The search identified 24 articles found in MEDLINE, 5 articles in EMBASE (already found in MEDLINE), 3 articles in Cochrane Central of Register Controlled Trials (already found in MEDLINE).
The critical analysis of these 24 papers showed that:
1. all studies are published in English language.
2. three articles don't answer to the review question because: in one the Authors try to outline a relationship between Chlamydia Pneumoniae infection and pathogenesis of increased gingival volume [34
]; one study was conducted on animals [35
]; in the third one the Authors suggest to treat CsA-induced gingival overgrowth administrating Tacrolimus, an alternative immunosuppressant, instead of Cyclosporine [36
3. five are letters to editor or short communications about other previously published papers [37
4. four are case reports [42
5. one is a traditional review [46
6. four are clinical trials [47
7. two are controlled clinical trials (not randomised) [51
8. five are randomised controlled trials (RCTs) [53
In this systematic review were included only 5 RCTs excluding the remaining 19 studies.
These five studies were RCTs and subjects were kidney transplant patients.
In the study published by Nash & Zaltzman [53
], the efficacy of Azithromycin was examined in a double blind randomised crossover trial. 17 patients were randomised into 2 groups: one group received placebo for 5 days and after 2 weeks AZM (500 mg day 1, and 250 days 2–5) and the other group received AZM before placebo. Outcome measures were: gingival sulcus depths, tooth length and length of interdental papilla to the CEJ of two teeth in each of the four quadrants. The first group showed immediate improvement for the three analyzed periodontal parameters (pocket depth, tooth length, distance interdental papilla-CEJ) after receiving AZM, the second group had significant improvement immediately after AZM therapy but 3 weeks after there was a deterioration of the GD (gingival sulcus depth).
Besides the pharmacological therapy reduced the amount of gum bleeding and 67% of the patients reported that the treatment was at least somewhat useful.
In the study of Mesa et al. [54
] 40 adult renal transplanted patients were included in a double blinded controlled randomised study. Patients were randomised into 3 groups (A: 13 subjects received MZN 250 mg 3 times for 7 days, B: 14 subjects received AZM 500 mg 2 times/die for 7 days, C: 13 received one cap of placebo 3 times daily for 7 days). Gingival and dental area were measured and the relationship between them was considered the GO index. The pretreatment GO index was 0.895 ± 0.16 for group A and after 30 days GO index was 0.897 ± 0.28, for group B was 0.932 ± 0.11 and after 30 days it became 0.909 ± 0.15, for group C was 1.073 ± 0.32 and at the end was 1.130 ± 0.30. After 30 days none of the patients with GO showed complete remission.
Morphometric index of GO, a particular kind of photographic analysis matching the gingival area and the tooth area, didn't show an improvement after the proposed pharmacological therapies; a 7-day course of Azytromicin or Metronidazole or placebo didn't produce statistical significative differences. Antibiotics seemed to act against bacterial over-infection and concomitant gingival inflammation.
In the study conducted by Nafar et al.[55
] 25 patients were randomised into 4 groups (group 1 received systemic AZM on the first visit in the form of 6 caps, 2 on first day and 1 per day for 4 consecutive days, group 2 received placebo in the same way of group 1, group 3 received local AZM in form of oral gel for 1 week, group 4 received placebo in similar way to group 3).
Clinical parameters were bleeding on probing (BOP), GO index and plaque length (PL). Biometric parameters were probing pocket depth (PPD), crown length (CL) and stent interdental papilla (IDP).
Only BOP index showed an improvement after 2 or 6 weeks of the 4 therapies performed. But during the first visit all patients received a professional scaling and root planing using ultrasonic cavitron after the administration of 2 gr. of Amoxicillin: in this way local periodontal irritative deposits were removed. The other adopted periodontal parameters didn't show significant differences.
In the study published by Chand et al. [56
] 25 patients (mean age of 17.48 years) were included in a double blinded randomised study and divided into 2 groups: the first one received AZM 500 mg on the first day and 250 mg days 2–5, the other group received Metronidazole (MNZ) 45 mg/kg/die divided into 3 doses daily for 7 days. Baseline gingival measurements were 12.87 ± 0.40 mm for AZM group and 13.13 ± 0.29 mm for MNZ group. After 24 weeks gingival measurements were 11.50 ± 0.14 mm for the first group and 12.23 ± 0.12 mm for the second. The most significative difference was found at 4 weeks: at this time Azytromicin group was significantly more effective than Metronidazole.
In the study published by Ramalho et al. [57
] 20 renal transplanted patients with GO were enrolled and randomised into two groups: group A received AZM 500 mg for 3 days with oral hygiene program for 30 days, while the control group received only the oral hygiene program. Outcome measures were: subjective evaluation of oral hygiene, Simplified Oral Hygiene Index (SOHI) [58
] and GH index [59
About the first outcome measure patients in both groups declared to have improved their dental condition, in fact they had less pain and bleeding. For the other outcome measures, after 15, 30 and 60 days patients in AZM group showed statistically significant improvement of SOHI and GH index.
In the data summary table patients enrolled, therapy administered, study location, study design, duration, outcomes measures and results are available.