Efficacy of Systemic Antibiotic Combined with Non-surgical Periodontal Therapy for Aggressive Periodontitis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGYu-hui , SUNYu-liang , MATing ,  ZHAOJin

Department of Dentistry and Endodontics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ZHAOJin, Email: merryljin@sina.com

Keywords：

Periodontal therapy; Aggressive periodontitis; Antibiotic; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160090

Video：

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Objective To systematically evaluate the clinical efficacy of systemic antibiotic combined with non-surgical periodontal therapy for aggressive periodontitis. Methods We searched PubMed, EMbase, The Cochrane Library, WanFang Data, CBM, VIP and CNKI databases from inception to January, 2016, to collect randomized controlled trials (RCTs) about non-surgical periodontal therapy combined with systemic antibiotics for aggressive periodontitis. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 8 RCTs involving 236 patients were included. The results of meta-analysis showed, compared with non-surgical periodontal therapy alone, non-surgical periodontal therapy combined with systemic antibiotics showed a significant additional probing depth reduction at 3-, 6- and 12 months follow-up (MD=0.33, 95%CI 0.25 to 0.41, P<0.00001; MD=0.53, 95%CI 0.44 to 0.62, P<0.00001; MD=0.52, 95%CI 0.23 to 0.81, P=0.0004), and a significant clinical attachment gain at 3-, 6- and 12 months follow-up (MD=0.43, 95%CI 0.30 to 0.56, P<0.00001; MD=0.44, 95%CI 0.33 to 0.55, P<0.00001; MD=0.43, 95%CI 0.20 to 0.65, P=0.0002). Conclusion Current evidence shows that the treatment of patients with aggressive periodontitis, systemic antibiotic (Metronidazole and Amoxicillin) combined with non-surgical periodontal therapy has a significant additional effect than non-surgical therapy alone. However, because of the limitation of quality and quantity of included studies, the above conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.

Citation： ZHANGYu-hui, SUNYu-liang, MATing, ZHAOJin. Efficacy of Systemic Antibiotic Combined with Non-surgical Periodontal Therapy for Aggressive Periodontitis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(5): 585-591. doi: 10.7507/1672-2531.20160090 Copy

1.	孟焕新, 张立. 牙周临床治疗I．侵袭性牙周炎的诊断及治疗. 中华口腔医学杂志, 2005, 40(1): 81-84．.
2.	闰永发. 侵袭性牙周炎病因的研究进展. 现代口腔医学杂志, 2010, 24(1): 379-383.
3.	Teughels W, Dhondt R, Dekeyser C, et al. Treatment of aggressive periodontitis. Periodontol 2000, 2014, 65(1): 107-133.
4.	Mombelli A, Cionca N, Almaghlouth A, et al. Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery? Periodontol, 2000, 2011, 55(1): 205-216.
5.	Heller D, Varela VM, Silva-Senem MX, et al. Impact of systemic antimicrobials combined with anti-infective mechanical debridement on the microbiota of generalized aggressive periodontitis: a 6-month RCT. J Clin Periodontol, 2011, 38(4): 355-364.
6.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.1. Chichester: JohnWiley&Sons Ltd, 2008.
7.	Aimetti M, Romano F, Guzzi N, et al. Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: a randomized, placebo-controlled trial. J Clin Periodontol, 2012, 39(3): 284-294.
8.	Casarin RC, Peloso Ribeiro ED, Sallum EA, et al. The Combination of Amoxicillin and Metronidazole Improves Clinical and Microbiologic Results of One-Stage, Full-Mouth, Ultrasonic Debridement in Aggressive Periodontitis Treatment. J Periodontol, 2012, 83(8): 988-998.
9.	Yek EC, Cintan S, Topcuoglu N, et al. Efficacy of Amoxicillin and Metronidazole Combination for the Management of Generalized Aggressive Periodontitis. J Periodontol, 2010, 81(7): 964-974.
10.	Guerrero A, Griffiths GS, Nibali L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol, 2005, 32(10): 1096-1107.
11.	Mestnik MJ, Feres M, Figueiredo LC, et al. Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis. J Clin Periodontol, 2010, 37(4): 353-365.
12.	Mestnik MJ, Feres M, Figueiredo LC, et al. The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis: a 1-year double-blinded,placebo-controlled, randomized clinical trial. J Clin Periodontol, 2012, (10): 1-7.
13.	Oliveira APL, Faveri M, Gursky L, et al. Effects of periodontal therapy on GCF cytokines in generalized aggressive periodontitis subjects. J Clin Periodontol, 2012, 39(3): 295-302.
14.	Varela VM, Heller D, Silva-Senem MX, et al. Systemic Antimicrobials Adjunctive to a Repeated Mechanical and Antiseptic Therapy for Aggressive Periodontitis: A 6-Month Randomized Controlled Trial. J Periodontol, 2011, 82(8): 1121-1130.
15.	Silva-Senem MX, Heller D, Varela VM, et al. Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial. J Clin Periodontol, 2013,40(3): 242-251.
16.	Xajigeorgiou C, Sakellari D, Slini T, et al. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Clin Periodontol, 2006, 33(4): 254-264.
17.	Moreira RM, Feres-Filho EJ. Comparison Between Full-Mouth Scaling and Root Planing and Quadrant-Wise Basic Therapy of Aggressive Periodontitis: 6-Month Clinical Results. J Periodontol, 2007, 78(9): 1683-1688.
18.	Apatzidou DA, Kinane DF. Quadrant root planing versus same-day full-mouth root planning Ⅲ. Dynamics of the immune response. J Clin Periodontol, 2004, 31(3): 152-159.
19.	Wennstrom JL, Tomasi C, Bertelle A, et al. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol, 2005, 32(8): 851-859.
20.	Del Peloso Ribeiro E, Bittencourt S, Sallum EA, et al. Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study. J Clin Periodontol, 2008, 35(9): 789-798.
21.	Zanatta GM, Bittencourt S, Nociti H, et al. Periodontal Debridement With Povidone-Iodine in Periodontal Treatment: Short-Term Clinical and Biochemical Observations. J Periodontol, 2006, 77(3): 498-505.
22.	徐莉, 曹采方. 牙周临床治疗Ⅲ. 牙周非手术治疗的远期疗效. 中华口腔医学杂志, 2005, 40(3): 250-252．.
23.	Eick S, Seltmann T, Pfister W. Efficacy of antibiotics to strains ofperiodontopathogenicbacteriawithin a single species biofilm-an in vitro study. J Clin Periodontol, 2004, 31(5): 376-383.
24.	Rooney J, Wade WG, Sprague SV, et al. Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study. J Clin Periodontol, 2002, 29(4): 342-350.
25.	Winkel EG, Van Winkelhoff AJ, Timmerman MF, et al. Effects of metronidazole in patients with "refractory" periodontitis associated with Bacteroides forsythus. Journal of Clinical Periodontology, 1998, 24(8): 573-579.
26.	Pavicic MJ, Van Winkelhoff A, Jde Graaff J. In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations. Antimicrobial Agents and Chemotherapy, 1992, 36: 2634-2638.
27.	Rabelo CC, Feres M, Goncalves C, et al. Systemic antibiotics in thetreatment of aggressive periodontitis. A systematicreview and a Bayesian Networkmeta-analysis. J Clin Periodontol, 2015, 42: 647-657.
28.	Keestra JA, Grosjean I, Coucke W, et al. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. Journal of Periodontal Research, 2014, 50(6): 1-18.

1. 孟焕新, 张立. 牙周临床治疗I．侵袭性牙周炎的诊断及治疗. 中华口腔医学杂志, 2005, 40(1): 81-84．.
2. 闰永发. 侵袭性牙周炎病因的研究进展. 现代口腔医学杂志, 2010, 24(1): 379-383.
3. Teughels W, Dhondt R, Dekeyser C, et al. Treatment of aggressive periodontitis. Periodontol 2000, 2014, 65(1): 107-133.
4. Mombelli A, Cionca N, Almaghlouth A, et al. Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery? Periodontol, 2000, 2011, 55(1): 205-216.
5. Heller D, Varela VM, Silva-Senem MX, et al. Impact of systemic antimicrobials combined with anti-infective mechanical debridement on the microbiota of generalized aggressive periodontitis: a 6-month RCT. J Clin Periodontol, 2011, 38(4): 355-364.
6. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.1. Chichester: JohnWiley&Sons Ltd, 2008.
7. Aimetti M, Romano F, Guzzi N, et al. Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: a randomized, placebo-controlled trial. J Clin Periodontol, 2012, 39(3): 284-294.
8. Casarin RC, Peloso Ribeiro ED, Sallum EA, et al. The Combination of Amoxicillin and Metronidazole Improves Clinical and Microbiologic Results of One-Stage, Full-Mouth, Ultrasonic Debridement in Aggressive Periodontitis Treatment. J Periodontol, 2012, 83(8): 988-998.
9. Yek EC, Cintan S, Topcuoglu N, et al. Efficacy of Amoxicillin and Metronidazole Combination for the Management of Generalized Aggressive Periodontitis. J Periodontol, 2010, 81(7): 964-974.
10. Guerrero A, Griffiths GS, Nibali L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol, 2005, 32(10): 1096-1107.
11. Mestnik MJ, Feres M, Figueiredo LC, et al. Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis. J Clin Periodontol, 2010, 37(4): 353-365.
12. Mestnik MJ, Feres M, Figueiredo LC, et al. The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis: a 1-year double-blinded,placebo-controlled, randomized clinical trial. J Clin Periodontol, 2012, (10): 1-7.
13. Oliveira APL, Faveri M, Gursky L, et al. Effects of periodontal therapy on GCF cytokines in generalized aggressive periodontitis subjects. J Clin Periodontol, 2012, 39(3): 295-302.
14. Varela VM, Heller D, Silva-Senem MX, et al. Systemic Antimicrobials Adjunctive to a Repeated Mechanical and Antiseptic Therapy for Aggressive Periodontitis: A 6-Month Randomized Controlled Trial. J Periodontol, 2011, 82(8): 1121-1130.
15. Silva-Senem MX, Heller D, Varela VM, et al. Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial. J Clin Periodontol, 2013,40(3): 242-251.
16. Xajigeorgiou C, Sakellari D, Slini T, et al. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Clin Periodontol, 2006, 33(4): 254-264.
17. Moreira RM, Feres-Filho EJ. Comparison Between Full-Mouth Scaling and Root Planing and Quadrant-Wise Basic Therapy of Aggressive Periodontitis: 6-Month Clinical Results. J Periodontol, 2007, 78(9): 1683-1688.
18. Apatzidou DA, Kinane DF. Quadrant root planing versus same-day full-mouth root planning Ⅲ. Dynamics of the immune response. J Clin Periodontol, 2004, 31(3): 152-159.
19. Wennstrom JL, Tomasi C, Bertelle A, et al. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol, 2005, 32(8): 851-859.
20. Del Peloso Ribeiro E, Bittencourt S, Sallum EA, et al. Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study. J Clin Periodontol, 2008, 35(9): 789-798.
21. Zanatta GM, Bittencourt S, Nociti H, et al. Periodontal Debridement With Povidone-Iodine in Periodontal Treatment: Short-Term Clinical and Biochemical Observations. J Periodontol, 2006, 77(3): 498-505.
22. 徐莉, 曹采方. 牙周临床治疗Ⅲ. 牙周非手术治疗的远期疗效. 中华口腔医学杂志, 2005, 40(3): 250-252．.
23. Eick S, Seltmann T, Pfister W. Efficacy of antibiotics to strains ofperiodontopathogenicbacteriawithin a single species biofilm-an in vitro study. J Clin Periodontol, 2004, 31(5): 376-383.
24. Rooney J, Wade WG, Sprague SV, et al. Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study. J Clin Periodontol, 2002, 29(4): 342-350.
25. Winkel EG, Van Winkelhoff AJ, Timmerman MF, et al. Effects of metronidazole in patients with "refractory" periodontitis associated with Bacteroides forsythus. Journal of Clinical Periodontology, 1998, 24(8): 573-579.
26. Pavicic MJ, Van Winkelhoff A, Jde Graaff J. In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations. Antimicrobial Agents and Chemotherapy, 1992, 36: 2634-2638.
27. Rabelo CC, Feres M, Goncalves C, et al. Systemic antibiotics in thetreatment of aggressive periodontitis. A systematicreview and a Bayesian Networkmeta-analysis. J Clin Periodontol, 2015, 42: 647-657.
28. Keestra JA, Grosjean I, Coucke W, et al. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. Journal of Periodontal Research, 2014, 50(6): 1-18.

Chinese Journal of Evidence-Based Medicine

Efficacy of Systemic Antibiotic Combined with Non-surgical Periodontal Therapy for Aggressive Periodontitis: A Meta-analysis

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