Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Focused Question
2.2. Search Strategy
2.3. Screening and Selection
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- Health status ASA I;
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- Patients with periodontal disease: periodontitis stage I and II;
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- Topical agents with an action of biofilm disaggregation;
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- Primary outcomes: clinical outcomes of PPD (pocket probing depth), CAL (clinical attachment level), BOP (bleeding on probing);
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- Secondary outcomes: clinical outcomes of PI (plaque index) and REC (recession) and microbiological outcomes.
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- Patients treated with surgical therapy for periodontitis;
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- Dental implants;
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- Systemic diseases (ASA II, III);
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- No previous antibiotic prophylaxis;
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- Topical agents with a chemical action on biofilm (systemic administration of drugs, antibiotics, probiotics);
2.4. Risk of Bias Assessment
2.5. Data Extraction
2.6. Data Analysis
2.7. Grading the Body of Evidence
3. Results
3.1. Search and Selection Results
3.2. Characteristics of Included Studies
3.3. Sodium Hypochlorite
3.4. Desiccant Agent
3.5. Risk of Bias Assessment
3.6. Study Outcomes Results: Qualitative Analysis
3.7. Meta-Analysis
3.8. Grading the Body of Evidence
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Year | Study Design | Country | Sample Number | N Test/Age N Control/Age | Gender | Test and Control Interventions | Follow-Up | Outcome |
---|---|---|---|---|---|---|---|---|---|
Bizzarro et al. [26] | 2016 | RCT, full-mouth | Amsterdam, the Netherlands | 56 | n 27/47.7 n 29/46.9 | F: 20, M: 36 | 1. BPT + NaOCl 2. BPT + saline solution | 12 months | PPD, CAL, BOP, PS |
Daniel Diehl et al. [25] | 2022 | Retrospective analysis | Witten, Germany | 29 | n 29/54.6 | F: 20, M: 9 | 1. gel NaOCl/aa + UD e/o SRP + HA | 6 months | PPD, CAL, BOP, GR |
Iorio-Siciliano et al. [24] | 2021 | RCT, full-mouth | Messina, Italy | 37 | n 18/53.3 n 19/48.5 | F: 21, M: 16 | 1. MINST + gel NaOCl/aa 2. MINST | 6 months | PD, CAL, BOP, FMPS, GR |
Isola et al. [30] | 2018 | RCT, split-mouth | Messina, Italy | 36 | n 36/46.7 | F: 17, M: 19 | 1. SRP + Hybenx 2. SRP | 12 months | PD, CAL, BOP, PS, GR |
Khalil et al. [32] | 2023 | RCT, split-mouth | Damascus, Syria | 25 | n 25/45.2 | F: 15, M: 10 | 1. SRP + Hybenx 2. SRP | 6 months | PPD, RAL, GI, BOP, PLI, GH |
Lombardo et al. [31] | 2015 | RCT, split-mouth | Verona, Italy | 16 | n 16/55 | F: 9, M: 7 | 1. UD + Hybenx 2. UD | 3 months | PPD, CAL, GI, BOP, VPI, GM, microbiology |
Megally et al. [23] | 2020 | RCT, full-mouth | Geneva, Switzerland | 32 | n 16/61.7 n 16/62.1 | F: 11, M 21 | 1. US + gel NaOCl/aa 2. US | 12 months | PD, BOP, GR, microbiology |
Radulescu et al. [28] | 2022 | RCT, full-mouth | Timisoara, Romania | 42 | n 20/44.60 n 18/50.61 | F: 22, M 16 | 1. UMI + air polish + gel NaOCl/aa 2. UMI + air polish + placebo gel | 12 months | PPD, CAL, FMBS, FMPS, GR, microbiology |
Ramanauskaite et al. [29] | 2023 | RCT, full-mouth | Kaunas, Lithuania | 48 | n 24/47.3 n 24/49.3 | F: 35, M 13 | 1. SRP + NaOCl/aa + HA 2. SRP | 6 months | PPD, CAL, BOP, PI |
Sethiya et al. [27] | 2021 | RCT, full-mouth | Maharashtra, India | 29 | n 11/28.27 n 11/29.09 | F: 11, M 11 | 1. OSFMD + NaOCl gel + mouthwash 2. OSFMD + CHX gel + mouthwash | 6 months | PPD, CAL, mSBI, PI |
Soancă et al. [33] | 2023 | RCT, split-mouth | Cluj-Napoca, Romania | 36 | n 30/44.8 | F: 13, M 17 | 1. SRP + Hybenx 2. SRP | 3 months | PD, CAL, GBI, OHI, GR |
Author | Periodontitis | Study Design | SRP (Test and Control) | Topical Agent (Test) | Topical Agent (Control) |
---|---|---|---|---|---|
Bizzarro et al., 2016 [26] | CAL ≥ 3 mm PPD ≥ 5 mm | Full-mouth | Ultrasound (Hu-Friedy EMS piezon; Hu-Friedy, Chicago, IL, USA); manual instrumentation | After 3 days: NaOCl solution | After 3 days: saline solution |
Diehl et al., 2022 [25] | PPD ≥ 5 mm | Full-mouth | Ultrasound supra-gingivally; manual instrumentation with Gracey curettes (Deppeler, American Dental Systems, Monaco, Germany) | After SRP: 30–45 s gel NaOCl/aa (Perisolv; Regedent AG, Zurig, Switzerland); further application of the gel as needed After SRP: gel IA (xHyA; hyaDENT BG, Regedent AG, Zurig, Switzerland) Further application within 7 days | No placebo |
Iorio-Siciliano et al., 2022 [24] | Stage III/IV, grade A/B PPD ≥ 5 mm | Full-mouth | Ultrasound (Instrument PS®EMS Electro Medical System S.A., Nyon, Switzerland); Gracey micro-curette (Hu-Friedy®, Chicago, IL, USA); polishing | Before SRP: 30 s gel NaOCl/aa (Perisolv®, Regedent AG, Zurich, Switzerland) No rinse After SRP: further application of the hyaluronic gel | No placebo |
Isola et al., 2018 [30] | Cronic periodontitis, PPD ≥ 5 mm | Split-mouth | Ultrasound with insert number 5/6/7 (Satelec Ultrasonics, Acteon, VA, Italy); manual instrumentation (Gracey curettes, ASA Dental, Bozzano, Italy) | Before SRP: 60 s sulfonated gel (HYBENX, oral tissue decontaminant, EPIEN Medical, St Paul, MN, USA); Saline solution removal | Before SRP: 60 s saline solution |
Khalil et al., 2023 [32] | Stage III, PPD ≥ 6 mm | Split-mouth | Manual instrumentation (CK6 e U-15, ZaffiroTM, Beckum, Germany; Gracey curettes: ZaffiroTM, Germany) | Before SRP: 30 s sulfonated gel (HYBENX, oral tissue decontaminant, EPIEN Medical, St Paul, MN, USA); Saline solution removal | No placebo |
Lombardo et al., 2015 [31] | Moderate or severe PPD ≥ 5 mm | Split-mouth | Ultrasound (Piezon Master 400, EMS, Nyon, Switzerland) with standards inserts | Before SRP: 45–60 s sulfonated gel (HYBENX, oral tissue decontaminant, EPIEN Medical, St Paul, MN, USA); Saline solution removal | No placebo |
Megally et al., 2020 [23] | PPD ≥ 5 mm | Full-mouth | Ultrasound (Piezon® LED, EMS Electro Medical System S.A., Nyon, Switzerland) | Before SRP: 30 s gel NaOCl/aa (Perisolv®, Regedent AG, Zürich, Switzerland) After SRP: further application of hyaluronic gel | No placebo |
Radulescu et al., 2022 [28] | Stage III/IV, PPD ≥ 4 mm | Full-mouth | Supragingival ultrasound (EMS Piezon® Master, EMS, Nyon, Switzerland); air polishing (standard air-flow nozzle, AIRFLOW® PLUS powder EMS, Nyon, Switzerland); sites with PPD > 4 mm: ultrasound with subgingival insert (PS, EMS, Nyon, Switzerland) | Before SRP: 30 s gel NaOCl/aa (Perisolv®, Regedent AG, Zürich, Switzerland) After 15 min, further application of hyaluronic gel and SRP | Before SRP: placebo |
Ramanauskaite et al., 2023 [29] | Stage II-III, grade A/B | Full-mouth | Ultrasound (Satelec/Acteon Suprasson Newtron ultrasonic scaler); manual instrumentation (LM SharpDiamond 1/2, 7/8, 11/12, 13/14 SD Gracey curettes and mini-curettes, LM Dental™, Pargas, Finland); polish (Lunos Super Soft, RDA < 5, Dürr Dental, Germany) | Before SRP: 60 s gel NaOCl/aa (Perisolv®, Regedent AG, Zurig, Switzerland) Further application of gel as needed (max 2–3 months)After SRP: gel IA (Hyadent® BG, Regedent AG, Zurigo, Switzerland) | No placebo |
Sethiya et al., 2021 [27] | PPD ≥ 4 mm and BOP or PPD ≥ 5 mm | Full-mouth | SRP in 24 h supra- and subgingivally | After SRP: gel NaOCl 0.05% (5 mL 10% NaOCl and 995 mL sterile water) Gel application for 2 months | After SRP: gel CHX |
Soancă et al., 2023 [33] | Stage III/IV, PPD ≥ 4 mm | Split-mouth | Ultrasound (Unit-P5 Booster Suprasson-Satelec, Acteon, Mount Laurel, NJ, USA); manual instrumentation: Gracey curettes (Hu-Friedy, Chicago, IL, USA) | Before SRP: 20 s sulfonated gel | No placebo |
ΔPPD (mm) | |||
---|---|---|---|
Control (Mean ± SD) | Test (Mean ± SD) | Follow-Up | |
Bizzarro et al., 2016 [26] | 1 ± 0.5 | 0.9 ± 0.4 | Baseline—6 months |
Iorio-Siciliano et al., 2021 [24] | 1.98 ± 0.8 | 2.49 ± 0.76 | Baseline—6 months |
Isola et al., 2018 [30] | 2.3 ± 0.43 | 2.85 ± 0.48 | Baseline—6 months |
Khalil et al., 2023 [32] | 0.83 ± 0.52 | 1.57 ± 0.42 | Baseline—6 months |
Lombardo et al., 2015 [31] | 0.6 ± 1.4 | 0.85 ± 1.5 | Baseline—3 months |
Radulescu et al., 2022 [28] | 0.68 ± 0.73 | 0.98 ± 0.31 | Baseline—3 months |
Ramanauskaite et al., 2023 [29] | 1.9 ± 0.57 | 2.5 ± 0.29 | Baseline—3 months |
Soancă et al., 2023 [33] | 0.85 ± 0.91 | 0.82 ± 0.72 | Baseline—3 months |
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Pardo, A.; Fiorini, V.; Zangani, A.; Faccioni, P.; Signoriello, A.; Albanese, M.; Lombardo, G. Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 2179. https://doi.org/10.3390/jcm13082179
Pardo A, Fiorini V, Zangani A, Faccioni P, Signoriello A, Albanese M, Lombardo G. Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13(8):2179. https://doi.org/10.3390/jcm13082179
Chicago/Turabian StylePardo, Alessia, Vera Fiorini, Alessandro Zangani, Paolo Faccioni, Annarita Signoriello, Massimo Albanese, and Giorgio Lombardo. 2024. "Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 13, no. 8: 2179. https://doi.org/10.3390/jcm13082179