A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation.
A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation.
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DOI：
10.1002/jper.17-0368
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发表时间：
2018-05
影响因子：
4.3
通讯作者：
Chu H
中科院分区：
文献类型：
--
作者：
Kotsakis GA;Lian Q;Ioannou AL;Michalowicz BS;John MT;Chu H
消费者可以选择多种牙间口腔卫生（IOH）辅助工具。然而，由于缺乏现有研究的直接比较，对选择的建议受到限制。我们的目的是利用贝叶斯网络荟萃分析（BNMA）评估IOH辅助治疗的比较疗效。基于一个重点问题，两名独立审稿人对评估IOH辅助工具的随机临床试验进行了系统的文献综述。牙龈炎症（牙龈指数（GI）、探牙出血（BOP））是主要结局，菌斑和探牙深度是次要结局。后验中位数和95%可信区间（ci）总结了参数的边际分布。两阶段的选择过程确定了22项试验，评估了10种IOH辅助剂作为刷牙辅助剂。牙间刷（IB）作为刷牙辅助工具，GI降低幅度最大（0.23 [95% CI: 0.09, 0.37]），其次是水枪（WJ） （0.19 [95% CI: 0.14, 0.24]）。基于后验概率的排名显示，IB和WJ在降低GI方面具有最高的“最佳”概率（分别为64.7%和27.4%），而牙签和牙线作为“最佳”IOH辅助工具的概率接近于零。值得注意的是，除了牙签，所有IOH辅助剂在降低GI方面都比对照组好。BNMA使我们能够定量评估IOH助剂，并提供其疗效的全球排名。牙间刷和水射流在减少牙龈出血方面排名靠前，牙签和牙线排名最后。由于牙龈炎症测量是牙周健康的物理指标，因此患者认为IOH辅助治疗的益处尚不清楚。
A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta-Analysis (BNMA). Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding-on-probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random-effects arm-based BNMA model was run for each outcome; posterior medians and 95% credible-intervals (CIs) summarized marginal distributions of parameters. A two-phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water-jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being “best” (64.7% and 27.4%, respectively) for GI reduction, while the probability for toothpick and floss being the “best” IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared to control. BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water-jets ranked high for reducing gingival bleeding, while toothpicks and floss ranked last. The patient-perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.