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Volume 21, Issue 7
  • ISSN: 1573-3998
  • E-ISSN: 1875-6417
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Abstract

Objective

This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D).

Methods

Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane’s tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included.

Results

In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64 mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD -0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty).

Conclusion

The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

© 2025 Bentham Science Publishers
© 2025 The Author(s). Published by Bentham Science Publisher. This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
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2024-09-03
2025-04-15

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Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis
Curr. Diabetes Rev. 21, E15733998320667 (2025); https://doi.org/10.2174/0115733998320667240805045742
/content/journals/cdr/10.2174/0115733998320667240805045742
/content/journals/cdr/10.2174/0115733998320667240805045742
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Supplementary File : Complete search strategy for each database. Supplementary File - Excluded articles and reasons for exclusion. Supplementary File - League table for each comparison (Mean Differences). Supplementary File - Assessment of inconsistency for all studies (MD). Supplementary File - GRADE explanations and results (containing Supplementary Tables S1, S2, S3 and S4). Supplementary File - PRISMA NMA Checklist.

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  • Article Type:     Research Article
Keyword(s): Antimicrobials; network meta-analysis; non-surgical periodontal therapy; periodontitis; systematic review; type 2 diabetes mellitus

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