Non-surgical treatment of cyclosporin A-induced gingival overgrowth: A systematic review and meta-analysis

Background: Cyclosporin A-induced (CsA-induced) gingival overgrowth (GO) is a common side effect affecting many patients. While surgical intervention is often considered the primary treatment, the effectiveness of nonsurgical periodontal therapy for CsA-induced GO remains unclear. This meta-analysis aimed to assess the efficacy of nonsurgical periodontal treatment in CsA-induced GO. Methods: Articles were retrieved from 7 databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chinese Academic Database, Clinical Trials Database, and Grey Literature Database) until November 5th, 2024. Randomized controlled trials (RCTs) or pre–post studies containing patients with GO caused by cyclosporine who received nonsurgical periodontal treatment were included. The protocol was published in International Prospective Register of Systematic Reviews with the ID CRD42024570280. Results: A total of 13 studies were included. Five studies were RCTs comparing nonsurgical periodontal treatment groups and control groups among patients with GO; the other 8 studies were single group pre–post studies. Meta-analysis of RCTs demonstrated the hypertrophy index (standardized mean difference [SMD] = −1.14; 95% confidence intervals [CI]: [−1.59, −0.69]) and plaque index (SMD = −1.06, 95% CI: [−2.04, −0.07]) were significantly lower in the nonsurgical treatment groups than those in the control groups. Meta-analysis of single group pre–post studies showed that the levels of hypertrophy index (SMD = −1.49; 95% CI: [−2.92, −0.06]), probing depth (SMD = −1.52, 95% CI: [−2.46, −0.58]) and plaque index (SMD = −1.53, 95% CI: [−2.18, −0.88]) decreased significantly after treatment. Subgroup analyses indicated that antibiotics are important sources of heterogeneity. Conclusion: This meta-analysis supports the effectiveness of nonsurgical treatments for CsA-induced GO, and comprehensive pre and posttransplant oral care is recommended. Further studies are needed to determine the biological mechanisms and influence of each variable on the efficacy of nonsurgical treatments in reducing drug-induced GO.