Effect of adjuvant bisphosphonates on treatment of periodontitis: Systematic review with meta-analyses

Background Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown. Objectives This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP). Methodology This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure. Results Thirteen studies were included. It was showed MD of 1.52 ​mm (95%CI: 0.97–2.07) and 1.44 ​mm (95%CI: 1.08–1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: −0.17–2.91) and PPD (MD: 1.35; 95%CI: −0.13–2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94–5.74). MD for systemically administered BP was 0.40 ​mm (95%CI: 0.21–0.60), 0.51 ​mm (95%CI: 0.19–0.83) and 1.05 (95%CI: 0.80–1.31) for PPD, CAL and RADIO, respectively. Conclusion The administration of BP in adjunct to SRP may result in additional clinical effects.