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Title:	Clinical efficacy of local drug delivery and adjunctive agents in nonsurgical periodontal therapy : a systematic review and network meta-analysis
Authors:	Tan Oi Leng (P91341)
Supervisor:	Masfueh Razali, Dr.
Keywords:	Periodontium Pharmaceutical Preparations Dental Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	5-Aug-2020
Description:	The aim of this study was to compare and rank the clinical efficacy of local drug delivery and adjunctive agents (LDA) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Five electronic databases, hand searching, and grey literature were searched from inception until January 2020. Randomised controlled clinical trials (RCTs) comparing locally delivered adjuncts, against SMD alone, or with placebo, in adults (aged at least 18 years) diagnosed with periodontitis with at least 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented using statistical software package R. The efficacy of the locally delivered adjuncts measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain was reported as mean difference (MD) with 95% confidence intervals (CI) to summarise the effect of each comparison tested. The treatments were ranked according to their P-score. The search identified 1,065 articles, of which 179 were screened for full-text eligibility. 39 RCTs with data from 2,592 patients utilising 15 types of adjunctive agents were included in the analysis. Six network meta-analyses suggested that sulfonic/sulphuric acid gel (PPD MD -1.13 mm, 95% CI -1.74 to -0.53, P-score 0.91; CAL MD -1.09 mm, 95% CI -1.58 to -0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD -0.90 mm, 95% CI -1.50 to -0.30, P-score 0.93; CAL MD -0.84 mm, 95% CI -1.40 to -0.28, Pscore 0.92) were the most effective at reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty evidence). Other adjuncts with moderate certainty are minocycline gel, minocycline microspheres, antimicrobial photodynamic therapy (aPDT) methylene blue 1%, and aPDT indocyanine green. No recommendations can be made for repeated use of LDA as certainty of evidence is very low. An average reduction of 0.3 to 0.48 mm in PPD (ranged between -0.7 and 1.13 mm) and 0.27 to 0.3 mm gain in CAL (ranged between -0.56 and 1.09 mm) can be seen from a single LDA application compared with SMD alone. There are some differences in efficacy between LDA but in general, they present with moderate clinical benefits over mechanical debridement alone in NSPT,Ijazah Doktor Pergigian Klinikal (Periodontologi)
Pages:	212
Call Number:	WU240.T161c 2020 9 tesis
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Dentistry / Fakulti Pergigian

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