title: A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis.
abstract: OBJECTIVE
  To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis.
  
  
  METHODS
  Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria.
  
  
  RESULTS
  The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm).
  
  
  CONCLUSIONS
  The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.
authors: Graduate Periodontology, Faculty of Odontology, University Complutense, Plaza Ramon y Cajal s/n, Madrid, Spain.
authors: Paula
authors: P
authors: Matesanz-Pérez
authors: María
authors: M
authors: García-Gargallo
authors: Elena
authors: E
authors: Figuero
authors: Antonio
authors: A
authors: Bascones-Martínez
authors: Mariano
authors: M
authors: Sanz
authors: David
authors: D
authors: Herrera
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D003774:Dental Plaque Index; D006801:Humans; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000628:therapy; D057747:Periodontal Debridement / Q000379:methods*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000188:drug therapy / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D003692:Delayed-Action Preparations