Local and systemic antimicrobial therapy in periodontics

Area of Science:

• Periodontology
• Microbiology
• Pharmacology

Background:

• Periodontitis management often faces clinical limitations with standard nonsurgical treatments.
• Adjunctive local and systemic antimicrobials are explored to enhance treatment efficacy.
• Evidence on their effectiveness and optimal application requires updating.

Purpose of the Study:

• To review current evidence on the efficacy of adjunctive local and systemic antimicrobials in periodontitis treatment.
• To assess their potential to overcome limitations of standard nonsurgical approaches.
• To identify gaps in clinical protocols for antimicrobial use in periodontitis.

Main Methods:

• Systematic review of randomized clinical trials (RCTs) published between 2008-2012 for local and 2010-2012 for systemic antimicrobials.
• Inclusion of evidence from systematic reviews and major dental workshops.
• Focus on adjunctive therapies compared to debridement alone or with placebo.

Main Results:

• Systemic antimicrobials (amoxicillin, metronidazole, azithromycin) show clinical and microbiological benefits in aggressive and chronic periodontitis.
• Local antimicrobials demonstrate clinical efficacy, but cost-effectiveness and indications remain debated.
• Evidence supports benefits but highlights variability in study outcomes.

Conclusions:

• Adjunctive local and systemic antimicrobials are clinically effective in periodontitis management.
• A significant lack of evidence exists for well-defined clinical protocols, including specific products and dosages.
• Further research is needed to establish standardized treatment guidelines.