Meta-analysis of local metronidazole in the treatment of chronic periodontitis.
BACKGROUND
Meta-analysis was used to assess the effectiveness of local delivery of metronidazole alone or as an adjunct to mechanical therapy in patients with chronic periodontitis.


METHODS
Studies were identified using MEDLINE and other sources. Meta-analyses were performed on the basis of probing depth (PD) at baseline and experimental and control regimens studied (i.e., metronidazole plus scaling and root planing [SRP] versus SRP and metronidazole versus SRP); the effect of local metronidazole on PD and attachment level (AL) was evaluated for follow-up times of 4, 8, 12, 24, and 36 weeks. The DerSimonian & Laird random effects model was used.


RESULTS
Twelve studies that met inclusion criteria were entered into the meta-analysis. A significant mean reduction in PD for the combined metronidazole and SRP was observed in all comparisons with initial PD > or = 4 mm (0.38 mm at 8 weeks to 0.6 mm at 12 weeks); whereas, with initial PD > or = 5 mm a significant mean reduction was observed from 12 weeks (0.29 to 0.48 mm at 24 and 36 weeks, respectively). Meta-analysis could be performed for AL to test the effectiveness of metronidazole as an adjunct to SRP and a significant AL improvement was found in all analyses (0.2 mm at 4 weeks to 0.29 mm at 24 and 36 weeks). Meta-analyses were performed including two to four studies.


CONCLUSIONS
Our results demonstrated the effectiveness of metronidazole as an adjunct to SRP in the treatment of chronic adult periodontitis, but clinical significance and dissemination of antibiotics should be taken into account in the evaluation of metronidazole as an alternative to SRP.
Medical School, University of Catanzaro Magna Graecia, Catanzaro, Italy.
Maria
M
Pavia
Carmelo G A
CG
Nobile
Aida
A
Bianco
Italo F
IF
Angelillo
D000287:Administration, Topical; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002908:Chronic Disease; D012534:Dental Scaling; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D017622:Periodontal Attachment Loss / Q000188:drug therapy; D010514:Periodontal Pocket / Q000188:drug therapy; D010518:Periodontitis / Q000188:drug therapy*; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity
D000891:Anti-Infective Agents, Local; D008795:Metronidazole