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Local Delivery of Tetracycline does not Improve Clinical Outcomes
THERAPY
ARTICLE ANALYSIS AND EVALUATION Local Delivery of Tetracycline does not Improve Clinical Outcomes ORIGINAL ARTICLE
SUMMARY
Meta-analysis of local tetracycline in treating chronic periodontitis. Pavia M, Nobile CG, Angelillo IF. J Periodontal 2003;74(6):916-32.
Subjects Twenty nine studies were included in the meta-analysis. Twenty of the 29 studies were of a split mouth design. The range of sample sizes in individual studies was 3 to 162 patients in the experimental group and 3 to 155 subjects in the control group.
LEVEL OF EVIDENCE 1a
PURPOSE To assess the clinical effectiveness of local delivery of tetracycline alone or as an adjunct to conventional mechanical therapy in patients with chronic periodontitis by conducting a meta-analysis of published studies
SOURCE OF FUNDING Government
TYPE OF STUDY/DESIGN Systematic review
J Evid Base Dent Pract 2007;7:110-111 1532-3382/$35.00 © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2007.09.005
Therapy Local delivery of tetracycline.
Main Outcome Measure Periodontal pocket depth, attachment level.
Main Results Pocket Depth: Local tetracycline ⫹ scaling/root planning: A significant reduction in mean pocket depth from baseline readings was observed for local tetracycline combined with scaling and root planning; 0.69 mm (0.57-0.81; P ⬍ 0.001) at 12 weeks and 0.70 mm (0.55-0.86; P ⬍ 0.001) at 24 weeks. Local tetracycline: Tetracycline alone did not perform better than scaling/root planning except at 4 weeks of follow-up, when the mean reduction was 0.38 mm (0.37-1.13; P ⫽ 0.05). Tetracycline compared with placebo: In comparing tetracycline to placebo, a significant reduction was seen only in those studies that include subjects with initial pocket depths 6 mm or greater, 0.57 mm (0.44-0.7; P ⬍ 0.001) after 4 weeks, and 0.91 mm (0.27-1.56; P ⫽ 0.005) after 8 weeks. For monocycline compared with placebo, significant decreases were observed at 4 weeks: monocycline 0.71 (0.12-1.29; P ⫽ 0.017); placebo 0.27 mm (0.28-0.59; P ⬍ 0.001) and after 6 months for sites with initial pocket depths 5 mm or more. Attachment Level: Local tetracycline ⫹ scaling/root planning: Significant gains in attachment were seen at 8 weeks of 0.33 mm (0.1-0.55; P ⬍ 0.001) and 12 weeks of 0.74 mm (0.49-0.99; P ⬍ 0.001). Local tetracycline alone compared with scaling/root planing: Clinical attachment gain was observed in the tetracycline-treated sites compared with scaling and root planing in sites with initial pocket depths of 6 mm or more and 4 mm or more ranging from 0.05 mm to 0.12 muscle. Tetracycline compared with placebo: A difference of 0.63 mm was observed in sites with initial pocket depths of 6 mm or more at 4 and 8 weeks. No significant improvements were observed for monocycline or doxycycline.
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
COMMENTARY Conclusions The authors conclude that local delivery of tetracycline improves the clinical outcomes of scaling and root planning and should be considered as an adjunct to conventional treatment.
Analysis I do not agree that the use of local tetracycline alone or as an adjunct provides clinically significant benefits in terms of pocket depth reduction or attachment level gain in comparison with conventional treatment (i.e., scaling/ root planning). Although there were statistically significant results reported for local tetracycline as an adjunct to conventional treatment, the results have no clinical significance. In addition, the range of changes in pocket depth and attachment level fall within the error range of measurement.1,2 Further, the analysis should have been conducted among treatments incorporating the various treatment times using a two-way ANOVA. In this meta-analysis, the results were compared from baseline to the various follow-up times for each treatment group. This increases
Volume 7, Number 3
the number of statistical tests that were conducted and thus increases the likelihood of finding significant results by chance alone. Based on this meta-analysis and the individual studies, I do not recommend that local delivery of tetracycline offers any meaningful benefits in treating periodontal disease alone or as an adjunct to conventional therapy. The slight benefits reported in this paper do not outweigh the potential risks and additional treatment time and costs that this treatment would require.
REFERENCES 1. Van der Velden U, Jansen J. Microscopic evaluation of pocket depth measurements performed with six different probing forces in dogs. J Clin Periodontol 1981;8:107-16. 2. Van der Velden U. Location of probe tip in bleeding and nonbleeding pockets with minimal gingival inflammation. J Clin Periodontol 1982;9:421-7.
REVIEWER Catherine Hayes, DMD, DMSc Harvard School of Dental Medicine Boston, Massachusetts [email protected]
Pavia et al
111
ARTICLE ANALYSIS AND EVALUATION Local Delivery of Tetracycline does not Improve Clinical Outcomes ORIGINAL ARTICLE
SUMMARY
Meta-analysis of local tetracycline in treating chronic periodontitis. Pavia M, Nobile CG, Angelillo IF. J Periodontal 2003;74(6):916-32.
Subjects Twenty nine studies were included in the meta-analysis. Twenty of the 29 studies were of a split mouth design. The range of sample sizes in individual studies was 3 to 162 patients in the experimental group and 3 to 155 subjects in the control group.
LEVEL OF EVIDENCE 1a
PURPOSE To assess the clinical effectiveness of local delivery of tetracycline alone or as an adjunct to conventional mechanical therapy in patients with chronic periodontitis by conducting a meta-analysis of published studies
SOURCE OF FUNDING Government
TYPE OF STUDY/DESIGN Systematic review
J Evid Base Dent Pract 2007;7:110-111 1532-3382/$35.00 © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2007.09.005
Therapy Local delivery of tetracycline.
Main Outcome Measure Periodontal pocket depth, attachment level.
Main Results Pocket Depth: Local tetracycline ⫹ scaling/root planning: A significant reduction in mean pocket depth from baseline readings was observed for local tetracycline combined with scaling and root planning; 0.69 mm (0.57-0.81; P ⬍ 0.001) at 12 weeks and 0.70 mm (0.55-0.86; P ⬍ 0.001) at 24 weeks. Local tetracycline: Tetracycline alone did not perform better than scaling/root planning except at 4 weeks of follow-up, when the mean reduction was 0.38 mm (0.37-1.13; P ⫽ 0.05). Tetracycline compared with placebo: In comparing tetracycline to placebo, a significant reduction was seen only in those studies that include subjects with initial pocket depths 6 mm or greater, 0.57 mm (0.44-0.7; P ⬍ 0.001) after 4 weeks, and 0.91 mm (0.27-1.56; P ⫽ 0.005) after 8 weeks. For monocycline compared with placebo, significant decreases were observed at 4 weeks: monocycline 0.71 (0.12-1.29; P ⫽ 0.017); placebo 0.27 mm (0.28-0.59; P ⬍ 0.001) and after 6 months for sites with initial pocket depths 5 mm or more. Attachment Level: Local tetracycline ⫹ scaling/root planning: Significant gains in attachment were seen at 8 weeks of 0.33 mm (0.1-0.55; P ⬍ 0.001) and 12 weeks of 0.74 mm (0.49-0.99; P ⬍ 0.001). Local tetracycline alone compared with scaling/root planing: Clinical attachment gain was observed in the tetracycline-treated sites compared with scaling and root planing in sites with initial pocket depths of 6 mm or more and 4 mm or more ranging from 0.05 mm to 0.12 muscle. Tetracycline compared with placebo: A difference of 0.63 mm was observed in sites with initial pocket depths of 6 mm or more at 4 and 8 weeks. No significant improvements were observed for monocycline or doxycycline.
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
COMMENTARY Conclusions The authors conclude that local delivery of tetracycline improves the clinical outcomes of scaling and root planning and should be considered as an adjunct to conventional treatment.
Analysis I do not agree that the use of local tetracycline alone or as an adjunct provides clinically significant benefits in terms of pocket depth reduction or attachment level gain in comparison with conventional treatment (i.e., scaling/ root planning). Although there were statistically significant results reported for local tetracycline as an adjunct to conventional treatment, the results have no clinical significance. In addition, the range of changes in pocket depth and attachment level fall within the error range of measurement.1,2 Further, the analysis should have been conducted among treatments incorporating the various treatment times using a two-way ANOVA. In this meta-analysis, the results were compared from baseline to the various follow-up times for each treatment group. This increases
Volume 7, Number 3
the number of statistical tests that were conducted and thus increases the likelihood of finding significant results by chance alone. Based on this meta-analysis and the individual studies, I do not recommend that local delivery of tetracycline offers any meaningful benefits in treating periodontal disease alone or as an adjunct to conventional therapy. The slight benefits reported in this paper do not outweigh the potential risks and additional treatment time and costs that this treatment would require.
REFERENCES 1. Van der Velden U, Jansen J. Microscopic evaluation of pocket depth measurements performed with six different probing forces in dogs. J Clin Periodontol 1981;8:107-16. 2. Van der Velden U. Location of probe tip in bleeding and nonbleeding pockets with minimal gingival inflammation. J Clin Periodontol 1982;9:421-7.
REVIEWER Catherine Hayes, DMD, DMSc Harvard School of Dental Medicine Boston, Massachusetts [email protected]
Pavia et al
111