Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis A systematic review
Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis A systematic review
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DOI：
10.1016/j.adaj.2014.12.015
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发表时间：
2015-03-01
影响因子：
3.9
通讯作者：
Loomer, Peter M.
中科院分区：
文献类型：
--
作者：
Canas, Pablo Garcia;Khouly, Ismael;Loomer, Peter M.
背景资料。联合使用全身抗生素和根面刮治(SRP)可能会改善临床结果，甚至对于牙周炎的成功治疗是必不可少的。然而，这种联合治疗的有效性和临床安全性仍不清楚。这项研究的作者回顾了与这一假说相关的现有文献，评估了SRP与SRP联合使用与单独使用SRP治疗慢性牙周炎(CP)或侵袭性牙周炎(AGP)的有效性。作者使用3个电子数据库，手工检索2001年4月至2013年10月在选定期刊上发表的文章。作者选择了至少6个月随访的临床试验，在此期间，CP或AGP患者接受了全身抗生素加SRP治疗，与单独使用SRP或使用安慰剂进行比较。作者分析了临床依恋水平(CAL)、探诊袋深度(PPD)、探诊时出血(BOP)的减少以及患者相关变量(即不良反应)。在选择过程后，作者在这篇综述中纳入了23项临床试验。对研究质量的评估显示，偏见的风险是一个常见的发现。总体而言，在使用全身抗生素作为SRP辅助治疗的研究中，测量结果、CAL、PPD和BOP有改善的趋势。由于本综述中纳入的研究具有高度的异质性，作者不能就辅助全身抗生素的使用建立明确的结论和指南。然而，在本综述的限制范围内，在SRP中使用全身抗生素对特定人群可能是有益的。标准化的临床疾病诊断标准和额外的随机对照临床试验是必要的，以验证使用具有SRP实际意义的辅助全身抗菌药的有效性。由于评估SRP辅助的全身抗生素的临床试验的方法学差异和偏差，临床医生应该根据权衡每个患者的益处和风险的结果来决定开药。
Background. The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP).Methods. The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects).Results. After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP.Conclusion. Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP.Practical Implications. Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient.