title: Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis.
  
  
  BACKGROUND
  Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit.
  
  
  METHODS
  The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed.
  
  
  RESULTS
  The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent.
  
  
  CONCLUSIONS
  Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).
authors.affiliation: Department of Oral Health Sciences, Periodontology, KU Leuven & University of Leuven, Leuven, Belgium; Department of Periodontology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: J A J
authors.initials: JA
authors.lastname: Keestra
authors.forename: I
authors.initials: I
authors.lastname: Grosjean
authors.forename: W
authors.initials: W
authors.lastname: Coucke
authors.forename: M
authors.initials: M
authors.lastname: Quirynen
authors.forename: W
authors.initials: W
authors.lastname: Teughels
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D012534:Dental Scaling / Q000379:methods; D006801:Humans; D057747:Periodontal Debridement / Q000379:methods*; D016745:Root Planing / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: chronic periodontitis; non-surgical periodontal therapy; systemic antibiotics