Meta-analysis of local tetracycline in treating chronic periodontitis

Background: Meta-analysis was used to assess the clinical efficacy of local delivery of tetracycline alone or as an adjunct to conventional mechanical therapy in patients with chronic periodontitis. Methods: Studies were identified in MEDLINE and others sources. Meta-analyses were performed on the basis of probing depth (PD) at baseline, type of antimicrobial used, and experimental and control regimens (i.e., tetracycline plus scaling and root planing [SRP] versus SRP, tetracycline versus SRP, and tetracycline versus placebo, or no treatment). The effect of local tetracycline was evaluated for follow-up times of 4, 8, 12, 16, 24, and 36 weeks. Sensitivity analysis was performed according to antimicrobial delivery mode (irrigation, fibers, strips). A random effects model was used. Results: The literature search identified 29 studies that met our inclusion criteria and were entered into the meta-analysis. A significant mean reduction in PD for the combined tetracycline and SRP was observed regardless of initial probing depth and independently to the duration of follow-up. Tetracycline alone did not perform better than SRP, whereas they performed significantly better than placebo. Differences in improvement of attachment level (AL) were substantially similar to those encountered for PD. Conclusions: Our results documented that local delivery of tetracycline improves the clinical outcomes of traditional treatment and should be considered particularly as an adjunct to SRP Considerations regarding the adverse effects of widespread use of tetracycline should be taken into account when choosing a therapeutic strategy of chronic periodontitis.