1
|
Biewer B, Rompen E, Mittelbronn M, Hammer GP, Quatresooz P, Borgmann FK. Effects of Minocycline Hydrochloride as an Adjuvant Therapy for a Guided Bone Augmentation Procedure in The Rat Calvarium. Dent J (Basel) 2023; 11:dj11040092. [PMID: 37185470 PMCID: PMC10136768 DOI: 10.3390/dj11040092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
This in vivo study reports the influence of minocycline-HCl administration on extra-skeletal bone generation in a Guided Bone Augmentation model, utilizing titanium caps placed on the intact as well as perforated calvaria of rats. The test group was administered 0.5 mg/mL minocycline-HCl with the drinking water, and the amount of bone tissue in the caps was quantified at three time points (4, 8 and 16 weeks). A continuously increased tissue fill was observed in all groups over time. The administration of minocycline-HCl as well as perforation of the calvaria increased this effect, especially with regard to mineralization. The strongest tissue augmentation, with 1.8 times that of the untreated control group, and, at the same time, the most mineralized tissue (2.3× over untreated control), was produced in the combination of both treatments, indicating that systemic administration of minocycline-HCl has an accelerating and enhancing effect on vertical bone augmentation.
Collapse
|
2
|
Moore GC, Smith KT, Christiansen MM, Anderson L, Moravec LJ, Okano DK, Samson KK, Ramer-Tait A, Beede K, Reinhardt RA, Killeen AC. Effect of interproximal home oral hygiene on clinical parameters and inflammatory biomarkers in patients receiving periodontal maintenance. J Periodontol 2023. [PMID: 36799307 DOI: 10.1002/jper.22-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The purpose of this 6-week, single-blinded, randomized clinical trial was to determine if the use of an interproximal brush, with or without a tracking device, is more effective than an oral irrigator in improving interproximal probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and inflammatory markers. METHODS Seventy-six patients with Stages III-IV, Grade B periodontitis and a 5-7 mm posterior interproximal PD with BOP were randomized: (1) interproximal brush alone (IB; n = 26), (2) interproximal brush with tracking device (TD; n = 23), (3) oral irrigator (OI; n = 27). Participants used devices once daily for 6 weeks. Clinical measurements (PD, CAL, PI, BOP, GI) and gingival crevicular fluid (GCF) samples were collected at baseline and 6 weeks. RESULTS All groups showed a significant reduction in PD and CAL (≥1.1 mm, p < 0.0001) and improvement in BOP (≥56%, p < 0.0001) and GI (≥82%, p < 0.001) at the experimental site with no differences among groups. The IB and IB+TD groups showed a significant reduction in PI (≥0.9, p ≤ 0.01). Interleukin (IL)-1β was reduced in all groups (p = 0.006), but IB+TB more than OI (p ≤ 0.05). IL-10 was reduced among all groups (p = 0.01), while interferon-gamma significantly increased (p = 0.01) in all groups. CONCLUSIONS IB and OI improved clinical parameters of PD and CAL and reduced inflammatory markers (BOP, GI, GCF IL-1β). IB had better interproximal plaque reduction. Tracking did not significantly improve clinical parameters compared with the IB and OI groups, suggesting future modifications are needed.
Collapse
Affiliation(s)
- Grace C Moore
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Kevin T Smith
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Laura Anderson
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Lisa J Moravec
- Department of Dental Hygiene, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - David K Okano
- Department of Periodontics, University of Utah School of Dentistry, Salt Lake City, Utah, USA
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Amanda Ramer-Tait
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Kristin Beede
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska, USA
| |
Collapse
|
3
|
Hurtado-Celotti D, Martínez-Rodríguez N, Ruiz-Sáenz PL, Barona-Dorado C, Santos-Marino J, Martínez-González JM. Piperacillin-Tazobactam as an Adjuvant in the Mechanical Treatment of Patients with Periodontitis: A Randomized Clinical Study. Antibiotics (Basel) 2022; 11:antibiotics11121689. [PMID: 36551346 PMCID: PMC9774547 DOI: 10.3390/antibiotics11121689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
In this study, the aim was to evaluate the effects of the adjuvant piperacillin-tazobactam solution in the mechanical treatment of periodontitis. A single-blind split-mouth randomized study, it included 24 participants. All of them presented periodontitis stage III according to the 2018 World Workshop classification and the presence of at least one of the following periodontal pathogens: Aggregatibacter actinomycetemcomitans; Porphyromona gingivalis; Treponema denticola; Tannerella forsythia; Prevotella intermedia. The study established two groups: a control group (SRP: scaling and root planing) and a test group (SRP plus local piperacillin-tazobactam). The final recruitment included 11 women (45.8%) and 13 men (54.2%). The age range was between 25 and 72 years, and the mean age was 57 ± 10.20 years. Clinical controls were performed at 2 weeks, 3 months, and 6 months, repeating the SRP and applying the piperacillin-tazobactam solution again at the 3-month appointment. The clinical attachment level decreased by a mean of 2.13 ± 0.17 mm from the baseline to 6 months in the test group versus 1.63 ± 0.18 mm in the control group. The mean probing pocket depth decreased from 1.32 ± 0.09 mm in the test group, versus from 0.96 ± 0.14 mm on the control side. The plaque index in the test group decreased by 0.46 ± 0.04, while it decreased by an average of 0.31 ± 0.04 in the control group. In conclusion, the local use of piperacillin-tazobactam as complementary therapy produces better clinical results in patients with periodontitis. However, these results are not maintained over time, and so a more persistent local application is necessary.
Collapse
Affiliation(s)
- Dolores Hurtado-Celotti
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
| | - Natalia Martínez-Rodríguez
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
- Surgical and Implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, 28040 Madrid, Spain
| | - Pedro Luis Ruiz-Sáenz
- Department of Dentistry, Central Hospital of the Red Cross of Madrid, 28003 Madrid, Spain
| | - Cristina Barona-Dorado
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
- Surgical and Implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-606961821
| | - Juan Santos-Marino
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - José María Martínez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
- Surgical and Implant Therapies in the Oral Cavity Research Group, Complutense University of Madrid, 28040 Madrid, Spain
| |
Collapse
|
4
|
Cosgarea R, Ramseier CA, Jepsen S, Arweiler NB, Jervøe-Storm PM, Batori-Andronescu I, Rößler R, Conrad T, Eick S, Sculean A. One-Year Clinical, Microbiological and Immunological Results of Local Doxycycline or Antimicrobial Photodynamic Therapy for Recurrent/Persisting Periodontal Pockets: A Randomized Clinical Trial. Antibiotics (Basel) 2022; 11:antibiotics11060738. [PMID: 35740145 PMCID: PMC9220761 DOI: 10.3390/antibiotics11060738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
We evaluated, in this study, the clinical, microbiological and immunological effects of local drug delivery (LDD) or photodynamic therapy (PDT), adjunctive to subgingival instrumentation (SI) in persistent or recurrent periodontal pockets in patients enrolled in supportive periodontal therapy (SPT) after one year. A total of 105 patients enrolled in SPT with persistent/recurrent pockets were randomly treated with SI +PDT or SI + LDD or SI (control). The number of treated sites with bleeding on probing (n BOP+), probing pocket depths (PPD), clinical attachment level (CAL), full-mouth plaque and bleeding scores (gingival bleeding index, %bleeding on probing-BOP) was evaluated at baseline and after 12 months. Additionally, eight periodontopathogens and the immunomarkers IL-1β (interleukin)and MMP-8 (matrix metalloprotease) were quantitatively determined using real-time PCR and ELISA, respectively. All three treatments resulted in statistically significant clinical improvements (p < 0.05) without statistically significant intergroup differences (p > 0.05), which were maintained up to 12 months. The presence of BOP negatively affected the PPD and CAL. Moreover, statistically significantly fewer bleeding sites at 12 months were observed in the test groups (p = 0.049). Several periodontopathogens were reduced after 12 months. In conclusion, the present data indicate that in periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical, microbiological and immunological improvements, which are maintained up to 12 months. Secondly, the presence of BOP directly impacts the PPD and CAL.
Collapse
Affiliation(s)
- Raluca Cosgarea
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, 35033 Marburg, Germany;
- Department of Prosthodontics, Iuliu Hatieganu University Cluj-Napoca, 400006 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +49-(0)-228-2872-2480; Fax: +49-(0)-228-2872-2161
| | - Christoph A. Ramseier
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| | - Søren Jepsen
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
| | - Nicole Birgit Arweiler
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, 35033 Marburg, Germany;
| | - Pia Merete Jervøe-Storm
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
| | | | - Ralf Rößler
- University for Digital Technologies in Medicine and Dentistry, 9516 Wiltz, Luxembourg; (R.R.); (T.C.)
| | - Torsten Conrad
- University for Digital Technologies in Medicine and Dentistry, 9516 Wiltz, Luxembourg; (R.R.); (T.C.)
- Clinic for Mouth, Jaw and Plastic Facesurgery, University of Frankfurt, 6059 Frankfurt, Germany
- Private Practice, 55411 Bingen am Rhein, Germany
| | - Sigrun Eick
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| | - Anton Sculean
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| |
Collapse
|
5
|
Killeen AC, Krell LE, Bertels M, Christiansen MM, Anderson L, Hattervig RL, Samson KK, Wang D, Reinhardt RA. The Effect of Locally Applied Simvastatin on Clinical Attachment Level and Alveolar Bone in Periodontal Maintenance Patients: Randomized Clinical Trial. J Periodontol 2022; 93:1682-1690. [PMID: 35622060 PMCID: PMC10084343 DOI: 10.1002/jper.21-0708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/25/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this double-masked, randomized, controlled trial was to determine if the local application of simvastatin (SIM), combined with minimally invasive papilla reflection and root preparation (PR/RP), is effective in improving clinical attachment level (CAL), probing depth (PD) reduction, and increasing interproximal bone height (IBH) in persistent 6-9 mm periodontal pockets in patients receiving periodontal maintenance therapy (PMT). METHODS: : Fifty patients with Stage III, Grade B periodontitis presenting with a 6-9 mm interproximal PD with a history of bleeding on probing (BOP) were included in the study. Experimental [PR/RP+SIM/methylcellulose (MCL); n=27] and control (PR/RP + MCL; n=23) therapies were randomly assigned. Root surfaces were accessed via reflection of interproximal papillae, followed by root planing assisted with endoscope evaluation, acid etching, and SIM/MCL or MCL application. CAL, PD, BOP, plaque presence and IBH (using standardized vertical bitewing radiographs) were evaluated at baseline and 12 months. Measurements were compared by group and time using Chi-square, Wilcoxon rank sum, and t-tests. RESULTS Both PR/RP+SIM/MCL and PR/RP+MCL, respectively, resulted in improvements in clinical outcomes (CAL: -1.9 ± 0.3 mm, p<0.0001; -1.0 ± 0.3 mm, p<0.003; PD: -2.3 mm ± 0.3, p<0.0001; -1.3 mm ± 0.3, p<0.0001; BOP: -58.7%; -41.7%, p<0.05) and stable IBH (-0.2 ± 0.12, -0.4 ± 0.2, p=0.22) from baseline to 12 months post-therapy. PR/RP+SIM/MCL had more improvement in CAL (p=0.03), PD (p=0.007), and BOP (p=0.047). CONCLUSIONS The addition of SIM/MCL to PR/RP improved CAL, PD, and BOP compared to PR/RP alone in periodontal maintenance patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Lauren E Krell
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Mattie Bertels
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Laura Anderson
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Robin L Hattervig
- Department of Adult Restorative Dentistry, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - Dong Wang
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center College of Pharmacy, Omaha, NE, USA
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE, USA
| |
Collapse
|
6
|
Laza GM, Sufaru IG, Martu MA, Martu C, Diaconu-Popa DA, Jelihovschi I, Martu S. Effects of Locally Delivered Minocycline Microspheres in Postmenopausal Female Patients with Periodontitis: A Clinical and Microbiological Study. Diagnostics (Basel) 2022; 12:diagnostics12061310. [PMID: 35741120 PMCID: PMC9221947 DOI: 10.3390/diagnostics12061310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection.
Collapse
Affiliation(s)
- Georgeta-Maria Laza
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania; (G.-M.L.); (S.M.)
| | - Irina-Georgeta Sufaru
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania; (G.-M.L.); (S.M.)
- Correspondence: (I.-G.S.); (M.-A.M.)
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania; (G.-M.L.); (S.M.)
- Correspondence: (I.-G.S.); (M.-A.M.)
| | - Cristian Martu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania;
| | - Diana Antonela Diaconu-Popa
- Department of Oral Implantology, Removable Dentures and Technology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania;
| | - Igor Jelihovschi
- Department of Microbiology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania;
| | - Silvia Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania; (G.-M.L.); (S.M.)
| |
Collapse
|
7
|
Teles FRF, Lynch MC, Patel M, Torresyap G, Martin L. Bacterial resistance to minocycline after adjunctive minocycline microspheres during periodontal maintenance: A randomized clinical trial. J Periodontol 2021; 92:1222-1231. [PMID: 33866555 DOI: 10.1002/jper.17-0565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite widespread use, the impact of minocycline hydrochloride microspheres on the shifts of oral bacterial species resistant to minocycline remains unknown. This study aimed at examining the percentage and taxonomy of minocycline-resistant isolates in saliva and subgingival plaque samples before and after minocycline microspheres application in periodontitis patients during maintenance. METHODS Patients received supra- and sub-gingival debridement with (test) or without (control) minocycline microspheres application to sites with probing depth >4 mm and were clinically monitored at baseline, 1, 3, and 6 months. Samples were collected at baseline, 1 and 6 months and analyzed via cultivation with or without 4 μg/mL minocycline. Percentage of resistant strains was determined by colony counting and taxonomy by checkerboard DNA-DNA hybridization. Significant clinical changes were sought with the Mann-Whitney test and differences in percentage of resistant isolates with the Friedman and Mann-Whitney tests. RESULTS Groups showed similar clinical improvements. Mean percentage of resistant isolates rose at 1 month and decreased at 6 months in saliva and plaque samples in test group (P <0.05) but remained unchanged in control group. Percentage of resistant isolates of Gemella morbillorum and Eubacterium saburreum increased significantly at 6 months in both groups. Antibiotic resistance by Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis was either absent or infrequent. CONCLUSION Minocycline microspheres result in transient selection of minocycline resistant species in saliva and subgingival plaque samples.
Collapse
Affiliation(s)
- Flavia R F Teles
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Innovation and Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA
| | | | - Michele Patel
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA
| | - Gay Torresyap
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA
| | - Lynn Martin
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
8
|
Toledano M, Osorio MT, Vallecillo-Rivas M, Toledano-Osorio M, Rodríguez-Archilla A, Toledano R, Osorio R. Efficacy of local antibiotic therapy in the treatment of peri-implantitis: A systematic review and meta-analysis. J Dent 2021; 113:103790. [PMID: 34455016 DOI: 10.1016/j.jdent.2021.103790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/01/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to state the efficacy of local administration of antibiotics in the treatment of peri-implantitis in terms of peri-implant probing depth (PPD) and bleeding on probing (BoP) reduction. DATA, SOURCES AND STUDY SELECTION Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). Due to the encountered heterogeneity between the studies being combined, random-effects models were applied in order to analyze effect sizes. Twelve studies (365 patients and 463 implants) were included in the systematic review. After peri-implantitis treatment with local antibiotics, PPD was reduced 1.40 mm (95% confidence interval: 0.82-1.98). When local antibiotics were applied, a 0.30 mm higher reduction of PPD was obtained than in the control group (95% confidence interval: 0.07-0.53). BoP attained an odds ratio value of 1.82 (95% confidence interval: 1.09-3.04), indicating that the likehood of bleeding is almost two-fold when antibiotics are not locally administrated. Adverse effects were not found after applying local antibiotics. CONCLUSIONS The local antibiotic administration does reduce, without adverse effects, both peri-implant probing depths and bleeding on probing in patients affected by peri-implantitis, if compared to control groups without local antibiotic application. CLINICAL SIGNIFICANCE Patients with dental implants frequently suffer from peri-implantitis. Clinical features of peri-implantitis lesions include the presence of bleeding on probing and increased peri-implant probing depths. Both BoP and PPD have become reduced after local administration of antibiotics.
Collapse
Affiliation(s)
- Manuel Toledano
- University of Granada, Faculty of Dentistry, Colegio Máximo de Cartuja s/n, Granada 18071, Spain
| | | | - Marta Vallecillo-Rivas
- University of Granada, Faculty of Dentistry, Colegio Máximo de Cartuja s/n, Granada 18071, Spain
| | - Manuel Toledano-Osorio
- University of Granada, Faculty of Dentistry, Colegio Máximo de Cartuja s/n, Granada 18071, Spain.
| | | | | | - Raquel Osorio
- University of Granada, Faculty of Dentistry, Colegio Máximo de Cartuja s/n, Granada 18071, Spain
| |
Collapse
|
9
|
Wu J, Lin L, Xiao J, Zhao J, Wang N, Zhao X, Tan B. Efficacy of scaling and root planning with periodontal endoscopy for residual pockets in the treatment of chronic periodontitis: a randomized controlled clinical trial. Clin Oral Investig 2021; 26:513-521. [PMID: 34145479 DOI: 10.1007/s00784-021-04029-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Residual pockets are a risk factor of periodontitis progression. This study evaluated the efficacy of periodontal endoscopy (PE) during scaling and root planning (SRP) of residual pockets in chronic periodontitis patients after initial periodontal treatment. MATERIALS AND METHODS A single-blinded, randomized controlled clinical trial was conducted in systemically healthy subjects presenting at least three residual pockets with a probing depth (PD) ≥ 5 mm in each quadrant. Subjects were randomly allocated to one of two trial groups using a computer-generated program: SRP + PE (test group) or SRP alone (control group). Clinical parameters (PD, clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PLI)) were then measured at baseline, 3-, and 6-month follow-up. RESULTS A total of 1629 sites in 37 patients were examined. Both treatments significantly improved all clinical outcomes (PD, CAL, BOP, and PLI) from baseline to 6 months (P < 0.05), although greater reductions in PD and PLI were observed in the test group at both 3- (PD: 3.45 ± 0.56 vs. 4.14 ± 0.59 mm; PLI: 0.55 ± 0.23 vs. 0.73 ± 0.27) and 6-month follow-up (PD: 3.12 ± 0.63 vs. 4.0 ± 0.68 mm; PLI: 0.49 ± 0.21 vs. 0.72 ± 0.28, respectively; P = 0.001 for PD and P = 0.021 for PLI). No significant differences in CAL or BOP were observed. CONCLUSIONS SRP + PE resulted in significant reductions in PD and PLI compared to SRP alone in residual pockets with a PD ≥ 5 mm. CLINICAL RELEVANCE The findings highlight the benefits of SRP + PE, supporting use as an alternative strategy in nonsurgical periodontal treatment.
Collapse
Affiliation(s)
- Juan Wu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Xuanwu District, Nanjing, 210008, Jiangsu, China
| | - Liangyuan Lin
- Department of Stomatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jianping Xiao
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Xuanwu District, Nanjing, 210008, Jiangsu, China
| | - Jie Zhao
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Xuanwu District, Nanjing, 210008, Jiangsu, China
| | - Ningxiang Wang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Xuanwu District, Nanjing, 210008, Jiangsu, China
| | - Xingxing Zhao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Jiangsu, China
| | - Baochun Tan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Xuanwu District, Nanjing, 210008, Jiangsu, China.
| |
Collapse
|
10
|
Wang N, Huang Z, Wang S, Lang M, Zhang X. Minocycline hydrochloride loaded mPEG-PCLA membranes: Preparation and in vitro evaluation for periodontitis therapy. J BIOACT COMPAT POL 2021. [DOI: 10.1177/0883911521992795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study was aimed at alleviating shortcomings in the treatment of periodontitis by preparation of a biopolymer membrane loaded with minocycline hydrochloride (MH) inserted into periodontal pockets to treat infections. Monomethoxy-poly (ethylene glycol)-poly (ε-caprolactone-co-L-lactide) (mPEG-PCLA) is a biocompatible and biodegradable amphiphilic block copolymer. It, therefore, has attracted considerable attention in drug delivery systems and periodontal treatment. We chose it as a membrane material for MH-drug loading. The MH-loaded membranes were prepared by the solvent casting technique with the content of 5, 8 and 10 wt.%, respectively. Fourier transform infrared spectra (FTIR) revealed no interaction between MH and polymer. The drug-loaded membrane surface morphology was investigated by scanning electron microscopy (SEM). In vitro release studies showed that the initial drug release exceeded 40% within 24 h, followed by a sustained release for up to 2 weeks, which would enable the therapeutic level to maintain over a longer time. The antibacterial activity studies in vitro demonstrated a positive effect on the periodontal pathogen. MH drug-loaded membranes have no adverse effect on the growth of periodontal ligament fibroblasts in the MTT test. The study suggests that mPEG-PCLA membranes containing MH are a potential antibacterial drug delivery system for local treatment of periodontitis.
Collapse
Affiliation(s)
- Ningtao Wang
- Department of 2nd Dental Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhengmei Huang
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shenchun Wang
- School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Meidong Lang
- School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Xiuyin Zhang
- Department of Prosthodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Trombelli L, Farina R, Pollard A, Claydon N, Franceschetti G, Khan I, West N. Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:144-154. [PMID: 32060940 DOI: 10.1111/jcpe.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". METHODS A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. RESULTS Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p = .351). CONCLUSIONS Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
Collapse
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Alexander Pollard
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Nicholas Claydon
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Iftekhar Khan
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Nicola West
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| |
Collapse
|
12
|
Herrera D, Matesanz P, Martín C, Oud V, Feres M, Teughels W. Adjunctive effect of locally delivered antimicrobials in periodontitis therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:239-256. [PMID: 31912531 DOI: 10.1111/jcpe.13230] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To answer the following PICOS question: in adult patients with periodontitis, which is the efficacy of adjunctive locally delivered antimicrobials, in comparison with subgingival debridement alone or plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up. MATERIAL AND METHODS A systematic search was conducted: 59 papers, reporting 50 different studies, were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs) and 95% confidence intervals (CI), and prediction intervals (PI), in case of significant heterogeneity. RESULTS Statistically significant differences were observed, in 6- to 9-month studies, for PPD (WMD = 0.365, 95% CI [0.262; 0.468], PI [-0.29; 1.01]) and clinical attachment level (CAL) (WMD = 0.263, 95% CI [0.123; 0.403], PI [-0.43; 0.96]). For long-term studies, significant differences were observed for PPD (WMD = 0.190, 95% CI [0.059; 0.321]), but not for CAL. For adverse events, no differences were observed. Results were affected by study design (split-mouth versus parallel studies) and assessment (full- or partial-mouth), as well as by the formulation tested. CONCLUSIONS The use adjunctive locally delivered antimicrobials in periodontitis therapy results in statistically significant benefits in clinical outcomes, without relevant side effects.
Collapse
Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Conchita Martín
- BIOCRAN (Craniofacial Biology) Research Group, University Complutense, Madrid, Spain
| | - Valerie Oud
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Brazil
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Clinical and Microbiological Evaluation of Local Doxycycline and Antimicrobial Photodynamic Therapy during Supportive Periodontal Therapy: A Randomized Clinical Trial. Antibiotics (Basel) 2021; 10:antibiotics10030277. [PMID: 33803281 PMCID: PMC8001251 DOI: 10.3390/antibiotics10030277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to evaluate the clinical and microbiological effects of subgingival instrumentation (SI) alone or combined with either local drug delivery (LDD) or photodynamic therapy (PDT) in persistent/recurrent pockets in patients enrolled in supportive periodontal therapy (SPT). A total of 105 patients enrolled in SPT were randomly treated as follows: group A (n = 35): SI +PDT and 7 days later 2nd PDT; group B (n = 35): SI+LDD; group C (n = 35): SI (control). Prior intervention, at 3 and 6 months after therapy, probing pocket depths, clinical attachment level, number of treated sites with bleeding on probing (n BOP), full mouth plaque and bleeding scores (gingival bleeding index, %BOP) were recorded. At the same time points, 8 periodontopathogens were quantitatively determined. All three treatments resulted in statistically significant improvements (p < 0.05) of all clinical parameters without statistically significant intergroup differences (p > 0.05). Several bacterial species were reduced in both test groups, with statistically significantly higher reductions for LDD compared to PDT and the control group. In conclusion, the present data indicate that: (a) In periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical improvements and (b) the adjunctive use of LDD appears to provide better microbiological improvements for some periodontal pathogens than SI alone or combined with PDT.
Collapse
|
14
|
West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent 2021; 106:103562. [PMID: 33573801 DOI: 10.1016/j.jdent.2020.103562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.
Collapse
Affiliation(s)
- Nicola West
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK.
| | - Nick Claydon
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Francesco D'Aiuto
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Nikos Donos
- Periodontology, Institute of Dentistry, Barts and The London School of Medicine & Dentistry, Queen Mary University, Turner Street, London E1 2AD, UK.
| | - Mark Ide
- Periodontology, Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE1 9RT, UK.
| | - Ian Needleman
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA.
| |
Collapse
|
15
|
Zhao Y, Pu R, Qian Y, Shi J, Si M. Antimicrobial photodynamic therapy versus antibiotics as an adjunct in the treatment of periodontitis and peri-implantitis: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2021; 34:102231. [PMID: 33621702 DOI: 10.1016/j.pdpdt.2021.102231] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical efficacy of antimicrobial photodynamic therapy (aPDT) as compared to antibiotics in periodontitis and peri-implantitis has been tested in several clinical trials. Yet controversial results were reported. The aim of the present study was to answer the question: "Will adjunctive antimicrobial photodynamic therapy be more effective than antibiotics agent in the treatment of periodontitis and peri-implantitis?". METHODS Publications compared outcomes between aPDT and antibiotics in adult patients with periodontitis or peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. PubMed, EMBASE and Cochrane Central were searched until December of 2020. Clinical parameters including pocket probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were evaluated. The risk of bias was assessed by Cochrane Collaboration Tool. Weighted mean differences (WMD), 95 % confidence interval(CI) and heterogeneity were estimated by Review Manager software. RESULTS 10 trials in periodontitis and 5 trials in peri-implantitis were included. Meta-analysis outcomes revealed equal clinical evidence for aPDT and antibiotics in periodontitis and peri-implantitis. In addition, aPDT significantly reduced the red complex in both diseases. However, owing to the heterogeneity of protocols in articles and the limited number of studies, the comparative conclusion remained unconfirmed. CONCLUSION aPDT can be considered as an alternative to antibiotics in the treatment of peri-implantitis and periodontitis. Given that high heterogeneity in outcome was found in this review, future long-term clinical trials with standard aPDT and antibiotic treatment should be tested to arrive at a firm conclusion.
Collapse
Affiliation(s)
- Yuxin Zhao
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, China
| | - Rui Pu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, China
| | - Yinjie Qian
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, China
| | - Jue Shi
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, China
| | - Misi Si
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, China.
| |
Collapse
|
16
|
Wang CY, Yang YH, Li H, Lin PY, Su YT, Kuo MYP, Tu YK. Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1496-1510. [PMID: 33010026 DOI: 10.1111/jcpe.13379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
AIM This systematic review and network meta-analysis aimed to evaluate the efficacy of adjunctive locally delivered antimicrobials, compared to subgingival instrumentation alone or plus a placebo, on changes in probing pocket depth (PPD) and clinical attachment level (CAL), in patients with residual pockets during supportive periodontal care. MATERIALS AND METHODS Literature search was performed with electronic databases and by hand until 31 May 2020. Primary outcome was the changes in PPD. The treatment effects between groups were estimated with weighted mean differences (WMD) with 95% confidence intervals (CI) and prediction intervals (PI) by using random-effects network meta-analysis. RESULTS Twenty-two studies were included. Significantly greater PPD reduction was achieved in chlorhexidine chip group (WMD: 0.65 mm, 95% CI: 0.21-1.10) and tetracycline fibre group (WMD: 0.64 mm, 95% CI: 0.20-1.08) over 6-month follow-up. Other adjunctive antimicrobial agents achieved non-significant improvements compared to scaling and root planing alone. All differences between adjunctive therapies were statistically non-significant. Similar findings were observed for CAL gain. CONCLUSION Adjunctive local antimicrobial agents achieved small additional PPD reduction and CAL gain in residual pockets for a follow-up of up to 6 months. Tetracycline fibre and chlorhexidine chip achieved better results than other antimicrobials.
Collapse
Affiliation(s)
- Chen-Ying Wang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hao Yang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Ting Su
- Department of Dentistry, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mark Yen-Ping Kuo
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
17
|
Yamamoto Y, Morozumi T, Hirata T, Takahashi T, Fuchida S, Toyoda M, Nakajima S, Minabe M. Effect of Periodontal Disease on Diabetic Retinopathy in Type 2 Diabetic Patients: A Cross-sectional Pilot Study. J Clin Med 2020; 9:E3234. [PMID: 33050355 PMCID: PMC7600038 DOI: 10.3390/jcm9103234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Both periodontal disease and diabetes are common chronic inflammatory diseases. One of the major problems with type 2 diabetes is that unregulated blood glucose levels damage the vascular endothelium and cause complications. A bidirectional relationship between periodontal disease and diabetic complications has been reported previously. However, whether periodontal disease affects the presence of diabetic complications has not been clarified. Therefore, we examined the effect of the periodontal disease status on diabetic complications in patients with type 2 diabetes. Periodontal doctors examined the periodontal disease status of 104 type 2 diabetic patients who visited a private diabetes medical clinic once a month between 2016 and 2018. The subject's diabetic status was obtained from their medical records. Bayesian network analysis showed that bleeding on probing directly influenced the presence of diabetic retinopathy in type 2 diabetes patients. In addition, bleeding on probing was higher in the diabetic retinopathy group (n = 36) than in the group without diabetic retinopathy (n = 68, p = 0.006, Welch's t-test). Bleeding on probing represents gingival inflammation, which might affect the presence of diabetic retinopathy in type 2 diabetes patients who regularly visit diabetic clinics.
Collapse
Affiliation(s)
- Yuko Yamamoto
- Department of Dental Hygiene, Kanagawa Dental University, Junior College, 82 Inaoka, Yokosuka 2388580, Kanagawa, Japan;
| | - Toshiya Morozumi
- Division of Periodontology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka 2388580, Kanagawa, Japan; (T.H.); (M.M.)
| | - Takahisa Hirata
- Division of Periodontology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka 2388580, Kanagawa, Japan; (T.H.); (M.M.)
| | - Toru Takahashi
- Department of Health and Nutrition, Faculty of Human Health, Kanazawa Gakuin University, 10 Sue-machi, Kanazawa 9201392, Ishikawa, Japan;
| | - Shinya Fuchida
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka 2388580, Kanagawa, Japan;
| | - Masami Toyoda
- Nakajima Internal Medicine Clinic, 1-17 Yonegahamadori, Yokosuka 2380011, Kanagawa, Japan; (M.T.); (S.N.)
| | - Shigeru Nakajima
- Nakajima Internal Medicine Clinic, 1-17 Yonegahamadori, Yokosuka 2380011, Kanagawa, Japan; (M.T.); (S.N.)
| | - Masato Minabe
- Division of Periodontology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka 2388580, Kanagawa, Japan; (T.H.); (M.M.)
| |
Collapse
|
18
|
Ali A, Saliem S, Abdulkareem A, Radhi H, Gul S. Evaluation of the efficacy of lycopene gel compared with minocycline hydrochloride microspheres as an adjunct to nonsurgical periodontal treatment: A randomised clinical trial. J Dent Sci 2020; 16:691-699. [PMID: 33854720 PMCID: PMC8025195 DOI: 10.1016/j.jds.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/15/2020] [Indexed: 11/28/2022] Open
Abstract
Background/purpose The prescription of antibiotics as an adjunct to mechanical periodontal therapy in patients with severe periodontitis is recommended; however, the side effects of antibiotics are a major concern. The aim of this study was to evaluate the efficacy of lycopene (Lyc) antioxidant gel versus minocycline hydrochloride microspheres (ARISTIN) as an adjunct to the nonsurgical treatment of periodontitis. Materials and methods Three identical periodontal pockets/patient received root surface debridement followed by the random application of either ARISTIN, Lyc, or placebo gel (control, Ctrl). Clinical parameters, plaque index, bleeding on probing, probing pocket depth, and clinical attachment loss, were recorded at the baseline and after 30 days. Additionally, the levels of interleukin-8 (IL-8), matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases 1 (TIMP1) in gingival crevicular fluid samples were assessed at the same time points. Results Twenty-three patients with periodontitis completed the study. Both ARISTIN and Lyc treatments showed significantly greater gains in attachment (1.94 ± 1.33 and 1.72 ± 0.88, respectively) than the Ctrl treatment (1.04 ± 0.96). Compared with those in the Ctrl, only ARISTIN showed a significant reduction in IL-8 level, whereas TIMP1 levels were significantly upregulated in the Lyc gel and ARISTIN sites. The effect size estimation indicated that Lyc gel exhibited considerably greater efficacy than the Ctrl gel. Conclusion Lyc gel and ARISTIN offer almost equal improvement in both clinical and biochemical parameters of periodontitis.
Collapse
Affiliation(s)
- Aya Ali
- College of Dentistry, Mustansiriya University, Baghdad, Iraq
| | - Saif Saliem
- College of Dentistry, University of Baghdad, Baghdad, Iraq
| | | | - Hani Radhi
- College of Dentistry, Mustansiriya University, Baghdad, Iraq
| | - Sarhang Gul
- College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| |
Collapse
|
19
|
Jasa EE, Gradoville JM, Christiansen MM, Samson KK, Reinhardt RA, Payne JB, Killeen AC. Effects of enamel matrix derivative on clinical and inflammatory outcomes in periodontal maintenance patients: Randomized controlled clinical trial. J Periodontol 2020; 91:1400-1408. [PMID: 32182380 DOI: 10.1002/jper.19-0623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Efficient methods to treat persistent pockets during periodontal maintenance therapy (PMT) require further investigation. The hypothesis of this randomized controlled clinical trial was that local application of enamel matrix derivative (EMD) added to papilla reflection/root preparation (PR/RP) could enhance clinical and inflammatory outcomes, primarily clinical attachment level (CAL). METHODS Fifty PMT patients with generalized stage III-IV, grade B periodontitis presenting with a 6- to 9-mm interproximal PD were randomly allocated to (PR/RP+EMD; n = 24) and control (PR/RP+saline; n = 26) therapies by sex and smoking status. Roots were treated with reflection of interproximal papillae, root planing assisted with endoscope evaluation, and acid etching, followed by EMD or saline application. Probing depth (PD), CAL, plaque index (PI), and interproximal bone height were evaluated at baseline and 12-months post-therapy. Gingival crevicular fluid, bleeding on probing (BOP), and interleukin-1β were tested (ELISA) at baseline, 2 weeks, and 6 and 12 months. Groups were compared over time and between groups with Wilcoxon Rank Sum and t-tests. RESULTS Both PR/RP+ EMD and PR/RP+S resulted in significant improvements in clinical outcomes (PD and CAL, BOP) from baseline to 12 months. No significant differences were found in clinical or inflammatory outcomes between the experimental and control groups. CONCLUSIONS The addition of EMD to PR/RP does not significantly improve clinical or inflammatory outcomes compared with PR/RP alone during periodontal maintenance therapy.
Collapse
Affiliation(s)
- Erica E Jasa
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jessica M Gradoville
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jeffrey B Payne
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| |
Collapse
|
20
|
Cheng R, Wu Z, Li M, Shao M, Hu T. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review. Int J Oral Sci 2020; 12:2. [PMID: 31900383 PMCID: PMC6949296 DOI: 10.1038/s41368-019-0068-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023] Open
Abstract
Interleukin(IL)-1β, a pro-inflammatory cytokine, was elevated and participates in periodontitis. Not only the link between IL-1β and periodontitis was proved by clinical evidence, but also the increased IL-1β triggers a series of inflammatory reactions and promotes bone resorption. Currently, IL-1β blockage has been therapeutic strategies for autoimmune and autoinflammatory diseases such as rheumatoid arthritis, cryopyrin-associated periodic syndromes, gout and type II diabetes mellitus. It is speculated that IL-1β be a potential therapeutic target for periodontitis. The review focuses on the production, mechanism, present treatments and future potential strategies for IL-1β in periodontitis.
Collapse
Affiliation(s)
- Ran Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiwu Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mingming Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Meiying Shao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
21
|
Li N, Jiang L, Jin H, Wu Y, Liu Y, Huang W, Wei L, Zhou Q, Chen F, Gao Y, Zhu B, Zhang X. An enzyme-responsive membrane for antibiotic drug release and local periodontal treatment. Colloids Surf B Biointerfaces 2019; 183:110454. [PMID: 31473407 DOI: 10.1016/j.colsurfb.2019.110454] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
Periodontitis is a chronic, destructive inflammatory disease that injures tooth- supporting tissues, eventually leading to tooth loss. Complete eradication of periodontal pathogenic microorganisms is fundamental to allow periodontal healing and commonly precedes periodontal tissue regeneration. To address this challenge, we report a strategy for developing an enzyme-mediated periodontal membrane for targeted antibiotic delivery into infectious periodontal pockets; the unique components of the membrane will also benefit periodontal alveolar bone repair. In this approach, a chitosan membrane containing polyphosphoester and minocycline hydrochloride (PPEM) was prepared. Physical, morphological, and ultrastructural analyses were carried out in order to assess cellular compatibility, drug release and antibacterial activity in vitro. Additionally, the functionality of the PPEM membrane was evaluated in vivo with a periodontal defect model in rats. The results confirm that the PPEM membrane exhibits good physical properties with excellent antibacterial activity and successfully promotes periodontal tissue repair, making it promising for periodontal treatment.
Collapse
Affiliation(s)
- Ning Li
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China; Department of Stomatology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Liting Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China; Department of Stomatology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Hua Jin
- Instrumental Analysis Center, School of Chemistry and Chemical Engineering, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yan Wu
- Instrumental Analysis Center, School of Chemistry and Chemical Engineering, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yongjia Liu
- Instrumental Analysis Center, School of Chemistry and Chemical Engineering, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wei Huang
- Instrumental Analysis Center, School of Chemistry and Chemical Engineering, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Li Wei
- Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 200025, Shanghai, China
| | - Qi Zhou
- Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 200025, Shanghai, China
| | - Feng Chen
- Department of Orthopaedics, Shanghai Fengxian Central Hospital, South Campus of Shanghai Sixth People's Hospital, Shanghai Jiaotong University, 201499, Shanghai, China
| | - Yiming Gao
- Department of Stomatology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Bangshang Zhu
- Instrumental Analysis Center, School of Chemistry and Chemical Engineering, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Xiuyin Zhang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China.
| |
Collapse
|
22
|
Bai YL, Zheng TJ, Zhang ZW, Gan Y, Huang J. [Efficacy of minocycline hydrochloride combined with flap surgery for chronic periodontitis: a Meta-analysis]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:421-427. [PMID: 30182571 DOI: 10.7518/hxkq.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of 2% minocycline hydrochloride combined with flap surgery in the treatment of chronic periodontitis. The superiority of this therapy to simple flap surgery was also explored. METHODS We searched the databases of CNKI, VIP, Wanfang, Chinese Biomedical Literature, PubMed, ScienceDirect, and Embase from inception to July 2017. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of seven randomized controlled trials involving 217 patients were included. Meta-analysis showed that, in two groups, the changes in probing depth (PD) [MD=-0.55, 95%CI (-0.84, -0.26), P=0.000 2] and plaque index [MD=-0.08, 95%CI (-0.15, -0.01), P=0.03] at 3 and 6 months of PD [MD=-0.62, 95%CI (-1.04, -0.21), P=0.003] had statistically significant difference (P<0.05). The clinical attachment loss (CAL) [MD=-0.21, 95%CI (-0.47, 0.04), P=0.10] had no statistically significant difference after 3 months (P>0.05), but the improvement in CAL was significantly improved by minocycline hydrochloride combined with flap therapy. CONCLUSIONS Periodontal flap combined with minocycline adjuvant therapy for chronic periodontitis is effective in short-term observations.
Collapse
Affiliation(s)
- Yuan-Liang Bai
- Dept. of Periodontics, Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing 400015, China;Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400015, China
| | - Tai-Jing Zheng
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400015, China;Dept. of Stomatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhi-Wei Zhang
- Dept. of Periodontics, Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing 400015, China;Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400015, China
| | - Yi Gan
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400015, China;Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400015, China
| | - Jiao Huang
- Dept. of Periodontics, Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing 400015, China;Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400015, China
| |
Collapse
|
23
|
Manresa C, Sanz‐Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev 2018; 1:CD009376. [PMID: 29291254 PMCID: PMC6491071 DOI: 10.1002/14651858.cd009376.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs). OBJECTIVES To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria. MAIN RESULTS We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution. AUTHORS' CONCLUSIONS Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.
Collapse
Affiliation(s)
- Carolina Manresa
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
| | - Elena C Sanz‐Miralles
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
- Columbia UniversityDivision of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental MedicineNew YorkNYUSA
| | - Joshua Twigg
- Cardiff UniversitySchool of DentistryDepartment of Oral and Biomedical SciencesHeath ParkCardiffUKCF14 4XY
| | - Manuel Bravo
- Dental School, University of GranadaPreventive DentistryCampus de la Cartuja s/nGranadaSpain08071
| | | |
Collapse
|