Management of Necrotising Periodontal Diseases: A Systematic Review

To evaluate the efficacy of interventions for treating necrotising periodontal diseases (NPDs), including the management of the acute condition and subsequent therapies targeting sequelae and/or predisposing factors.

Following PRISMA guidelines, electronic and manual searches were conducted up to April 2025. Randomised controlled trials (RCTs), controlled clinical trials (CCTs) and case series assessing any therapeutic intervention for NPDs (separating them for acute disease resolution and treatment of the preexisting condition and/or management of sequelae) were included.

Thirty-five studies were included (18 RCTs, 2 CCTs, 15 case series). Mechanical debridement combined with antiseptic rinses (e.g., chlorhexidine or hydrogen peroxide) constitutes the primary therapeutic approach. Systemic antimicrobials, mainly metronidazole, have also frequently been evaluated and used as adjuncts or monotherapy. Reduced pain, bleeding and ulcer resolution within days were the common findings for all tested interventions. Recent trials explored photodynamic therapy (PDT) as adjuncts, showing short-term clinical and microbiological benefits. Evidence was heterogeneous and of high risk of bias. Only five studies addressed post-acute management, with none of them investigating reconstructive approaches or long-term recurrence prevention.

Management of NPDs relies primarily on mechanical debridement and antiseptics, with systemic antimicrobials reserved for cases with systemic involvement. Adjunctive modalities such as PDT have shown promising results but require further validation. Evidence on reconstructive approaches and recurrence prevention is lacking.