What do systematic reviews say?

Azithromycin + SRP vs SRP

Azithromycin + SRP led to lower probing pocket depth compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.57 [-1.08, -0.07]
  6 studies · 216 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -0.77 [-2.33, 0.79]
  2 studies · 110 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.60 [-1.02, -0.18]
  7 studies · 258 participants
  GRADE not reported

Metronidazole + SRP vs SRP

It is very uncertain whether metronidazole + SRP changes probing pocket depth compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -1.11 [-2.84, 0.61]
  2 studies · 47 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.59 [-0.95, -0.23]
  4 studies · 94 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.10 [-0.37, 0.16]
  4 studies · 108 participants
  GRADE not reported

Doxycycline + SRP vs SRP

Doxycycline + SRP showed no clear difference in probing pocket depth compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 0.10 [-0.29, 0.50]
  2 studies · 43 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -1.00 [-1.78, -0.22]
  1 study · 22 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.43 [-0.88, 0.01]
  3 studies · 65 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

Amoxicillin + metronidazole + SRP led to lower probing pocket depth compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.47 [-0.68, -0.26]
  6 studies · 215 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.18 [-0.33, -0.04]
  15 studies · 562 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -0.30 [-0.42, -0.18]
  2 studies · 389 participants
  Very low

Doxycycline + SRP vs Metronidazole + SRP

Doxycycline + SRP showed no clear difference in probing pocket depth compared with metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 0.38 [0.00, 0.76]
  3 studies · 75 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD 1.00 [0.30, 1.70]
  1 study · 27 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.16 [-0.56, 0.24]
  2 studies · 49 participants
  GRADE not reported

Clindamycin + SRP vs Metronidazole + SRP

Clindamycin + SRP showed no clear difference in probing pocket depth compared with metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.14 [-0.82, 0.54]
  1 study · 26 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.10 [-0.79, 0.59]
  1 study · 26 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD 0.20 [-0.38, 0.78]
  1 study · 26 participants
  Very low

Tetracycline + SRP vs SRP

The review found no eligible studies for this question.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.53 [-1.14, 0.08]
  1 study · 38 participants
  GRADE not reported

Doxycycline + SRP vs Amoxicillin + metronidazole + SRP

Doxycycline + SRP showed no clear difference in probing pocket depth compared with amoxicillin + metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 0.14 [-0.12, 0.40]
  2 studies · 50 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 0.23 [-0.41, 0.87]
  1 study · 20 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP led to lower probing pocket depth compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.20 [-0.35, -0.05]
  1 study · 46 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.10 [-0.26, 0.06]
  1 study · 46 participants
  GRADE not reported

Clindamycin + SRP vs Doxycycline + SRP

It is very uncertain whether clindamycin + SRP changes probing pocket depth compared with doxycycline + SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -0.80 [-1.58, -0.02]
  1 study · 23 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 0.20 [-0.36, 0.76]
  1 study · 23 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.40 [-1.14, 0.34]
  1 study · 23 participants
  GRADE not reported

Clindamycin + SRP vs SRP

It is very uncertain whether clindamycin + SRP changes probing pocket depth compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -1.80 [-2.47, -1.13]
  1 study · 21 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -1.10 [-1.94, -0.26]
  1 study · 21 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 0.10 [-0.55, 0.75]
  1 study · 21 participants
  GRADE not reported

Clarithromycin + SRP vs SRP

Clarithromycin + SRP led to lower probing pocket depth compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.59 [-1.17, -0.01]
  2 studies · 77 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.67 [-1.33, -0.01]
  2 studies · 77 participants
  GRADE not reported

Metronidazole + SRP vs Amoxicillin + metronidazole + SRP

Metronidazole + SRP showed no clear difference in probing pocket depth compared with amoxicillin + metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.26 [-0.83, 0.31]
  1 study · 22 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 0.10 [-0.12, 0.32]
  3 studies · 84 participants
  GRADE not reported

Amoxicillin + clavulanate + SRP vs Tetracycline + SRP

Amoxicillin + clavulanate + SRP showed no clear difference in probing pocket depth compared with tetracycline + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.40 [-1.11, 0.31]
  1 study · 8 participants
  GRADE not reported

Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing) vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart

Full-mouth disinfection (FMD): scaling/root planing (subgingival… showed no clear difference in change in probing pocket depth (PPD) compared with quadrant scaling and root planing (control): SRP of each quadrant in… (low certainty).

• Full‐mouth treatment modalities (within 24 hours) for periodontitis in adults 2022 · Cochrane All outcomes

  6 to 8 months (SoF); similar at 3 to 4 months
  MD 0.11 [-0.04, 0.27]
  6 studies · 214 participants
  Low

Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart

Full-mouth scaling (FMS): scaling/root planing (subgingival… showed no clear difference in change in probing pocket depth (PPD) compared with quadrant scaling and root planing (control): SRP of each quadrant in… (low certainty).

• Full‐mouth treatment modalities (within 24 hours) for periodontitis in adults 2022 · Cochrane All outcomes

  6 to 8 months (SoF); similar at 3 to 4 months
  MD 0.03 [-0.14, 0.20]
  5 studies · 148 participants
  Low

Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing)

Full-mouth scaling (FMS): scaling/root planing (subgingival… showed no clear difference in change in probing pocket depth (PPD) compared with full-mouth disinfection (FMD): scaling/root planing (subgingival… (low certainty).

• Full‐mouth treatment modalities (within 24 hours) for periodontitis in adults 2022 · Cochrane All outcomes

  6 to 8 months (SoF); similar at 3 to 4 months
  MD -0.11 [-0.30, 0.07]
  4 studies · 112 participants
  Low

Enamel matrix derivative (EMD; Emdogain) vs Guided tissue regeneration (GTR) with barriers

Enamel matrix derivative (EMD; Emdogain) showed no clear difference in change in probing pocket depth (PPD) compared with guided tissue regeneration (GTR) with barriers (low certainty).

• Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects 2009 · Cochrane All outcomes

  1 year (time-points 1, 5 and 10 years planned)
  MD -0.4 [-1.1, 0.2]
  6 studies · 304 participants
  Low

Enamel matrix derivative (EMD; Emdogain) vs placebo or control

Enamel matrix derivative (EMD; Emdogain) may leads to higher change in probing pocket depth (PPD) compared with placebo or control (same surgical or non-surgical intervention… (low certainty).

• Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects 2009 · Cochrane All outcomes

  1 year (time-points 1, 5 and 10 years planned)
  MD 0.88 [0.44, 1.31]
  9 studies · 371 participants
  Low

Enamel matrix derivative (EMD; Emdogain) vs Various bone grafting (BG) procedures (animal-derived or synthetic bone / bioactive ceramic filler)

• Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects 2009 · Cochrane All outcomes

  1 year (time-points 1, 5 and 10 years planned)
  No statistically significant differences (one trial, Leknes 2009).
  1 study
  GRADE not reported