Conclusive support for mechanical nonsurgical pocket therapy in the treatment of periodontal disease. How effective is mechanical nonsurgical pocket therapy?

DATA SOURCES: Sources of studies were the Cochrane Oral Health Group List of Systematic Reviews in Dentistry, Database of Abstracts of Reviews of Effectiveness, Medline, Embase, and Scisearch. No date or language restriction was imposed. Reference lists of located reviews were checked for additional references. STUDY SELECTION: Twelve reviews addressing the question were included. DATA EXTRACTION AND SYNTHESIS: A narrative appraisal of the reviews was conducted. RESULTS: A number of implications for clinical practice were identified. These are as follows:Initial therapy: In people who have periodontitis, mechanical nonsurgical pocket therapy reduces inflammation and pocket depth and increases clinical attachment level.The magnitude of pocket depth reduction correlates with greater pocket depth before treatment.Nonsurgical mechanical debridement may cause loss of attachment in shallow pockets (相似文献   

Lasers in minimally invasive periodontal and peri‐implant therapy

Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri‐implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium‐doped yttrium aluminium garnet (Nd:YAG), erbium‐doped yttrium aluminium garnet (Er:YAG) and erbium, chromium‐doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta‐analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence‐based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri‐implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser‐treatment modalities of different wavelengths and better‐defined indications for each protocol.     

Topical antimicrobial therapy and diagnosis of subgingival bacteria in the management of inflammatory periodontal disease

Bacterial specificity in human periodontal diseases suggests the possibility of diagnosing and treating periodontitis as specific infections and using microbiological diagnostic means to evaluate the efficacy of periodontal therapy. In a series of clinical trials, the usefulness of topical antimicrobial agents in combination with surgical and non-surgical conventional periodontal therapy were tested. The healing result was estimated by monitoring probing attachment levels (PAL). The usefulness of clinical and microbiological parameters to evaluate post-treatment healing result was tested. 9 of the patients exhibiting sites with recurrent periodontal disease were then evaluated for clinical and microbiological parameters to define accurate means to differentiate between active and inactive periodontal disease. The results showed that the frequency of periodontal lesions with significant loss of PAL after treatment was less in patients treated with antimicrobial agent. Specific microbiological parameters showed stronger correlation than clinical parameters with gain and/or loss of PAL post-treatment. Thus Actinobacillus actinomycetemcomitans and Bacteroides gingivalis occurred in periodontal lesions with progressing disease after treatment, but were rarely detected in samples from pockets of the same depths which did not exhibit further loss of PAL over a study period of 1 year. This study points to the usefulness of topical antimicrobial agent as an adjunct to mechanical subgingival debridement in the treatment of periodontitis in adults. The results also indicate the utility of diagnostic microbiology in the assessment of periodontal disease activity post-treatment.     

A report of laser-assisted modified Widman flap for periodontal regeneration: Clinical and radiographic evaluation

Periodontitis is a relatively common disease. Various therapies have been recommended for its treatment which includes nonsurgical, antimicrobial, and surgical therapy. In recent years lasers have been used for all the three above-mentioned purposes. Lasers have been applied for hard and soft tissue debridement, contouring as well as the bacterial load reduction in the pocket. Here we present a case report of chronic periodontitis treated with the help of a new technique, laser-assisted modified Widman flap (LAMWF). The surgical procedure followed with a 980 nm diode laser has been described. The present case report resulted in significant pocket depth reduction, attachment gain, and radiographic evidence of bone fill. The laser-assisted modified Widman flap provided excellent results without complications and high patient as well as clinician satisfaction.     

Reviewing nonsurgical periodontal therapy

Selection of the appropriate case and clinical competency in treatment modalities results in success in nonsurgical periodontal therapy. The patient with early periodontitis with significant local factors in the form of professionally accessible plaque and calculus is the most receptive to nonsurgical periodontal treatment. The clinician must make decisions centering around the important question, "Can the patient, or moreover, can the therapist delivering the debridement, gain access to the microbial subgingival plaque on a frequent basis below the host defense threshold of the respective patient?" If the answer is "yes," nonsurgical periodontal therapy will be rewarding. If the answer is "no," other modalities such as periodontal surgery must be instituted.     

Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review

1 Background

This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient‐centered outcomes in patients with periodontitis.

2 Methods

Randomized clinical trials (RCTs) with a follow‐up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta‐analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures.

3 Results

Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta‐analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low‐to‐moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion.

4 Conclusions

In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (< 1 mm) and provide modest clinical relevance compared with SRP alone.     

Enamel matrix proteins in the treatment of periodontal sites with horizontal type of bone loss

OBJECTIVES: The present study aims to assess the clinical and radiographic outcome of horizontal type of bone loss over a period of 8 months following periodontal surgery with adjunctive use of enamel matrix proteins (EMP). MATERIALS AND METHODS: Twenty patients, who received nonsurgical periodontal therapy and had radiographic horizontal bone loss with an associated probing depth (PD) of > or =4 mm at the maxillary incisor/canine segment, were included. One side of the selected segment divided by the mid-sagittal plane was treated with EMP as part of a crevicular flap. The other side was treated either with a similar intracrevicular (ICI) or a reverse bevel incision (RBI) as part of a conventional flap debridement. Therefore, patients were divided into two groups of 10 patients according to the type of incision performed on the control side. The analysis was based on a classification of two severity groups according to preoperative PD, with the patient's means of measurements for each treatment being the experimental units for the statistical analysis. RESULTS: For pockets of 4-6 mm, EMP treatment was significantly better than the ICI/flap debridement in terms of PD reduction (p<0.001), relative attachment level (RAL) gain (p<0.001) and recession (REC) (p<0.05). Although sites exposed to EMP treatment exhibited significantly greater RAL gain than RBI/flap debridement sites (p<0.01), both treatments resulted in equally effective PD reduction. Less REC occurred with EMP application than with ICI-RBI/flap debridement (p<0.05). Treatment of shallow sites by the conventional flap with both incisions resulted in a tendency for loss of attachment whereas EMP treatment maintained the attachment levels. No significant difference in the degree of probing and radiographic bone levels was found between the treatments. CONCLUSION: EMP treatment showed better clinical improvements as compared to the conventional flap debridement performed with two different incisions. Clinical improvements were more pronounced at periodontal sites with deep, rather than shallow, periodontal pockets. The results of this study provided an important preliminary base for further clinical and histologic studies.     

Initial preparation: anti-infective therapy

The primary aim of anti-infective therapy is to eliminate or reduce the subgingival plaque and to arrest tissue breakdown associated with chronic or progressive periodontitis. Four to six weeks following anti-infective therapy, initial healing is usually complete, and the clinical status should be re-evaluated. After assessing the reduction in probing depths, bleeding on probing and clinical attachment levels, the clinician must decide whether the anti-infective therapy has arrested the disease. If it is determined that maximum healing has occurred, the initial phase of therapy is complete, and the patient is placed into the maintenance program. In sites that remain > or = 6 mm following anti-infective therapy, surgical debridement may be indicated to increase visualization of the roots for deposit removal because the evidence points to better calculus removal in an open versus closed environment. During surgical root preparation, fine diamonds or finishing burs produce the smoothest root surface followed by manual and power-driven scalers. Endoscopic cameras that enable the clinician to see subgingival calculus without benefit of surgical access may prove to be a valuable diagnostic tool for sites that do not respond to therapy. Diamond-coated ultrasonic inserts are available from some manufacturers and have been shown to be efficient and effective in surgical root preparation. New designs and finer grits may enable clinicians to use these instruments in nonsurgical applications in the future. Finally, new evidence from one group in Belgium has shown that significantly more attachment gain and probing depth reduction is achieved when scaling and root planing is done in one or two visits within 24 hours compared with the traditional method of scaling quadrant by quadrant over four visits. These preliminary results need to be confirmed by others but hold a great deal of promise for improving the outcomes from nonsurgical root preparation in the future.     

Tooth loss in periodontal patients

OBJECTIVE: To compare tooth loss between patients who received surgical therapy for chronic periodontitis and those who received nonsurgical therapy alone. METHODS: A retrospective chart study was conducted at Dalhousie University. All patients who had periodontal treatment and were active cases for at least 10 years were included (n = 335). The sample consisted of 120 males (35.8%) and 215 females (64.2%). Ages ranged from 16 to 77 (mean = 46.1 +/- 12.0 years). All patients received nonsurgical therapy; 44.8% received periodontal surgery as well. Variables recorded were demographics, initial attachment loss, treatment type, recall frequency, patient compliance and history of extracted teeth. Independent t-tests or chi-squared tests were used to compare these for surgical and nonsurgical patients. ANOVA was used to test for interactions between initial attachment loss, age, gender, compliance and type of therapy a patient received as reasons for tooth loss. RESULTS: 521 teeth were lost in 69 patients (20.6% of sample). Of teeth lost, 61.8% were due to periodontal disease; 24.8% to caries; 13.2% to other reasons. Patients initially diagnosed with early attachment loss lost an average of 0.37 (+/- 1.33) teeth. Patients diagnosed with moderate attachment loss lost an average of 1.50 (+/- 2.54) teeth and those diagnosed with advanced attachment loss lost an average of 3.11 (+/- 3.01) teeth. Those who received surgical therapy lost more teeth (mean = 1.31 +/- 2.36) than those who received nonsurgical treatment (mean = 0.68 +/- 1.87; p = 0.001). However, initial attachment loss was the only factor that could predict tooth loss. The type of therapy (surgical or nonsurgical) was not statistically significant. CONCLUSIONS: Most periodontal patients (79.4%) who received treatment at this dental school clinic did not lose any teeth due to periodontal disease over at least 10 years. Although patients who had surgical therapy lost more teeth than those who had nonsurgical therapy alone, this was not an important predictor of tooth loss.     

Subgingival debridement: end point,methods and how often?

Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air‐polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air‐polishing compared with hand‐ and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected.     

Clinical trials in periodontal therapy

The success of periodontal therapy is evaluated not only after the termination of the comparatively short active treatment phase, but also at regular intervals during the extended maintenance phase. The main objectives of the active treatment include: (1) elimination of the inflammatory lesions present in the periodontium (2) reduction of probing pocket depth and (3) improvement of attachment levels, while the aim of the maintenance phase of therapy is the prevention of disease recurrence. Elimination of the inflammatory lesions in the periodontium is accomplished by meticulous plaque and calculus removal performed either as a single measure or combined with one of several different surgical treatment modalities. Findings from clinical trials have demonstrated that it is not the technique - nonsurgical-surgical - used during basic therapy, but the degree of root debridement accomplished that seems to be the determining factor for success in terms of resolution of periodontitis. Furcation involved premolars/molars constitute a problem with respect to effectiveness of therapy. Reliable research data describing treatment effects in the furcation regions of multirooted teeth are scarce. As a result of the elimination of the inflammatory lesions the periodontal tissues will offer more resistance to probing. This is clinically identified as probing pocket depth reduction, attachment level imrpovements and recession of the marginal gingiva. Research findings reveal that surgical and nonsurgical methods are almost equally effective in these respects. The concept that surgical methods which include resective measures will cause more gingival recession than non-resective measures should be questioned. Long-term clinical trials have demonstrated that patients who, following active treatment, are enrolled in carefully supervised plaque control programs only occasionally show signs of disease recurrence, while in this respect non-monitored patients frequently display signs of recurrent disease. It is suggested that the long-term effect of periodontal therapy is more related to the quality of the maintenance care program than the techniques utilized during active therapy.     

Evaluation of Efficacy of Chlorhexidine Intracanal Medicament on the Periodontal Healing of Concomitant Endodontic‐Periodontal Lesions Without Communication: An Interventional Study

Background: Treatment of concomitant endodontic‐periodontal lesions remains a challenge in clinical practice and requires effective endodontic and regenerative periodontal therapy. Among other factors, cross seeding and recolonization of flora may affect the outcome of periodontal therapy. Intracanal medicaments have been shown to exert antimicrobial activity on the external root surface, and local delivery of antimicrobials has been suggested to be a complementary approach in the management of periodontitis. Therefore, the objective of this study is to determine the influence of chlorhexidine (CHX) intracanal medicament on the clinical outcomes of therapy. Methods: Thirty‐one patients were divided into two treatment groups: 1) open flap debridement (OFD) in endodontically treated teeth (control); and 2) OFD in endodontically treated teeth with CHX placed in the coronal space (test). The clinical variables evaluated were probing depth (PD), clinical attachment level (CAL), and percentage of sites with PD ≥5 mm. Reevaluation was performed at 3 and 6 months post‐surgery. Results: Both treatments resulted in improvement in all the clinical variables evaluated. Postoperative measurements from test and control groups showed reductions in mean PD of 2.22 ± 1.27 and 0.91 ± 0.81 mm, mean CAL gains of 2.16 ± 1.12 and 0.60 ± 0.93 mm, and 43.33% ± 31.37% and 17.71% ± 14.23% reduction in sites with PD ≥5 mm. Significantly more PD reduction, CAL gain, and percentage reduction in sites with PD ≥5 mm were observed in the test group at 6 months (P <0.05). Conclusion: CHX may be used as an effective intracanal medicament for promoting periodontal healing in concomitant endodontic‐periodontal lesions.     

Factors influencing periodontal therapy for the geriatric patient

Anatomic changes in the periodontium occur with aging. There is no indication that these changes predispose to periodontal breakdown. In the United States, there is evidence that older individuals are retaining more teeth and that these teeth have less periodontal disease than previous generations of seniors. Studies comparing the healing of older and younger patients have clearly demonstrated that both groups of patients respond equally well to therapy. Proven methods of periodontal therapy include modified Widman surgery, pocket elimination surgery, or nonsurgical scaling and root planing. Surgical treatment may be used with confidence unless there are medical contraindications. In these cases, nonsurgical therapy may be preferred. If there are physical or mental disabilities that make effective home care difficult, antimicrobial agents, such as the extensively tested chlorhexidine rinse, may be valuable adjuncts. In the future, senior adults can look forward to the benefits of regenerative periodontal procedures that seek to regain lost periodontal support. Age alone should not diminish an individual's right to care because the practitioner has qualms about his or her longevity. Successful treatment of periodontitis by surgical and nonsurgical methods has been extensively documented. Senior patients can benefit from these treatments as much as younger patients, and age is not a barrier to effective periodontal therapy.     

Periodontal Debridement: Still the Treatment of Choice

Periodontal debridement (PD) remains a gold standard for the treatment of inflammatory periodontitis.Background/PurposeThe evidence base regarding the causal relationship between oral biofilm and the host inflammatory response to the etiology of periodontal disease has substantially increased over the years. What has not changed significantly during that time is the conservative manner in which the disease can be treated with periodontal debridement (PD). Since dental hygienists, in particular, specialize in providing these procedures it is important to evaluate the evidence that supports periodontal debridement as a primary and fundamental treatment modality.MethodAn extensive narrative literature review that included systematic reviews, examined traditional PD, the use of adjuncts to enhance PD and newer PD procedures to determine what are the best practices for achieving optimal clinical outcomes.ConclusionCompared to surgical therapy, PD results in maintenance of attachment levels over time, but is not as effective in the initial reduction of probing depths in deep pockets. Sustained release local drug delivery agents have some modest adjunctive effects when used with PD, as do systemic antibiotics in aggressive periodontitis cases. Reported analyses of the long term effects of chemotherapeutic agents usually do not extend beyond a few months to a year. While laser therapy is still under investigation it remains as a potential PD therapy. New instruments being refined to better visualize the root surface either non-surgically or with mini papilla reflection flaps, hold promise for the future when they become more affordable and accessible. Despite the development of new technology, it still appears that periodontal debridement (PD) remains the gold standard for the treatment of inflammatory periodontitis.     

Clinical concepts for regenerative therapy in intrabony defects

Evidence indicates that periodontal regeneration is an efficacious and predictable procedure for the treatment of isolated and multiple intrabony defects. Meta‐analyses from systematic reviews indicate an added benefit, in terms of clinical attachment level gain, when demineralized freeze‐dried bone allograft, barrier membranes and active biologic products/compounds are applied in addition to open flap debridement. On the other hand, a consistent amount of variability of the outcomes is evident among different studies and within the experimental population of each study. This variability is explained, at least in part, by different patient and defect characteristics. Patient‐related factors include smoking habit, compliance with home oral hygiene and residual inflammation after cause‐related therapy. Defect‐associated factors include defect depth and radiographic angle, the number of residual bony walls, pocket depth and the degree of hypermobility. In addition, surgical‐related variables, such as surgical skill, clinical experience and knowledge, and application of the different regenerative materials, have a significant impact on clinical outcomes. This paper presents a strategy to optimize the clinical outcomes of periodontal regeneration. The surgical design of the flap, the use of different regenerative materials and the application of appropriate passive sutures are discussed in this review along with the scientific foundations.     

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.     

Surgical treatment of the residual periodontal pocket

The ultimate goal of periodontal therapy is to prevent further disease progression in order to reduce the risk of tooth loss. This objective can be achieved through a number of therapeutic modalities comprising both the nonsurgical and surgical phases of periodontal therapy. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. However, despite completion of nonsurgical treatment, a number of periodontal pockets, defined as ‘residual’, often remain. The presence of residual pockets may jeopardize tooth survival and be a risk factor of further disease progression, and ultimately tooth loss. Therefore, the aim of this review is to analyze the knowledge available on the indications for and the performance of periodontal surgical treatment of residual pockets in terms of ‘traditional’ (clinical, microbiological), patient‐based and systemic health outcomes.     

Using antimicrobial agents to manage periodontal diseases

Periodontal diseases are bacterial infections and anti-microbials have been shown to be useful in their treatment and prevention. State-of-the-art treatment of refractory forms of destructive periodontal disease presently includes adjunctive use of systemic antibiotics directed to eliminating or suppressing pathogenic subgingival bacteria. Also, local application of antimicrobials by subgingival deposition or their use as irrigants during periodontal therapy are soon likely to be major components of anti-infective management of periodontal diseases. A new approach to anti-infective periodontal therapy combines ultrasonic surgical debridement with antimicrobial irrigation.     

Nonsurgical therapy for teeth and implants—When and why?

As periodontal and peri‐implant diseases represent opportunistic infections, antiinfective therapy is the method of choice. Correctly performed, the treatment outcomes will include resolution of the inflammation concomitant with shrinkage of the tissues, reflected in reduced probing depths. Depending on the patient data obtained after initial antiinfective therapy, further – mostly surgical – treatment may be rendered to reach the goals of a healthy periodontium and peri‐implant tissues. Patient compliance is as important as operator skills for optimal treatment outcomes. Regenerative therapy may be applied in compliant patients and for appropriate defects. This article depicts the historical development of periodontal therapy during the 20th century and addresses the various outcome parameters to be used in daily decision making. Obviously, nonsurgical therapy has gained clinical relevance, resulting in highly satisfactory treatment outcomes in many cases. The critical probing depth above which positive attachment gain is registered varies from one treatment modality to another. It is a concept that helps facilitate decision making for additional therapeutic measures after initial therapy. Treatment of peri‐implant mucositis prevents development of peri‐implantitis. Hence, nonsurgical treatment of mucositis is frequently performed during the continuous monitoring of oral implants. This chapter of Periodontology 2000 presents evidence for the prevention and therapy of peri‐implant diseases.     

Efficacy of Local and Systemic Antimicrobials in the Non‐Surgical Treatment of Smokers With Chronic Periodontitis: A Systematic Review

Background: The aim of this systematic review is to evaluate whether use of local or systemic antimicrobials would improve clinical results of non‐surgical periodontal therapy for smokers with chronic periodontitis (CP). Methods: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and The Cochrane Central Register of Controlled Trials were searched up to and including March 2016. Randomized clinical trials of duration of at least 6 months were included if they reported on treatment of smokers (≥10 cigarettes per day for minimum 12 months) with CP with non‐surgical periodontal therapy either alone or associated with local or systemic antimicrobials. Random‐effects meta‐analyses were undertaken to evaluate mean differences in probing depth (PD) and clinical attachment level (CAL). Results: Of 108 potentially eligible articles, seven were included. Most individual studies (75%) testing locally delivered antibiotics reported that smokers benefited from this treatment approach. Pooled estimates found additional PD reduction of 0.81 mm (P = 0.01) and CAL gain of 0.91 mm (P = 0.01) at sites with baseline PD ≥5 mm. Conversely, meta‐analysis on systemic use of antimicrobials failed to detect significant differences in mean changes from baseline, and only one trial supported their use. Conclusions: In smokers with CP, adjunctive use of local antimicrobials improved efficacy of non‐surgical periodontal therapy in reducing PD and improving CAL at sites presenting PD ≥5 mm before treatment. Current evidence does not demonstrate similar gains when scaling and root planing plus systemic antimicrobial/antibiotics were associated with therapy.