"Efficacy of adjunctive local antimicrobials to non-surgical periodontal therapy on pocket reduction and metabolic control of patients with type 2 diabetes: a network meta-analysis"
"Antimicrobials; Type 2 Diabetes Mellitus; Periodontitis; Non-Surgical Periodontal Therapy; Systematic Review; Network Meta-Analysis"
"This network meta-analysis (NMA) investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy (NSPT) on the metabolic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). Seven databases,grey literature, and registry platforms were searched up to February 2022 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane’s tool (RoB 2.0). Two frequentists NMA were performed using a random-effects model to calculate mean differences as effect measure and to quantitatively assess the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was evaluated through the GRADE approach and the partially contextualized framework for the interpretation of results. Ten RCTs were included. 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 with the use of satranidazole gel (moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel, chlorhexidine gel, and tetracycline fiber showed promising results after three months (low evidence certainty). In 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"