Adjunctive therapies in non-surgical periodontal treatment I
PD Dr. Kristina Bertl, PhD MSc MBA
Another topic that was discussed as part of the Perio Workshops 2019 was the effectiveness of local and systemic adjunctive therapies or medications in non-surgical periodontal treatment.
Periodontitis is a bacterial disease. However, if we take a closer look at the causes of periodontal attachment loss, it becomes clear that the body’s own immune response plays an important role here. The bacterial load triggers a strong immune response, resulting in the release of large quantities of pro-inflammatory molecules, which cause the soft and hard tissues to degrade. Accordingly, local and systemic adjunctive therapies in non-surgical periodontal treatment are regularly tested as part of research studies. These therapies not only have an anti-bacterial effect, they are also intended to regulate the immune response, thereby potentially reducing the loss of periodontal tissue.
As part of the Perio Workshop 2019, a comprehensive systematic review by Donos et al. (2019) pooled the results of all placebo-controlled randomized studies on this topic that had a follow-up of at least six months.
The following local and/or systemic adjunctive therapies were discussed in the 58 included studies:
- Statin gel – twelve studies
- Subantimicrobial dose doxycycline – fourteen studies
- Bisphosphonate gel – nine studies
- Metformin gel – six studies
- Probiotics – five studies
- Non-steroidal anti-inflammatory drugs – four studies
- Essential oils – four studies
- Omega-3 polyunsaturated fatty acids – three studies
- Food supplements – one study
According to the authors, the most promising of these therapies was the application of a 1.2% statin gel. Among patients with vertical bone defects, the local application of this product during non-surgical periodontal treatment resulted in an additional reduction in probing pocket depth of 1.8 mm. Unfortunately, however, a non-commercial product is not yet available. You can find out more about this topic in two earlier systematic reviews (Bertl et al. 2017, Bertl et al. 2018).
Furthermore, the long-term use of subantimicrobial dose doxycycline (Periostat®) produced a clinically relevant additional improvement in probing pocket depths, particularly with regard to deep baseline probing pocket depths (≥ 7 mm). A disadvantage of this approach is its long-term duration of use, which requires high patient compliance.
For both bisphosphonates and metformin, a local application (gel form) seemed promising in the case of vertical bone defects, but there is currently not yet enough study data available to make definitive conclusions.
Probiotics produced only a small additional reduction in probing pocket depth (≤ 0.5 mm additional reduction).
In general, results from long-term studies of these products are still required, and from a scientific point of view, independent multi-centre studies would be desirable.
You can find other articles on this topic in the Prophy Community:
- Bertl K, Parllaku A, Pandis N, Buhlin K, Klinge B, Stavropoulos A. The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis. J Dent. 2017 Dec;67:18-28. doi: 10.1016/j.jdent.2017.08.011.
- Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res. 2018 Jun;53(3):267-287. doi: 10.1111/jre.12514.
- Donos N, Calciolari E, Brusselaers N, Goldoni M, Bostanci N, Belibasakis GN. The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies. J Clin Periodontol. 2019 Dec 13. doi: 10.1111/jcpe.13232.