title: Meta-analysis of the effect of systemic metronidazole as an adjunct to scaling and root planing for adult periodontitis.
abstract: The purpose of this meta-analysis was to provide a quantitative overview of clinical trials assessing the use of systemic metronidazole (S-MET) as an adjunct to scaling and root planning (S&RP) in the treatment of adult periodontitis. Eight clinical trials were chosen based upon a priori selection criteria, and two outcomes, "reduction in probing pocket depth" (PD) and "gain in clinical attachment level" (CAL), were analyzed. Results for each outcome were stratified by initial PD 1-3 mm, 4-6 mm, or > or = 7 mm and length of follow-up 4-6 wk, 9-13 wk, or 14-26 wk. S-MET in conjunction with S&RP was superior to S&RP alone in reducing PD where initial PD was 4-6 mm and follow-up was 9-13 wk (0.43 mm; 99% CI 0.12, 0.73). No significant advantage was observed for S-MET for reducing PD where initial PD was less than 4 mm or follow-up was longer than 13 wk. S-MET in conjunction with S&RP was superior to S&RP alone in reducing CAL where initial PD was 4-6 mm and follow-up was 4-6 wk (0.29; 99% CI 0.01, 0.58) and where follow-up was 9-13 wk (weighted mean difference 0.32; 99% CI 0.03, 0.61). Significant heterogeneity of effect was not seen for PD or Cal at any level of initial PD or length of follow-up. No significant dose-response relationship was observed. This meta-analysis was limited due to diversity of data presentation and the small number of trials in each stratum. These results suggest that S-MET in conjunction with S&RP may offer a benefit over S&RP alone in the treatment of adult periodontitis patients in managing pockets of 4 mm or greater, but the additional benefit was not evident if initial PD was less than 4 mm or follow-up was beyond 13 wk.
authors.affiliation: Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill 27599-7450, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Elter
authors.forename: H P
authors.initials: HP
authors.lastname: Lawrence
authors.forename: S
authors.initials: S
authors.lastname: Offenbacher
authors.forename: J D
authors.initials: JD
authors.lastname: Beck
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D012534:Dental Scaling; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D018579:Patient Selection; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D010518:Periodontitis / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D016745:Root Planing; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole