Passato, presente e futuro dei coadiuvanti locali e sistemici nel trattamento non chirurgico di perimplantiti e parodontiti: indicazioni e limiti

This expert consensus review examines the past, present, and future of local and systemic adjuvants in non-surgical treatment of periodontitis and peri-implantitis. Starting from an Italian survey showing confusion among dentists about antibiotic indications in periodontal therapy, the authors discuss current scientific evidence on various adjunctive treatments including antimicrobials (chlorhexidine, amine/stannous fluoride), photodynamic therapy, laser therapy, chemical desiccants (HybenX), full mouth disinfection protocols, systemic antibiotics (amoxicillin + metronidazole), and local antibiotics (tetracyclines, metronidazole, doxycycline). The review emphasizes that most adjuvants show limited clinical benefits beyond mechanical debridement alone, with differences often being statistically but not clinically significant. Local controlled-release doxycycline 14% (Ligosan) emerges as a promising adjunct, particularly for acute periodontal/peri-implant abscesses and active pockets, showing encouraging preliminary results in case series.