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Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review

Abstract

Background

Gingival recessions inevitably occur during healing after scaling and root planing, but synoptic data on this topic is still lacking. This review compared the recession formation with and without the administration of systemic antibiotics.

Objectives

To evaluate the formation of recession with and without the administration of antibiotics during the healing after scaling and root planing.

Materials and methods

This study re-analyzed publications that reported clinical attachment levels (CAL) and probing pocket depths (PD) up to January 2019, including the pivotal review by Zandbergen and co-workers (2013). Whereas these studies traditionally focused on PD and CAL, the present analysis compared recession formation (ΔREC) after adjunctive systemic administration of amoxicillin (amx) and metronidazole (met) during scaling and root planing (SRP) and SRP alone. The mean increase in ΔREC, if not reported, was calculated from CAL and PD values and statistically analyzed. Recession formation was compared after 3 and 6 months after therapy. Results were separately reported for chronic periodontitis (CP) as well as aggressive periodontitis (AP) cases.

Results

Recessions increased consistently between baseline and follow-up. In the AP group, median ΔREC was 0.20 mm after 3 months, irrespective of whether antibiotics were administered or not. After 6 months, median ΔREC increased to 0.35 mm after AB and remained stable at 0.20 mm with SRP alone. In the CP group, after 3 months with and without antibiotics, median ΔREC accounted for 0.30 mm and 0.14 mm, respectively. After 6 months, median ΔREC accounted for 0.28 mm (with AB) and 0.20 mm (without AB). The quantitative assessment by meta-analyses also yielded small values (≤ 0.25 mm) for the estimated differences in recession formation between AB and noAB; however, none of them reached statistical significance.

Conclusions

Although a slight tendency towards higher recession formation after SRP in combination with AB could be observed in many studies, quantitative meta-analyses showed no clinically relevant difference in recession formation due to the administration of AB. In general, the description and discussion of recessions in the literature seems not to be a major focus so far.

Clinical relevance

Since the preservation of gingival tissues is important by preventive and therapeutic means, e.g., when avoiding postoperative root sensitivity or performing regenerative surgery, these aspects should not be neglected. We thus suggest to report REC measurements along with PD and CAL values for more direct recession formation (ΔREC) assessments in the future.

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Acknowledgments

The authors would like to thank Mrs. Dr. Sabine Klein, librarian of the main library of the University of Zurich who performed the electrical literature search.

This study was supported by the Clinic of Conservative and Preventive Dentistry, (MAS in Periodontology Program).

Availability of data and materials

All relevant data supporting the conclusion of this article are within or mentioned in the manuscript.

Author information

PRS conceived the study and supervised the study. DW did the statistical evaluation of the papers and participated in its design. MK did the literature search. MK, AS and UZ drafted the manuscript. TA helped to supervise the methodological correctness of the performed study and the coordination. All authors carefully read and approved the final text.

Correspondence to Manuela E. Kaufmann.

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Kaufmann, M.E., Wiedemeier, D.B., Zellweger, U. et al. Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review. Clin Oral Invest (2020) doi:10.1007/s00784-020-03198-4

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Keywords

  • Scaling and root planing
  • Debridement
  • Clinical attachment level
  • Periodontal healing
  • Systemic antibiotics