Systemic Doxycycline as an Adjunct to Scaling and Root Planing in Diabetic Patients With Periodontitis

A Systematic Review and Meta-analysis

Kenneth Chou Hung Yap; Shaju Jacob Pulikkotil


BMC Oral Health. 2019;19(209) 

In This Article


This review reported based on PRISMA guidelines and was registered in PROSPERO database (CDR42018103828). This is a systematic review of randomized clinical trials that evaluate differences in clinical attachment levels (CAL), pocket depth (PD), bleeding on probing (BOP) and glycated hemoglobin (HbA1c) levels in diabetic patients with periodontitis after scaling and root planing (SRP) with systemic doxycycline in comparison to just SRP alone.

Research Question According to PICOS

What is the difference in the effect on the periodontal and glycemic status (O) with systemic doxycycline as an adjunct to scaling and root planing (SRP) (I) as compared to SRP alone (C) in diabetic patients with periodontitis (P) from randomized controlled trials (S)?

Study Selection

Two electronic databases, Pubmed and Scopus, were searched using suitable keywords in various combinations until April 2018 to identify randomized controlled trails (RCTs) that compared systemic doxycycline as an adjunct to SRP (test group) to SRP alone (control group) in diabetic (type 1 or 2) patients with periodontitis.

Inclusion Criteria

The subsequent inclusion criteria were used for the selection of studies:

  1. Randomized clinical trials;

  2. patients diagnosed with periodontitis and diabetes mellitus.

  3. interventions assessing the effectiveness of systemic doxycycline as an adjunct to SRP.

  4. studies reporting one or more clinical periodontal parameters as outcome including pocket depth (PD), or clinical attachment level (CAL)

  5. studies reporting metabolic parameter such as HbA1c before and after systemic doxycycline application and;

  6. studies published in English language only.

Exclusion Criteria

The exclusion criteria included.

  1. in vitro and experimental studies.

  2. ex vivo studies.

  3. case reports.

  4. animal studies.

Data Extraction

Titles and abstracts of articles that satisfy the selection protocol were screened independently by two reviewers (KY and SJ) with discord solved by discussion. Following selection of studies, data extraction was done on patient characteristics, disease characteristics, periodontal attachment outcome data in form of clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP) and glycemic status (HbA1c levels) with CAL and HbA1c levels being the primary outcome measurements for periodontal status and glycemic status respectively. Data extracted from the eligible studies were independently by two reviewers (KY and SJ) and disagreement resolved through discussion.

Risk of Bias Assessment

Risk of Bias assessment was done using the revised Cochrane tool 2.0 for Risk Of Bias (ROB) was done for all studies independently by two reviewers (KY and SJ) and consensus reached on disagreement.

Statistical Analysis

Meta-analysis was done using Review Manager 5.3. Primary meta-analysis using random effects model was done for eligible RCTs on CAL, PD, BOP and HbA1c levels. Subgroup analysis was done based on the patient characteristics identified from the studies. Sensitivity analysis based on risk of bias on the included studies. Publication bias was assessed through visualization of the funnel plot was done. Quality of evidence and confidence in estimates was assessed using GRADE Working Group criteria which was done using GRADE development tool using the method of assessing the certainty in evidence (also known as quality of evidence or confidence in effect estimates) and the strength of recommendations in health care.