Efficacy of Adjunctive Agents in the Management of Biofilm-Induced Gingivitis: A Systematic Review and Meta-Analysis

Aim: In systemically healthy humans with gingivitis, what is the efficacy of active agents compared to negative control/placebo when used adjunctively to mechanical biofilm control in terms of changes in gingivitis/bleeding indices and/or disease resolution in randomised controlled clinical trials (RCTs) with at least 3-months follow-up? Material and methods: Electronic searches, study selection, data extraction, risk of bias analysis, meta-analyses and certainty of the evidence were performed (GRADE). Results: Seventy-two RCTs were included (antiseptics n = 71; systemic intake n = 1). High heterogeneity was found in the definition of gingivitis. Antiseptic agents showed greater reductions in bleeding (%) than control groups at 3 months (ncomparison [nc] = 19; weighted mean differences [WMD] = 10.66%; p < 0.001) and 6 months (nc = 20; WMD = 10.79%; p < 0.001). Gingivitis resolution was rarely determined. Prevalence of local adverse effect (tooth-related and soft-tissue-related) varied from 0% to 13.1%. Systemic effects were scarcely evaluated. Conclusions: In adults with gingivitis, the adjunctive use of specific antiseptics determined higher reduction of gingival inflammation at 3 months (moderate evidence for stannous fluoride and low-to-very low for chlorhexidine, essential oils or cetylpyridinium chloride [CPC]) and 6 months (moderate for chlorhexidine, low for CPC and very low for essential oils) over placebo/negative controls. Adverse effects are neither frequently nor extensively reported. Gingivitis resolution is rarely reported and achieved.