title: Network meta-analysis of studies included in the Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis.
abstract: OBJECTIVE
  The recent ADA-commissioned Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis has provided the most exhaustive library of clinical trials on scaling and root planing (SRP) with or without adjuncts. This network meta-analysis (NMA) compared the adjuncts against each other.
  
  
  METHODS
  A star-shaped NMA was performed based on 36 indirect comparisons of clinical attachment-level (CAL) gains among nine adjuncts in 74 studies from the Clinical Practice Guideline.
  
  
  RESULTS
  All pairwise differences were accompanied by wide confidence intervals, and none of the adjuncts were statistically significantly superior to another. Local doxycycline hyclate and photodynamic therapy with a diode laser had the highest probabilities for ranking first and second, respectively. Publication bias was evident, with fewer than expected studies with small effects. The lack of these studies inflated the treatment effects by an estimated by 20%.
  
  
  CONCLUSIONS
  Adjuncts improve CAL gain by about a third of a mm over 6-12 months compared with SRP alone, but no significant differences were found among the adjuncts. The patient-perceived benefit of this gain is unclear because CAL is a physical measure made by the clinician and not a patient-oriented outcome. Publication bias inflated the observed treatment effects.
authors.affiliation: Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mike T
authors.identifier: http://orcid.org/0000-0002-5169-7691
authors.initials: MT
authors.lastname: John
authors.affiliation: University of Minnesota School of Dentistry, Minneapolis, MN, USA.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Michalowicz
authors.affiliation: Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Kotsakis
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
mesh_terms: D000890:Anti-Infective Agents / Q000592:standards / Q000627:therapeutic use; D055113:Chronic Periodontitis / Q000628:therapy*; D016208:Databases, Factual; D003777:Dental Prophylaxis / Q000379:methods / Q000592:standards*; D012534:Dental Scaling / Q000379:methods / Q000592:standards; D004318:Doxycycline / Q000627:therapeutic use; D055094:Evidence-Based Dentistry; D006801:Humans; D053685:Laser Therapy / Q000592:standards; D054023:Lasers, Semiconductor; D010778:Photochemotherapy / Q000379:methods; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016745:Root Planing / Q000379:methods / Q000592:standards
chemical_list: D000890:Anti-Infective Agents; D004318:Doxycycline
keywords: Periodontal disease; periodontitis