Vol. 12, Issue 1, Part B (2026)

Periodontal disease remains a significant global health concern, with periodontal pockets representing a critical clinical manifestation that necessitates effective therapeutic interventions. Tetracyclines have been widely investigated for their antimicrobial and anti-inflammatory properties, yet a comprehensive synthesis of their efficacy, comparative advantages, and clinical applications in periodontal pocket treatment is lacking. This systematic review aims to evaluate the role of tetracyclines in periodontal therapy, addressing their clinical effectiveness, delivery systems, and the emerging challenge of antibiotic resistance. We conducted a rigorous analysis of peer-reviewed studies, focusing on randomized controlled trials, clinical studies, and meta-analyses to assess the evidence base. The findings indicate that tetracycline-based treatments, particularly locally delivered formulations, demonstrate significant reductions in probing depth and clinical attachment loss, often outperforming mechanical debridement alone. However, their superiority over other antimicrobial agents remains inconsistent, with variations depending on the specific tetracycline derivative and delivery method. Subgingival delivery systems, such as fibers and gels, enhance drug retention and therapeutic outcomes, yet concerns persist regarding the potential for antibiotic resistance and its long-term implications. The review highlights the need for standardized protocols and further research to optimize tetracycline use in periodontal practice, balancing efficacy with antimicrobial stewardship. Collectively, this work provides a critical appraisal of tetracyclines in periodontal pocket management, offering insights for clinicians and guiding future research directions.