Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Clinical oral investigations
Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). RESULTS: From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. CONCLUSION: Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CLINICAL RELEVANCE: CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.
14 May 2026
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Treatment of gingival recession type 1 using coronally advanced flap with leucocytes-platelet rich fibrin: a randomized controlled trial
OBJECTIVE: This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months. MATERIALS AND METHODS: A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes. RESULTS: At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10 mm and 0.11 ± 0.10 mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm3 and 0.86 ± 0.84 mm3 (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs. CONCLUSION: Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF. CLINICAL RELEVANCE: Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.
11 May 2026
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