A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients
A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients
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DOI：
10.1034/j.1600-051x.29.s3.8.x
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发表时间：
2002-01-01
影响因子：
6.7
通讯作者：
Roldán, S
中科院分区：
文献类型：
--
作者：
Herrera, D;Sanz, M;Roldán, S
背景：洁治和根面平整是牙周炎非手术治疗的基础。目的：本系统综述的目的是评价在慢性牙周炎或侵袭性牙周炎(CP)或侵袭性牙周炎(AGP)的治疗中，与单纯使用SRP相比，联合应用系统抗菌药物(SRP)的有效性。检索策略：使用计算机数据库，即MEDLINE、Cochrane口腔健康组专业试验登记和EMBASE；手工检索相关文章的参考列表；手工检索至2001年4月。选择标准：如果研究设计为对照临床试验，系统健康的AGP或CP患者接受SRP加全身抗菌药治疗，与SRP单独治疗或安慰剂治疗相比较，至少6个月。主要观察指标为临床依恋水平(CAL)变化和探测袋深度(PPD)变化。资料收集和分析：两位评价者独立提取有关质量和研究特征的信息，一式两份。Kappa的分数决定了他们的同意。收集主要结果，并按药物、疾病和PPD类别进行分组。结果：初步筛选出158篇文献，手工检索和电子检索共鉴定出158篇文献，25篇文献符合纳入标准。他们的质量评估显示，随机化和分配隐藏方法很少报道，盲性通常没有明确的定义。总体而言，选定的研究表明变异性很大，缺乏适当评估所需的相关信息。总体而言，SRP加全身抗菌剂组在CAL和PPD改变方面显示出比单独SRP组或安慰剂组更好的结果。由于汇集研究的困难和缺乏适当的数据，只能进行有限的荟萃分析。这项分析显示，螺旋霉素(PPD变化)和阿莫西林/甲硝唑(CAL变化)在统计学上具有显著的额外益处。结论：在牙周炎的治疗中，全身抗菌药与SRP联合使用，可以在CAL和PPD变化方面提供比单独SRP更多的好处，并降低额外CAL丢失的风险。然而，研究方法的差异和数据的缺乏妨碍了充分和完整地汇集数据以进行更全面的分析。很难得出明确的结论，尽管财力雄厚、进展性或“活动性”疾病或特定微生物特征的患者可以从这种辅助治疗中受益更多。
Background: Scaling and root planing (SRP) are the bases of non-surgical therapy in the treatment of periodontitis. However, results from this therapy are often unpredictable and dependable from many different factors.Objectives: The aim of this systematic review was to evaluate the effectiveness of the adjunctive use of systemic antimicrobials with scaling and root planing (SRP) vs. SRP alone in the treatment of chronic (CP) or aggressive periodontitis (AgP).Search strategy: Use of computerized databases, namely MEDLINE, the Cochrane Oral Health Group Specialty Trials Register and EMBASE; reference lists from relevant articles were hand-searched; and a hand-search of selected journals until April 2001.Selection criteria: Studies were selected if they were designed as controlled clinical trials in which systemically healthy patients with either AgP or CP were treated with SRP plus systemic antimicrobials in comparison with SRP alone or with placebo, for a minimum of 6 months. Main outcome measures were clinical attachment level (CAL) change and probing pocket depth (PPD) change.Data collection and analysis: Two reviewers extracted independently information regarding quality and study characteristics, in duplicate. Kappa scores determined their agreement. Main results were collected and grouped by drug, disease and PPD category. For the quantitative data synthesis, the data was pooled (when mean differences and standard errors were available), and either a Fixed Effects or Random Effects meta-analysis was used for the analysis.Results: After an initial selection, 158 papers were identified by the manual and electronic searches; 25 papers were eligible for inclusion. Their quality assessment showed that randomization and allocation concealment methods were seldom reported and blindness was usually not defined clearly. In general, selected studies showed high variability and lack of relevant information for an adequate assessment. Overall, SRP plus systemic antimicrobial groups demonstrated better results in CAL and PPD change than SRP alone or with placebo groups. Only limited meta-analyses could be performed, due to the difficulties in pooling the studies and the lack of appropriate data. This analysis showed a statistically significant additional benefit for spiramycin (PPD change) and amoxicillin/metronidazole (CAL change) in deep pockets.Conclusion: Systemic antimicrobials in conjunction with SRP, can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of CAL and PPD change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or 'active' disease, or specific microbiological profile, can benefit more from this adjunctive therapy.