Local Use of Antiresorptive Drugs in the Treatment of Periodontal Diseases. A Systematic Review and Meta-Analysis of Human Trials.

Abstract

Abstract Aim: To evaluate clinically and radiographically the effect of using local antiresorptive drugs (ARDs) in the treatment of periodontal diseases in the form of non-surgically subgingival delivered gels or surgically applied into infrabony or furcation defects, alone or combined with other materials. Materials and Methods: Clinical human studies meeting predetermined inclusion criteria (i.e., controlled and/or randomised controlled clinical trials (RCT); ≥ 6 months follow up, and ≥ 5 patients with a local application of ARDs). Periodontal [i.e., clinical attachment level (CAL) and pocket depth (PD)] and radiographical [i.e., intrabony defect (IBD) and bone fill]. Sources: Medline (PubMed), CENTRAL (Ovid) and Scopus. Result: Seventeen studies included in this systematic review. Meta‐analyses based on 13 studies were divided into 4 comparisons: (1) non-surgical treatment of IBD with ARDs compared to placebo, (2) non-surgical treatment of furcation defect with ARDs compared to placebo, (3) surgical treatment of IBD with ARDs compared to placebo, and (4) surgical treatment of IBD with ARDs combined with bone substitutes compared to bone substitutes alone. Six months after intervention the effect size (ES) for residual PD and CAL gain in comparison 1 was 1.97 and 1.83, respectively. Six months after intervention the ES for residual PD and CAL gain in comparison 2 was 1.78, 1.45, respectively; twelve months after intervention it was 2.26, 2.28, respectively. Six months after intervention the ES for residual PD in comparison 3 was 0.55. Finally, six months after intervention the ES for residual PD and CAL gain in comparison 4 was 0.69 and 0.94, respectively. However, significantly larger CAL gain and lesser residual PD with p values of ≤ 0.001in all the comparisons were found which favoured ARDs. Conclusion: Our results revealed that adjunctive ARDs were successful in promoting bone repair and periodontal healing after non-surgical and surgical periodontal treatment. However, further studies are needed to confirm the positive effect of ARDs.