Clinical efficacy of oxygen releasing gel as an adjunct to Scaling and root planing compared to other local drug delivery adjuncts: A systematic review and Meta analysis

Background:
Periodontitis is a chronic multifactorial inflammatory disease characterized by the destruction of tooth-supporting tissues, primarily driven by microbial plaque. Scaling and root planing (SRP) remains the cornerstone of non-surgical periodontal therapy, whereas adjunctive agents may enhance outcomes, especially in complex anatomical sites. Oxygen-releasing gels, owing to their antimicrobial, anti-inflammatory, and wound-healing properties, have emerged as promising adjuncts.This systematic review and meta-analysis aimed to evaluate the clinical efficacy of subgingivally delivered oxygen-releasing gel as an adjunct to SRP in the treatment of chronic periodontitis.

Methods:
A comprehensive literature search was conducted across PubMed, PMC, Google Scholar, Scopus, ScienceDirect, and Cochrane databases up to October 2024, adhering to PRISMA guidelines. Studies comparing oxygen-releasing gel with SRP alone or with other adjuncts were included. Primary outcomes were changes in probing pocket depth (PPD) and clinical attachment level (CAL); secondary outcomes included plaque index (PI) and gingival index (GI). Risk of bias was assessed using the Cochrane RoB 2 tool.

Results:
Seven studies were included in qualitative synthesis and meta-analysis. Oxygen-releasing gel showed statistically significant improvements in PPD (SMD = 1.56; p = 0.006), while CAL, GI, and PI improvements were inconsistent or non-significant. High heterogeneity and varied methodologies limited data comparability. Thus, Subgingivally delivered oxygen releasing gel appears to be a promising adjunct to scaling and root planing, with significant improvement in probing pocket depth. Although findings for other clinical parameters remain inconsistent, current evidence supports its potential clinical benefit. Further well-designed randomized controlled trials with standardized protocols are needed to confirm its long-term efficacy.