| Hanes and Purvis 2003 [23] |
≥3 months |
28 RCTs, 2 CCTs, 2 cohort |
Local antimicrobials |
-
1.
Sample-size adjusted mean PPD reduction 1.45 mm (p = 0.002; 95% CI 0.56 to 2.34), and adjusted mean CAL gain 0.89 mm (p = 0.001; 95% CI 0.55 to 1.24) was seen from SRP alone.
-
2.
A WMD range of 0.06–0.51 mm PPD reduction and −0.40–0.39 mm CAL gain was observed with different sustained-released adjuncts.
-
3.
MINO gel and microencapsulated MINO had shown significant PPD reductions while CHX chip and DOXY gel had significant CAL gains.
-
4.
No additional benefits from local CHX irrigation studies.
-
5.
Adverse events were infrequent and minimal.
|
| Bonito et al., 2005 [22] |
Not specified |
50 RCTs |
Local antimicrobials |
-
1.
A range of 0.24–0.49 mm mean PPD reduction and 0.12–0.46 mm mean CAL gain can be seen with adjunctive local antibiotics.
-
2.
Combination of PPD and CAL results suggested local MINO to be the most promising adjunct (PPD 0.49 mm, CAL 0.46 mm), followed by local TET.
-
3.
Adverse events reported were relatively minor.
|
| Matesanz-Pérez et al., 2013 [21] |
Not specified |
52 RCTs |
Local antimicrobials |
-
1.
Overall effect was statistically significant (p = 0.000) for both changes in PPD (WMD 0.407 mm) and CAL (WMD 0.310 mm).
-
2.
No significant differences detected for bleeding on probing and plaque index.
-
3.
Subgingival application of TET fibers, sustained released DOXY and MINO had substantial advantages in PPD reduction (WMD between 0.5 and 0.7 mm).
|
| Smiley et al., 2015 [29] |
≥6 months |
72 RCTs |
Local and systemic adjuncts only available in the United States |
-
1.
Approximately 0.5 mm average improvement in CAL can be seen with SRP alone (moderate level of certainty).
-
2.
A range of 0.2–0.6 mm average CAL improvements can be seen in the combinations of assorted adjuncts over SRP alone.
-
3.
Four adjunctive therapies were beneficial compared with SRP alone (moderate level of certainty): SDD, systemic antimicrobials, CHX chips and photodynamic therapy with a diode laser.
|
| John et al., 2017 [25] * |
61 RCTs |
-
1.
NMA found DOXY hyclate (WMD 0.64 mm, 95% CI 0.02 to 1.26) and PDT with diode laser (WMD 0.55 mm, 95% CI 0.25 to 0.85) to have the highest probabilities for ranking first and second adjuncts in terms of CAL gain, respectively.
-
2.
0.32 mm (95% CI 0.24 to 0.40) CAL improvement seen with adjuncts over 6–12 months with no significant differences among them.
-
3.
Publication bias was detected, and the lack of studies inflated estimated 20% of treatment effects.
|
| Herrera et al., 2020 [26] |
≥6 months |
50 RCTs |
Local antimicrobials |
-
1.
Medium-duration studies (6–9 months) had statistically significant differences for PPD (WMD 0.365 mm, 95% CI 0.262 to 0.468) and CAL (WMD 0.263 mm, 95% CI 0.123 to 0.403).
-
2.
Long-duration studies (≥12 months) had statistically significant difference for PPD (WMD 0.190 mm, 95% CI 0.059 to 0.321).
-
3.
No adverse events observed.
|
| This study |
≥6 months |
45 RCTs |
Commercially available LDAs |
-
1.
SA gel (PPD MD −1.13 mm, 95% CI −1.74 to −0.53, P-score 0.91; CAL MD −1.09 mm, 95% CI −1.58 to −0.61, P-score 0.95) and DOXY hyclate gel (PPD MD −0.90 mm, 95% CI −1.50 to −0.30, P-score 0.93; CAL MD −0.84 mm, 95% CI −1.40 to −0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence).
-
2.
SA gel has probable to definite clinical significance in the primary outcome measures.
-
3.
The other LDAs that were probably superior compared with SMD alone and had possible clinical importance when used as adjuncts in NSPT were MINO gel, MINO microspheres, antimicrobial PDT MB 1% and antimicrobial PDT ICG (moderate level of certainty).
-
4.
Eight studies (17.8%) reported minor to moderate adverse events across the different adjuncts; thus, LDAs are relatively safe for use in clinical practice.
|
