Authors' objectives:

The key question is whether scaling and root planing (SRP) accompanied by an antimicrobial agent, as a supplemental or adjunct treatment, results in improved outcomes that persist over time in adults with chronic periodontitis when compared with SRP alone (or SRP and placebo). The primary outcomes of interest in this report are reductions in probing depth (PD) and gains in clinical attachment level (CAL). Of secondary interest are reductions in selected disease-causing bacteria, particularly reduction in the percentage of spirochetes present in dental plaque or in fluid from the gingival crevice.

Authors' recommendations: Although the findings differ for each antimicrobial and mode of delivery, the authors make some important overall observations relating to the key question. First, relative to the PD reductions achieved from the baseline measurement to the study end-point measurement, the difference in measurements between the treatment and control groups typically favored the treatment group, but was relatively modest. With respect to CAL gains, the picture was similar, but the effects are smaller and statistical significance was less common. Of the antimicrobials investigated, studies of locally applied tetracycline and minocyclineand locally delivered chlorhexidinehave fairly consistent results in moderately large studies that often reach statistical significance; improvements observed in these studies typically average in the neighborhood of 0.3 mm to 0.6 mm. The other agents and delivery modes produced less consistent outcomes and fewer outcomes that reached statistical significance; the majority of studies showed small, statistically nonsignificant PD improvements. CAL outcomes were not as positive as those for PD. The question remains, the authors note, whether such improvements are clinically meaningful.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/periotp.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)