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Nutrients Feb 2022(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in... (Meta-Analysis)
Meta-Analysis Review
The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis.
(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in response to periodontopathogens and may lead to the destruction of tooth-supporting structures, tooth loss, and systemic health problems. This systematic review and meta-analysis evaluated the effects of probiotic supplementation on the prevention and treatment of periodontal disease based on the assessment of clinical, microbiological, and immunological outcomes. (2) Methods: This study was registered under PROSPERO (CRD42021249120). Six databases were searched: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Dentistry and Oral Science Source. The meta-analysis assessed the effects of probiotic supplementation on the prevention and treatment of periodontal diseases and reported them using Hedge's g standardized mean difference (SMD). (3) Results: Of the 1883 articles initially identified, 64 randomized clinical trials were included in this study. The results of this meta-analysis indicated statistically significant improvements after probiotic supplementation in the majority of the clinical outcomes in periodontal disease patients, including the plaque index (SMD = 0.557, 95% CI: 0.228, 0.885), gingival index, SMD = 0.920, 95% CI: 0.426, 1.414), probing pocket depth (SMD = 0.578, 95% CI: 0.365, 0.790), clinical attachment level (SMD = 0.413, 95% CI: 0.262, 0.563), bleeding on probing (SMD = 0.841, 95% CI: 0.479, 1.20), gingival crevicular fluid volume (SMD = 0.568, 95% CI: 0.235, 0.902), reduction in the subgingival periodontopathogen count of (SMD = 0.402, 95% CI: 0.120, 0.685), (SMD = 0.392, 95% CI: 0.127, 0.658), and (SMD = 0.341, 95% CI: 0.050, 0.633), and immunological markers MMP-8 (SMD = 0.819, 95% CI: 0.417, 1.221) and IL-6 (SMD = 0.361, 95% CI: 0.079, 0.644). (4) Conclusions: The results of this study suggest that probiotic supplementation improves clinical parameters, and reduces the periodontopathogen load and pro-inflammatory markers in periodontal disease patients. However, we were unable to assess the preventive role of probiotic supplementation due to the paucity of studies. Further clinical studies are needed to determine the efficacy of probiotic supplementation in the prevention of periodontal diseases.
Topics: Biomarkers; Dietary Supplements; Humans; Inflammation; Periodontal Diseases; Probiotics; Randomized Controlled Trials as Topic
PubMed: 35268009
DOI: 10.3390/nu14051036 -
Frontiers in Bioengineering and... 2023This systematic review with meta-analysis evaluated the antioxidant effect of lycopene as an adjuvant treatment for periodontal disease. PubMed, EMBASE and Web of...
This systematic review with meta-analysis evaluated the antioxidant effect of lycopene as an adjuvant treatment for periodontal disease. PubMed, EMBASE and Web of Science databases were consulted. According to the PICOs strategy, inclusion criteria were established for intervention studies Randomized Controlled Trials in Probing depth subjects (participants) treated with conventional treatment and lycopene (intervention) compared to patients treated with conventional treatment (control) in which periodontal response to treatment (outcome) was assessed. The risk of bias for randomized studies was assessed using the Cochrane Risk of Bias Tool. The methodological quality of the studies included in the meta-analysis was measured using the Jadad scale. Quantitative data were analyzed using six random-effects meta-analyses, taking into account periodontal parameters: Probing Pocket Depth, Clinical Attachment Loss, Bleeding on Probing, Plaque Index, Uric Acid and Gingival Index. Six further meta-analyses were performed, according to the follow-up of the studies (short-, medium- and long-term). Of the 339 studies identified, only 7 met the eligibility criteria. The meta-analysis of the studies according to the parameters evaluated only obtained statistical significance in the assessment of plaque index ( = 0.003). Regarding follow-up periods, PPD was significant ( = 0.03) in the short term. bleeding on probing estimates were significant in the short and medium term ( = 0.008 and = 0.03, respectively), IP was significant in the short and medium term ( = 0.0003 and = 0.01, respectively) and gingival index in the short and medium term ( = 0.002 and = 0.02, respectively). Heterogeneity was high (I >50%) in all assessments, except for Clinical Attachment Loss (I = 16.7%). The results demonstrate that antioxidant treatment with lycopene could be useful as an adjunctive treatment for periodontal disease.
PubMed: 38344076
DOI: 10.3389/fbioe.2023.1309851 -
Antioxidants (Basel, Switzerland) Feb 2021In recent times, the use of natural products has gained momentum, either as a treatment or as adjuvants for other drugs in the treatment of different conditions.... (Review)
Review
In recent times, the use of natural products has gained momentum, either as a treatment or as adjuvants for other drugs in the treatment of different conditions. Propolis is a natural substance produced by bees which has proven useful for treating periodontal disease. This systematic review and meta-analysis gather evidence of the effectiveness of propolis in this kind of condition. The MEDLINE, CENTRAL, PubMed, EMBASE and Web of Science databases were searched for scientific articles to identify the findings published up to October 2020. The MeSH phrases used in the search were: "periodontal diseases AND propolis treatment"; "gingivitis AND propolis treatment"; "periodontitis AND propolis treatment"; "propolis treatment AND oral health"; "propolis AND oxidative stress AND periodontitis". The Boolean operator "AND" was used to combine the searches. Randomized trials where propolis was used in the treatment of different periodontal conditions were included. Non-randomized clinical studies were systematically reviewed and 224 studies were detected, eight of which met the criteria for inclusion in the meta-analysis. Only three of these were selected for quantitative synthesis. In conclusion, propolis is safe to use and can improve the results of periodontal disease treatment, reducing probing pocket depth compared with treatment with a placebo (difference in means, fixed effects -0.67 [95% CI: -0.84, -0.50]).
PubMed: 33578659
DOI: 10.3390/antiox10020269 -
International Journal of Environmental... Oct 2022The need to predict, diagnose and treat peri-implant diseases has never been greater. We present a systematic review of the literature on the changes in the expression... (Review)
Review
The need to predict, diagnose and treat peri-implant diseases has never been greater. We present a systematic review of the literature on the changes in the expression of biomarkers in peri-implant crevicular fluid (PICF) before and after treatment of peri-implantitis. Bacterial composition, clinical and radiographic parameters, and systemic biomarkers before and after treatment are reported as secondary outcomes. A total of 17 studies were included. Treatment groups were non-surgical treatment or surgical treatment, either alone or with adjunctive therapy. Our findings show that non-surgical treatment alone does not influence biomarker levels or clinical outcomes. Both adjunctive photodynamic therapy and local minocycline application resulted in a reduction of interleukin (IL)-1β and IL-10 twelve months after treatment. Non-surgical treatments with adjunctive use of lasers or antimicrobials were more effective at improving the clinical outcomes in the short-term only. Access flap debridement led to matrix metalloproteinase (MMP)-8 and tumour necrosis factor-α reduction twelve months post-surgery. Surgical debridement with adjunctive antimicrobials achieved a decrease in MMP-8 at three months. Adjunctive use of Emdogain (EMD) was associated with a reduction in 40 PICF proteins compared to access flap surgery alone. Surgical interventions were more effective at reducing probing pocket depth and bleeding on probing both in the short- and long-term. Surgical treatment in combination with EMD was found to be more effective in resolving inflammation up to twelve months.
Topics: Humans; Peri-Implantitis; Minocycline; Biomarkers; Debridement; Anti-Infective Agents
PubMed: 36360962
DOI: 10.3390/ijerph192114085 -
Evidence-based Complementary and... 2022The aim of this systematic review and meta-analysis was to assess the efficacy and safety of traditional Chinese medicine based on the method of "nourishing kidney and... (Review)
Review
Efficacy and Safety of Traditional Chinese Medicine Based on the Method of "Nourishing Kidney and Clearing Heat" as Adjuvant in the Treatment of Diabetes Mellitus Patients with Periodontitis: A Systematic Review and Meta-Analysis.
OBJECTIVE
The aim of this systematic review and meta-analysis was to assess the efficacy and safety of traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" as an adjuvant in the treatment of diabetes mellitus patients with periodontitis.
METHODS
An electronic literature search was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Scientific Journals Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, EMBASE, Web of Science, and Cochrane Library databases for articles published until October 2021. The primary outcomes were probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PLI), and sulcular bleeding index (SBI), while the secondary outcomes were tooth mobility (TM), glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total effective rate, and adverse effects.
RESULTS
Eleven randomized controlled trials (RCT) were included in the meta-analysis. The pooled results showed PPD (WMD = 1.07, 95%CI: (0.82, 1.33), < 0.00001, = 89%), CAL (WMD = 0.78, 95%CI: (0.62, 0.93), < 0.00001, = 58%), PLI (WMD = 0.44, 95%CI: (0.09, 0.79), =0.01, I = 97%), SBI (WMD = 0.87, 95%CI: (0.79, 0.95), < 0.00001, = 37%), TM (WMD = 0.26, 95%CI: (0.21, 0.30), < 0.00001, = 31%), HbA1c (WMD = 0.48, 95%CI: (0.28, 0.67), < 0.00001, I = 26%), FBG (WMD = 1.34, 95%CI: (0.96, 1.72), < 0.00001, = 52%), total effective rate (RR = 1.24, 95%CI: (1.14, 1.34), < 0.00001, = 0%), and adverse effects (RR = 0.78, 95%CI: (0.20, 3.03), =0.72, = 0%) in the traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" + routine western medicine treatment (periodontal basic treatment, PBT, with or without antibiotic) group were significantly improved compared to control group, but no significant difference was observed for PLI at 2-3 months and 6 months.
CONCLUSIONS
This review supports traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" as an adjuvant to routine western medicine treatment in the management of diabetes mellitus patients with periodontitis. Within the limits of the evidence, the well-designed, long-term efficacy, and high-quality multicenter RCTs need to be further confirmed.
PubMed: 36065270
DOI: 10.1155/2022/3853303 -
BMC Oral Health Jun 2023The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis.
MATERIALS AND METHODS
The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction.
RESULTS
Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction.
CONCLUSIONS
Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.
Topics: Humans; Anti-Bacterial Agents; Dental Care; Dental Implants; Peri-Implantitis; Treatment Outcome
PubMed: 37296382
DOI: 10.1186/s12903-023-03058-z -
The Japanese Dental Science Review Dec 2023Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as... (Review)
Review
Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of - 0.72% and - 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of - 0.67 and - 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (-0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by - 0.56 and - 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect.
PubMed: 38152384
DOI: 10.1016/j.jdsr.2023.06.001 -
International Journal of Environmental... Apr 2022This meta-analysis aimed to compare Marfan syndrome (MFS) patients with non-MFS populations based on orofacial health status to combine publicly available scientific... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis aimed to compare Marfan syndrome (MFS) patients with non-MFS populations based on orofacial health status to combine publicly available scientific information while also improving the validity of primary study findings. A comprehensive search was performed in the following databases: PubMed, Google Scholar, Scopus, Medline, and Web of Science, for articles published between 1 January 2000 and 17 February 2022. PRISMA guidelines were followed to carry out this systematic review. We used the PECO system to classify people with MFS based on whether or not they had distinctive oral health characteristics compared to the non-MFS population. The following are some examples of how PECO is used: P denotes someone who has MFS; E stands for a medical or genetic assessment of MFS; C stands for people who do not have MFS; and O stands for the orofacial characteristics of MFS. Using the Newcastle-Ottawa Quality Assessment Scale, independent reviewers assessed the articles' methodological quality and extracted data. Four case-control studies were analyzed for meta-analysis. Due to the wide range of variability, we were only able to include data from at least three previous studies. There was a statistically significant difference in bleeding on probing and pocket depth between MFS and non-MFS subjects. MFS patients are more prone to periodontal tissue inflammation due to the activity of FBN1 and MMPs. Early orthodontic treatment is beneficial for the correction of a narrow upper jaw and a high palate, as well as a skeletal class II with retrognathism of the lower jaw and crowding of teeth.
Topics: Case-Control Studies; Cleft Palate; Humans; Marfan Syndrome; Oral Health
PubMed: 35564443
DOI: 10.3390/ijerph19095048 -
Clinical Oral Investigations Jan 2023This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during... (Review)
Review
OBJECTIVE
This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST).
MATERIALS AND METHODS
A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken.
RESULTS
Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction.
CONCLUSIONS
Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis.
CLINICAL RELEVANCE
Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.
Topics: Humans; Dental Scaling; Periodontitis; Treatment Outcome; Ultrasonic Therapy; Ultrasonics; Root Planing
PubMed: 36565370
DOI: 10.1007/s00784-022-04759-5 -
Journal of Oral Biology and... 2021Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in... (Review)
Review
BACKGROUND
Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown.
OBJECTIVES
This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP).
METHODOLOGY
This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure.
RESULTS
Thirteen studies were included. It was showed MD of 1.52 mm (95%CI: 0.97-2.07) and 1.44 mm (95%CI: 1.08-1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: -0.17-2.91) and PPD (MD: 1.35; 95%CI: -0.13-2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94-5.74). MD for systemically administered BP was 0.40 mm (95%CI: 0.21-0.60), 0.51 mm (95%CI: 0.19-0.83) and 1.05 (95%CI: 0.80-1.31) for PPD, CAL and RADIO, respectively.
CONCLUSION
The administration of BP in adjunct to SRP may result in additional clinical effects.
PubMed: 33537188
DOI: 10.1016/j.jobcr.2021.01.008