Sammanfattning
Background – The goal in treating refractory periodontitis
(RP) is to arrest or slow disease progression,
which usually has included the use of systemic
antibiotics adjunct to conventional mechanical debridement.
The aim of this systematic review was
to evaluate the evidence that the association of
systemic antibiotics with conventional mechanical
debridement increases the efficacy of periodontal
therapy in the treatment of RP.
Types of studies reviewed – The authors searched
for studies in PubMed MEDLINE, Cochrane Central
Register of Controlled Trials, Thomson Reuters
Web of Science, Scopus, Latin American and
Caribbean Center on Health Sciences Information,
and Scientific Electronic Library Online electronic
databases by using selected key words from the
earliest records up through October 31, 2014.
Only clinical intervention studies in which investigators
compared the treatment of participants
with RP with either mechanical debridement alone
or associated with systemic antibiotics were eligible
for selection. Two authors independently assessed
the risk of bias of each selected study.
Results – The authors identified 13 articles and included
6 of them. Investigators in all studies reported
greater reductions in probing depth or in loss
of clinical attachment level after adjunct systemic
antibiotic therapy when compared with mechanical
debridement alone. Antibiotics tested included
metronidazole, clindamycin, tetracycline hydrochloride,
amoxicillin, and amoxicillin and potassium
clavulanate. Five studies presented a high risk of
bias, and one study presented an unclear risk.
Conclusions and practical implications – The overall
quality of the evidence does not allow the conclusion
that adjunct systemic antibiotics are of additional
benefit to conventional mechanical debridement
alone.