Effectiveness of antimicrobial gels on gingivitis during fixed orthodontic treatment: A systematic review and meta-analysis

MATERIALS AND METHODS: All randomized and non-randomized clinical trials done on human subjects were explored in major health science databases (PubMed, CINAHL Plus, EBSCO Dent & Oral Sciences and Cochrane). An additional manual search was done on Google Scholar and on www.clinicaltrials.gov to identify any grey literature and unpublished data. Date of publication was not restricted during the data search. The assessment of risk of bias was done using the Cochrane Collaboration\u27s Risk of Bias assessment tool. The meta-analysis was done using Review Manager Version 5.3.5 to analyse probing depth to be in two and four-week follow-up. This systematic review is reported according to the PRISMA statement and registered at PROSPERO (CRD42018084530).RESULTS: The electronic database search yielded 3733 records; hand search identified 14 articles meeting the selection criteria which were included in the qualitative data synthesis. Significant improvement in gingivitis has been reported using antioxidant-essential oil gel, cervitec gel (0.2% chlorhexidine), 2% chlorhexidine gel, amine fluoride gel, and 0.4% stannous fluoride gel with\u3e98% availability of Sn+2 ions. Three articles with probing depth as comparable parameter were used for quantitative analysis. At the two and four-week follow-up, overall insignificant differences were observed in the antimicrobial gel group compared to the control group with regard to probing depth.CONCLUSIONS: The use of antioxidant-essential oil gel, amine fluoride gel, 0.4% stannous fluoride gel (98% availability of Sn+2) and 2% chlorhexidine gel resulted in significant improvement in gingivitis. However, probing depth in follow-up visits showed no significant difference between antimicrobial gel and control group