A comprehensive literature search was systematically performed for published and unpublished literature. Moreover, references listed in previous systematic reviews and included studies were examined by hand searching in an attempt to identify any further articles that could be considered for inclusion, although there was no indication on the use of non-English resources.

The quality of nine out of the 11 included studies was considered unclear or high risk of bias, questioning the accuracy of the results.

Of the included studies six reported smokers and four included three different chlorhexidine regimens. The results of two studies that performed full mouth ultrasonic debridement instead of SRP were combined and included in the meta-analysis. Of the seven studies that used the combination Mtz + Amx, four had the same regimen. Four out of the five studies included in the meta-analysis for Mtz-Amx and SRP used the same intervention.

According to the authors, the results of both the pair-wise meta-analyses and the Bayesian network pooled estimates support a statistically significant benefit of adjunctive systemic antibiotics in the treatment of AgP. The most consistent advantages, being reduction in PD and CAL gain, were attained with the use of Mtz and Mtz + Amx. Curiously the authors' conclusions on the performance of Mtz alone come from two small RCTs (n=27) using two different regimens.

It is worthwhile to note that the statistical technique, Bayesian network estimates used in the analyses were sophisticated and innovative in the field of dentistry. The Bayesian technique is generally more robust to outliers and allows pooling of all existing information to compare all systemic antibiotic protocols for the treatment of AgP, with an increased degree of precision.

Considering the limitations present in the included studies, it is not clear if the complex data analysis is of clinical relevance.

The findings of the current meta-analysis are in agreement with previous systematic reviews on periodontal improvement values, however; there is no report on side effects or the growing concern of antibiotic resistance.