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Clinical Oral Investigations Sep 2021The present study aimed to systematically assess current evidence on effects of locally delivered antibiotics during periodontal surgery compared to periodontal surgery... (Meta-Analysis)
Meta-Analysis Review
AIM
The present study aimed to systematically assess current evidence on effects of locally delivered antibiotics during periodontal surgery compared to periodontal surgery alone on clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, recession depth (RD) changes, gingival index (GI), bleeding on probing (BOP), and plaque index (PI).
METHODOLOGY
MEDLINE-PubMed, Cochrane-CENTRAL and Scopus databases were searched up to April 2021 for randomized clinical trials (RCT), evaluating effects of locally delivered antibiotics during periodontal surgery. CAL gain served as primary, while PPD reduction, RD changes, GI and PI as secondary outcomes. The Cochrane Risk of Bias Tool was used to assess possible bias. Data were extracted, and meta-analysis was performed where appropriate.
RESULT
Screening of 2314 papers resulted in nine eligible studies. No adverse events were reported. Data on outcome variables were pooled and analyzed using generic inverse variance model and presented as weighted mean difference (WMD) and 95% confidence interval (95% CI). Statistically significant improvements in favor of antibiotics' delivery were observed in studies with follow-up of ≤6 months for CAL gain (WMD = 0.61 mm (95% CI [0.07, 1.14]; p = 0.03), PPD reduction (WMD = 0.41 mm (95% CI [0.02, 0.80]; p = 0.04)) and BOP (WMD = -28.47% (95% CI [-33.00, -23.94]); p < 0.001), while for GI improvements were notable for >6 to 12 months (WMD = -0.27 (95% CI [-0.49, -0.06]; p = 0.01)).
CONCLUSION
Within the current review's limitations, locally delivered antibiotics during surgical periodontal therapy results in post-surgical improvements for CAL, PPD, and BOP (≤6 months) with a longer-lasting GI improvement. Further randomized controlled trials are needed with true periodontal end-points to assess the ideal antibiotic agent, dosage, and delivery methods.
CLINICAL RELEVANCE
Local delivery of antibiotics during periodontal surgery improved clinical parameters for up to 6-month follow-up, with beneficial longer effects on gingival inflammation. Within the current study's limitation, the presented evidence could support the elective usage of locally delivered antibiotics during surgical periodontal therapy.
Topics: Anti-Bacterial Agents; Dental Care; Dental Scaling; Humans; Oral Surgical Procedures; Periodontal Index
PubMed: 34283285
DOI: 10.1007/s00784-021-04056-7 -
Evidence-based Dentistry Jun 2023Systematic review and meta-analysis of clinical trials, and prospective or retrospective cohort. The protocol of the study was registered in advance on PROSPERO. (Meta-Analysis)
Meta-Analysis
DESIGN
Systematic review and meta-analysis of clinical trials, and prospective or retrospective cohort. The protocol of the study was registered in advance on PROSPERO.
DATA SOURCES
An electronic search in MEDLINE (PubMed), Web of Science, Scopus, and The Cochrane Library was conducted by two independent authors up to September 2022. Additionally, OpenGrey and www.greylit.org were searched for gray literature, whereas ClinicalTrials.gov was searched for detecting any relevant unpublished data.
STUDY SELECTION
The review question was defined in PICOS format as follows: population (P), patients undergoing orthodontic therapy; intervention (I), orthodontic therapy with clear aligner (CA); comparison (C), orthodontic therapy with fixed appliances (FA); outcome (O), periodontal health status and development of gingival recession; studies (S), randomized clinical trials (RCTs), controlled clinical trials, and retrospective or prospective cohort studies. Cross-sectional studies, case series, case reports, studies without a control group, and studies with less than 2 months follow-up were excluded.
DATA ANALYSIS
Periodontal health status was assessed as a primary outcome and it was measured in terms of pocket probing depth (PPD), gingival index (GI), plaque index (PI) and bleeding on probing (BoP). Gingival recession (GR) was assessed as secondary outcome, and was measured as the development or progression of GR, shown by the apical migration of the gingival margin occurring between pre- and post-orthodontic treatment. Each periodontal index was assessed in three-time points; short-term (2-3 months from baseline), mid-term (6-9 months from baseline), and long-term (12 months or more from baseline). A descriptive analysis of included articles was performed. Pairwise meta-analyses were conducted to compare outcomes assessed in FA and CA groups and were only performed when studies reported similar periodontal indices at similar follow-ups.
RESULTS
12 studies (3 RCTs, 8 prospective cohort studies, 1 retrospective cohort study) were included in the qualitative synthesis, of which, 8 studies were included in the quantitative synthesis (meta-analysis). A total of 612 patients (321 treated with buccal FA and 291 with CA) were assessed. Results from meta-analyses favored CA in regards to PI, demonstrating a significant difference in the mid-term follow-up (number of studies = 4, standardized mean difference [SMD] = -0.99, 95% confidence interval [CI] = -1.94 to -0.03, I = 99%, P = 0.04). There was a tendency to report better GI values with CA, specifically in long-term (number of studies = 2, SMD = -0.46 [95% CI, -1.03 to 0.11], I = 96%, P = 0.11). However, no statistical significance between the two treatment modalities was shown for any follow-up intervals (P > 0.05). As for PPD, the long-term follow-up showed statistical significance favoring CA (SMD = -0.93 [95% CI, -1.06 to 0.7], P < 0.0001), whereas short- and mid-term follow-ups did not show significant differences between FA and CA. Overall, patients treated with CA showed better values of BoP and less GR when compared to patients treated with FA.
CONCLUSIONS
Available evidence is still not enough to conclude the superiority of clear aligner therapy in terms of periodontal status during orthodontic treatment compared to fixed appliances.
Topics: Humans; Dental Care; Gingival Recession; Orthodontic Appliances, Fixed; Orthodontic Appliances, Removable
PubMed: 37188919
DOI: 10.1038/s41432-023-00890-8 -
Journal of Dental Research, Dental... 2021It is critical to understand laser-microtextured implant collars' influence on peri-implant pocket depths and marginal bone levels, especially in crucial areas. The... (Review)
Review
It is critical to understand laser-microtextured implant collars' influence on peri-implant pocket depths and marginal bone levels, especially in crucial areas. The present review investigated the peri-implant marginal bone loss (MBL) and pocket depths and failure rates of dental implants with laser-microtextured collars. An electronic search was run in the PubMed and Embase databases until September 15, 2019. Randomized and prospective clinical studies comparing peri-implant MBL and pocket depths and failure rates between implants with laser-microtextured and machined collar surfaces were included. Five studies (two cohort studies and three RCTs) were included in the meta-analysis after the inclusion and exclusion criteria and qualitative assessments were applied. The risk ratio of osseointegrated implant failure and mean differences in peri-implant MBL and pocket depths were calculated using the Comprehensive Meta-Analysis (CMA) software. Implants with laser-microtextured collars exhibited significantly better marginal bone level scores ( < 0.001; MD: 0.54; 95% CI: 0.489‒0.592) and a significant reduction in peri-implant probing depths than implants with machined collars ( < 0.001; MD: 1.01; 95% CI: 0.90‒1.13). The assessed studies showed that 17 out of 516 implants failed (3.29%), comprising nine implants with machined (3.62%) and eight implants with laser-microtextured collars (2.98%). However, no significant differences were detected in the implant neck surface characterization ( = 0.695; RR: 1.205; 95% CI: 0.472‒3.076). This study suggests that laser-microtexturing of implant collar significantly affected the peri-implant MBL and probing depths. Although no significant differences were noted in implant failure rates between implants with laser-microtextured and machined collar surfaces, the peri-implant MBL and probing depths with laser-microtextured collars were significantly lower than the machined collars.
PubMed: 35070185
DOI: 10.34172/joddd.2021.048 -
Clinical Oral Investigations Jun 2022To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy).
MATERIALS AND METHODS
A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change.
RESULTS
Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% - 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% - 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I = 79% and 87%, respectively).
CONCLUSIONS
Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD.
CLINICAL RELEVANCE
The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone.
Topics: Dental Care; Dental Scaling; Humans; Randomized Controlled Trials as Topic
PubMed: 35389113
DOI: 10.1007/s00784-022-04474-1 -
The Journal of Contemporary Dental... Mar 2022The main purpose of the present study was to investigate the potential benefit of local use of hyaluronic acid as an adjunct to periodontal therapy, since commercial...
AIM
The main purpose of the present study was to investigate the potential benefit of local use of hyaluronic acid as an adjunct to periodontal therapy, since commercial products of hyaluronic acid (HA), due to its anti-inflammatory and anti-bacterial actions and its significant role in wound repair, have been proposed as adjuncts to either nonsurgical or surgical periodontal therapy.
MATERIALS AND METHODS
A total of 19 electronic databases were searched and the appropriate studies were identified with the use of specific eligibility criteria, according to PRISMA guidelines. Two reviewers independently screened and selected the studies and made the data extraction and the assessment of risk of bias, by using the Cochrane risk of bias tool.
RESULTS
Out of 3,186 papers, 38 randomized clinical trials (8 related to gingivitis therapy, 20 related to nonsurgical periodontal therapy, and 10 related to surgical periodontal therapy) were finally included in the review. The outcomes were categorized as primary (that answered the focus question) and secondary (regarding additional quality characteristics). The adjunct use of HA combined to all treatment modalities shows improvement of patients' postoperative course, in terms of decreased inflammatory reactions, and changes in periodontal pocket depth and clinical attachment level. No side effects were reported in any of the included studies. Among the secondary outcomes were the variety of HA formulations and chemical forms, the variety in application, follow-up protocol and blinding design, the uneven geographic distribution of the studies, and the low bibliometric characteristics of most studies.
CONCLUSION
Overall and despite the positive effects reported, further research is needed to define the ideal HA compound, formulation, and regimen characteristics for periodontal disease treatment.
CLINICAL SIGNIFICANCE
The adjunct use of HA may lead in the reduction of the prescription of nonsteroid anti-inflammatory drugs and achieve improved clinical parameters, including periodontal probing depth, periodontal inflammation, and clinical attachment level.
Topics: Dental Care; Dental Scaling; Humans; Hyaluronic Acid; Inflammation; Periodontal Diseases; Periodontal Pocket
PubMed: 35781443
DOI: No ID Found -
Clinical Implant Dentistry and Related... Apr 2022Nonsurgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonsurgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment approaches, in the initial nonsurgical treatment phase, particularly the airflow, are still not clear. The aim of this systematic review and meta-analyses was to evaluate the outcomes of nonsurgical treatment of peri-implantitis using airflow method in terms of changes in periodontal parameters, peri-implant marginal bone level, postoperative pain/discomfort, and patient satisfaction.
METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared airflow with mechanical debridement using ultrasonic/curettes. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.
RESULTS
A total of 316 studies were identified, of which, five RCTs with 288 dental implants in 174 participants were included. Overall meta-analysis showed more reduction in probing pocket depths at 1-3 months (mean difference [MD] -0.23; 95% confidence interval [CI] -0.50-0.05; p = 0.10) and 6 months (MD -0.04; 95% CI -0.34 to 0.27; p = 0.80) in favor of airflow, but the difference was not statistically significant. The use of airflow was associated with significant reduction in bleeding on probing and increase in peri-implant mucosal recession. The differences in plaque score, peri-implant marginal bone level changes, and patient reported outcomes between airflow and mechanical debridement were not statistically significant.
CONCLUSIONS
The short-term clinical and radiographic outcomes following nonsurgical treatment of peri-implantitis using airflow or mechanical debridement were comparable. The airflow has short-term positive effects on reducing bleeding on probing. Further evidence from RCTs are still required to substantiate the current findings.
Topics: Dental Implants; Humans; Peri-Implantitis
PubMed: 35156296
DOI: 10.1111/cid.13072 -
Dementia and Geriatric Cognitive... 2024The connection between periodontitis and mild cognitive impairment (MCI) continues to receive attention. However, whether periodontitis is a risk factor for MCI remains... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The connection between periodontitis and mild cognitive impairment (MCI) continues to receive attention. However, whether periodontitis is a risk factor for MCI remains still uncertain. This study aims to systematically analyze the available literature regarding the relationship between periodontitis and the risk of developing MCI and whether the periodontal health of MCI patients is poorer.
METHODS
A literature search of PubMed, Scopus, Embase, and Web of Science databases was conducted to include all studies on the relationship between periodontitis and MCI from inception to April 2023. The studies were independently screened by 2 researchers, and those meeting the inclusion criteria were extracted and cross-checked. Pooled odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI) was calculated using either a fixed-effects or random-effects model.
RESULTS
Seven studies with a total of 3,973 participants were included. Meta-analysis results showed a statistically significant higher incidence of MCI in patients with periodontitis (OR, 1.70 (95% CI: 1.24-2.32, p < 0.001) compared to healthy participants. A subgroup meta-analysis showed that the pooled OR for the risk of MCI in patients with severe periodontitis was 2.09 (95% CI: 1.49-2.92, p < 0.001). In addition, attachment loss (MD = 0.44, 95% CI: 0.12-0.75, p < 0.001) and plaque index (MD = 0.72, 95% CI: 0.50-0.93, p < 0.001) were higher in MCI patients compared with the control group, but the pocket probing depth (MD = 0.21, 95% CI: -0.08 to 0.49, p = 0.15) was not significantly different between the two groups.
CONCLUSIONS
Patients with periodontitis are at a higher risk of developing MCI, and the periodontal health of MCI patients is generally compromised. However, further well-designed studies should be conducted to confirm this relationship between MCI and periodontitis.
Topics: Humans; Periodontitis; Cognitive Dysfunction
PubMed: 38151010
DOI: 10.1159/000535776 -
Journal of Oral Biology and... 2023This study aimed to conduct a systematic evaluation of the literature on whether individuals exposed to alcohol intake present differences in the subgingival microbial... (Review)
Review
OBJECTIVES
This study aimed to conduct a systematic evaluation of the literature on whether individuals exposed to alcohol intake present differences in the subgingival microbial composition compared to those unexposed.
METHODS
Five databases (MEDLINE, EMBASE, LILACS, SCOPUS and Web of Science) and one source of grey literature (Google Scholar) were searched by two independent reviewers up to December 2022 according to pre-specified eligibility criteria. No restrictions were imposed regarding the date and language of publication and the periodontal status of the participants. The Newcastle-Ottawa Scale was used for methodological quality appraisal and a narrative synthesis was performed.
RESULTS
Eight cross-sectional studies and one cross-sectional analysis nested in a cohort were considered for qualitative analysis, including data of 4636 individuals. Overall, the studies exhibited considerable heterogeneity in terms of characteristics of the participants and microbiological methods. Four studies have high methodological quality. Exposed individuals have higher overall quantity of periodontal pathogens in shallow and moderate to deep pockets. Findings on richness, relative abundance, alpha- and beta-diversity were limited and inconclusive.
CONCLUSION
The subgingival microbiota of individuals exposed to alcohol intake has higher overall quantity of red (i.e., ) and orange-complex (i.e., ) bacteria when compared to those unexposed.
PubMed: 36866164
DOI: 10.1016/j.jobcr.2023.02.002 -
Journal of the International Academy of... Oct 2020To systemically review the literature on the effect of hand and sonic/ultrasonic instruments used for the non-surgical treatment of periodontitis. (Meta-Analysis)
Meta-Analysis
AIMS
To systemically review the literature on the effect of hand and sonic/ultrasonic instruments used for the non-surgical treatment of periodontitis.
MATERIALS AND METHODS
Five databases were searched for randomized clinical trials that compared the results of periodontal treatment using hand and sonic/ultrasonic for nonsurgical periodontal treatment. Four meta-analyses were performed, using the calculated mean differences (MD) between baseline and 3-months or 6-months after periodontal treatment for clinical attachment level (CAL), and probing pocket depth (PPD).
RESULTS
Eighteen studies were included. All included studies showed significant improvement, in at least one periodontal parameter, in both tested periodontal therapies. The sonic/ultrasonic instruments spend significantly less time in comparison to manual instrumentation. At both 3- and 6-months after periodontal therapy, no statistically significant differences were detected for CAL gain between therapies (MD; 95%CI: 0.05; -0.21-0.30 and -0.23; -0.59-0.12). Similarly, no statistically significant differences were detected for PPD reduction between therapies at 3-months of follow-up (MD; 95%CI: -0.03; -0.34-0.28). After 6-months, the PPD reduction was 0.21 (95%CI: -0.43-0.00, p=0.05).
CONCLUSION
Similar results may be expected for the periodontal treatment performed with hand and sonic/ultrasonic instruments. However, further studies with lower risk of bias are warranted.
Topics: Dental Scaling; Hand; Humans; Periodontitis; Root Planing; Ultrasonics
PubMed: 32980832
DOI: No ID Found -
Clinical Oral Investigations Mar 2021To systematically review the literature to compare the efficacy of air polishing to hand or ultrasonic instrumentation to reduce periodontal inflammation during... (Review)
Review
AIM
To systematically review the literature to compare the efficacy of air polishing to hand or ultrasonic instrumentation to reduce periodontal inflammation during treatment of residual pockets or supportive periodontal care.
METHODS
Electronic searches were performed in five different databases, and two databases were used to capture the "grey literature partially." Clinical trials that compared the use of an air-polishing device to either conventional scaling and root planing (hand and/or ultrasonic instrumentation) or no treatment during periodontal therapy were included without restriction of year and publication status. The Joanna Briggs Institute instrument for clinical trials was used to appraise the studies critically. The results were submitted to qualitative descriptive analysis. The systematic review protocol was registered in PROSPERO (CRD420220156176).
RESULTS
Electronic searches found 1100 hits published between 2008 and 2019. Thirteen studies were included in the review, out of which four had a follow-up longer than 180 days. Results indicated no differences between the efficacy of air polishing and hand or ultrasonic instruments to reduce periodontal inflammation.
CONCLUSIONS
Our findings suggest that there is no difference in the efficacy of air polishing and hand or ultrasonic instrumentation to control biofilm and reduce periodontal inflammation. However, these findings must be carefully interpreted owing to methodological issues, including a short follow-up, and a potential conflict of interest related to industry funding.
CLINICAL RELEVANCE
Air polishing for biofilm control may be used as an alternative to hand and ultrasonic instrumentation to reduce periodontal inflammation during treatment of residual pockets or supportive periodontal care.
Topics: Biofilms; Dental Polishing; Dental Scaling; Glycine; Humans; Periodontal Pocket; Root Planing
PubMed: 33464417
DOI: 10.1007/s00784-020-03762-y