Systemic Antibiotics in Aggressive Periodontitis Treatment: A Systematic Review

Objectives: The aim of this study was to conduct a pairwise and Bayesian network meta-analyses (NM) to assess the clinical effect of treatment of aggressive periodontitis (AgP) with scaling and root planing (SRP) alone or associated with systemic antibiotic therapy (SAT).

Methods: This review was conducted and reported in accordance with the PRISMA statement. Randomized clinical trials were considered eligible for inclusion in this study if they have assessed the treatment of subjects with AgP with either SRP alone or associated with SAT (single drugs or combinations). CENTRAL, MEDLINE and EMBASE were searched up to, and including, June 2014 without language restrictions. The Bayesian network meta-analyses were undertaken using the Bayesian random-effects hierarchical models based on the results collected at 6 months after treatment.

Results: The search strategy identified 321 possibly eligible studies, and 11 were included in this review. Statistically significant greater gain in clinical attachment (CA) (MD: 1.08 mm; p < 0.0001) and reduction in probing depth (PD) (MD: 1.05 mm; p < 0.00001) were observed for the use of SRP+metronidazole (MTZ) than SRP alone/Placebo. Similarly, SRP+MTZ+amoxicillin (AMX) promoted additional CAL gain (MD: 0.45 mm; p < 0.00001) and PD reduction (MD: 0.53 mm; p < 0.00001) than SRP alone/Placebo. Bayesian NM showed that when SRP was associated to a SAT protocol, additional benefits, over those attained with SRP alone, were observed in CA gain and PD reduction mainly for the adjunctive use of MTZ, followed by MTZ+AMX and by DOX.
Conclusions: SRP plus SAT led to an additional clinical effect compared with SRP alone in the non-surgical treatment of AgP, for both conventional pair-wise and Bayesian NM. Of the available SAT protocols available for inclusion into the NMs` models, MTZ and MTZ/AMX provided the most beneficial clinical effects.