Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm.
OBJECTIVE
The aim was to answer three relevant questions: can systemic antimicrobials be efficacious if the biofilm is not disrupted? Can the type of debridement of the subgingival biofilm impact upon the clinical outcomes of the adjunctive antimicrobial therapy? Is the efficacy of the adjunctive systemic antimicrobial therapy dependent on the quality of the debridement of the subgingival biofilm and the sequence debridement-antibiotic usage?


METHODS
Relevant papers were searched, critically analysed and their data were extracted.


RESULTS
For the first question, studies assessing susceptibility of bacteria in biofilms, and clinical studies evaluating systemic antimicrobials as monotherapy, were reviewed. For the second question, clinical studies comparing systemic antimicrobials as adjuncts to non-surgical debridement or to periodontal surgery and clinical trials using systemic antibiotics with periodontal surgery were evaluated. For the third question, a previous systematic review was updated.


CONCLUSIONS
If systemic antimicrobials are indicated in periodontal therapy, they should be adjunctive to mechanical debridement. There is not enough evidence to support their use with periodontal surgery. Indirect evidence suggests that antibiotic intake should start on the day of debridement completion, debridement should be completed within a short time (preferably <1 week) and with an adequate quality, to optimize the results.
Herrera
David
D
ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain. davidher@odon.ucm.es
Alonso
Bettina
B
León
Rubén
R
Roldán
Silvia
S
Sanz
Mariano
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects*; D003131:Combined Modality Therapy; D003646:Debridement; D012534:Dental Scaling; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D006801:Humans; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D016745:Root Planing; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004338:Drug Combinations