of the efficacy of local delivery of moxifloxacin and ibuprofen gel as an adjunct to scaling and root planing in chronic periodontitis patients. J Oral Maxillofac Pathol. 2020; 24(1):26-32. PMC: 7269311. DOI: 10.4103/jomfp.JOMFP_253_19. View

Polepalle T, Srinivas M, Swamy N, Aluru S, Chakrapani S, Chowdary B . Local delivery of hyaluronan 0.8% as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A clinical and microbiological study. J Indian Soc Periodontol. 2015; 19(1):37-42. PMC: 4365154. DOI: 10.4103/0972-124X.145807. View

Batool F, Strub M, Petit C, Bugueno I, Bornert F, Clauss F . Periodontal Tissues, Maxillary Jaw Bone, and Tooth Regeneration Approaches: From Animal Models Analyses to Clinical Applications. Nanomaterials (Basel). 2018; 8(5). PMC: 5977351. DOI: 10.3390/nano8050337. View

Sgolastra F, Petrucci A, Ciarrocchi I, Masci C, Spadaro A . Adjunctive systemic antimicrobials in the treatment of chronic periodontitis: A systematic review and network meta-analysis. J Periodontal Res. 2020; 56(2):236-248. DOI: 10.1111/jre.12821. View

Kumari M, Martande S, Pradeep A . Subgingivally delivered 1.2% atorvastatin in the treatment of chronic periodontitis among smokers: a randomized, controlled clinical trial. J Investig Clin Dent. 2016; 8(2). DOI: 10.1111/jicd.12213. View

Elgendy E, Ali S, Zineldeen D . Effect of local application of tea tree (Melaleuca alternifolia) oil gel on long pentraxin level used as an adjunctive treatment of chronic periodontitis: A randomized controlled clinical study. J Indian Soc Periodontol. 2013; 17(4):444-8. PMC: 3800405. DOI: 10.4103/0972-124X.118314. View

Kaur H, Grover V, Malhotra R, Gupta M . Evaluation of Curcumin Gel as Adjunct to Scaling & Root Planing in Management of Periodontitis- Randomized Clinical & Biochemical Investigation. Infect Disord Drug Targets. 2018; 19(2):171-178. DOI: 10.2174/1871526518666180601073422. View

Kassebaum N, Bernabe E, Dahiya M, Bhandari B, Murray C, Marcenes W . Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014; 93(11):1045-53. PMC: 4293771. DOI: 10.1177/0022034514552491. View

10.

Dubar M, Lizambard M, Delcourt-Debruyne E, Batool F, Huck O, Siepmann F . forming drug-delivery systems for periodontal treatment: current knowledge and perspectives. Biomed Mater. 2021; 16(6). DOI: 10.1088/1748-605X/ac254c. View

11.

Petit C, Schmeltz S, Burgy A, Tenenbaum H, Huck O, Davideau J . Risk factors associated with long-term outcomes after active and supporting periodontal treatments: impact of various compliance definitions on tooth loss. Clin Oral Investig. 2019; 23(11):4123-4131. DOI: 10.1007/s00784-019-02851-x. View

12.

Phogat M, Rana T, Prasad N, Baiju C . Comparative evaluation of subgingivally delivered xanthan-based chlorhexidine gel and herbal extract gel in the treatment of chronic periodontitis. J Indian Soc Periodontol. 2014; 18(2):172-7. PMC: 4033882. DOI: 10.4103/0972-124X.131319. View

13.

Trombelli L, Franceschetti G, Farina R . Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review. J Clin Periodontol. 2014; 42 Suppl 16:S221-36. DOI: 10.1111/jcpe.12339. View

14.

Reddy M, Geurs N, Gunsolley J . Periodontal host modulation with antiproteinase, anti-inflammatory, and bone-sparing agents. A systematic review. Ann Periodontol. 2004; 8(1):12-37. DOI: 10.1902/annals.2003.8.1.12. View

15.

Grover S, Tewari S, Sharma R, Singh G, Yadav A, Naula S . Effect of Subgingivally Delivered 10% Emblica officinalis Gel as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis - A Randomized Placebo-controlled Clinical Trial. Phytother Res. 2016; 30(6):956-62. DOI: 10.1002/ptr.5600. View

16.

Lecic J, Cakic S, Janjic Pavlovic O, Cicmil A, Vukotic O, Petrovic V . Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis. Acta Odontol Scand. 2016; 74(6):502-7. DOI: 10.1080/00016357.2016.1206964. View

17.

Kinane D, Stathopoulou P, Papapanou P . Periodontal diseases. Nat Rev Dis Primers. 2017; 3:17038. DOI: 10.1038/nrdp.2017.38. View

18.

Mahendra J, Mahendra L, Muthu J, John L, Romanos G . Clinical effects of subgingivally delivered spirulina gel in chronic periodontitis cases: a placebo controlled clinical trial. J Clin Diagn Res. 2013; 7(10):2330-3. PMC: 3843431. DOI: 10.7860/JCDR/2013/5793.3517. View

19.

Pradeep A, Kumari M, Rao N, Martande S, B Naik S . Clinical efficacy of subgingivally delivered 1.2% atorvastatin in chronic periodontitis: a randomized controlled clinical trial. J Periodontol. 2012; 84(7):871-9. DOI: 10.1902/jop.2012.120393. View

20.

Rao N, Pradeep A, Kumari M, B Naik S . Locally delivered 1% metformin gel in the treatment of smokers with chronic periodontitis: a randomized controlled clinical trial. J Periodontol. 2012; 84(8):1165-71. DOI: 10.1902/jop.2012.120298. View