Clinical efficacy of local application of sustained-release metronidazole in periodontal therapy

Abstract

Objective: To update and evaluate the existing scientific evidence in the efficacy of metronidazole as an adjunct as well as an alternative to subgingival debridement/instrumentation. Methods: Electronic data bases such as Pubmed, Cochrane Central Register of Controlled Trials and Embase were searched for randomized clinical trials (RCTs) that compared the scaling and root planing (SRP) with adjunctive and alternative metronidazole. Results: This review included twenty-six papers which evaluated the clinical indices such as probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP) and/or plaque index (PlI). A pair of papers reported the same data at two different papers. Four papers had two test groups. Seven adjunctive studies which used metronidazole in the gel formulation showed statistical significance in reduction of PPD whereas only two studies were able to show a statistical significant gain in CAL. Only one study revealed a significant reduction in BOP. Metronidazole monotherapy has shown a similar reduction in PPD and improvement in CAL to the same extent of SRP. Conclusions: Taken together it can be delineated that metronidazole may be indicated in patients who have localized persistent and recurrent lesions as an adjunct. However, more RCTs with strict methodological criteria are necessary to come to a firm conclusion.

Keywords

• Topical
• metronidazole
• adjunct
• periodontal therapy
• scaling and root planing