Effectiveness Of Alendronate As An Adjunct To Scaling And Root Planing In The Treatment Of Periodontitis: A Meta-analysis Of Randomized Controlled Clinical Trails

Purpose:Alendronate has been proposed as a local and systemic drug treatment used as an adjunct to scaling and root planing(SRP)for the treatment of periodontitis.However,its effectiveness has yet to be conclusively established.The purpose of the present meta-analysis was to assess the effectiveness of SRP with alendronate on periodontitis compared to SRP alone.Methods:PubMed,EMBASE,the Cochrane Central Register of Controlled Trials,the Cochrane Database of Systematic Reviews,Web of Science,and Science Direct were used by 2 independent reviewers to identify relevant articles from the earliest records up to September 2016.Randomized controlled trials(RCTs)comparing SRP with alendronate to SRP with placebo in the treatment of periodontitis were included.RevMan5.3 was used to measure the changes in bone defect fill,probing depth(PD),and clinical attachment level(CAL)from baseline to 6 months.A fixed-effect or random-effect model was used to pool the extracted data,as appropriate.Mean differences with 95%confidence intervals(CIs)were calculated.Heterogeneity was assessed using the I~2 test.We also conducted a sensitivity analyses using STATA when heterogeneity exist.Results:After the selection process,8 articles were included in the meta-analysis.Compared with SRP alone,the adjunctive mean benefits of locally delivered alendronate were 38.25%for bone defect fill increase(95%CI=33.05-43.45),p<0.00001,I~2=94%),2.29 mm for the PD reduction(95%CI=2.07-2.52 mm,p<0.0001,I~2=0%)and 1.92 mm for the CAL gain(95%CI=1.55-2.30 mm,p<0.00001,I~2=66%).In addition,systemically administered alendronate plus SRP statistically significantly reduced PD by0.36 mm(95%CI=0.18-0.55 mm,p=0.00001,I~2=0%)and increased CAL by 0.39 mm(95%CI=0.11-0.68 mm,p=0.006,I~2=6%).Conclusions:The collective evidence regarding the adjunctive use of alendronate locally and systemically with SRP indicates that the combined treatment can improve the efficacy of non-surgical periodontal therapy on increasing CAL and bone defect fill and reducing PD.However,precautions must be exercised in interpreting these results,and multicenter studies evaluating this specific application should be carried out.