Bonito Arthur J, Lux Linda, Lohr Kathleen N
Program on Health Care Organization, Delivery and Access, Health, Social, and Economic Research, Research Triangle Institute International, Research Triangle Park, NC 27709-2194, USA.
J Periodontol. 2005 Aug;76(8):1227-36. doi: 10.1902/jop.2005.76.8.1227.
Chronic periodontitis affects many adults in the United States, some severely enough to threaten tooth loss. Of particular clinical importance is whether scaling and root planing (SRP) accompanied by a local adjunctive therapeutic agent improves outcomes over time compared to SRP alone. The adjunctive therapeutic agents investigated include: tetracycline, minocycline, metronidazole, a group of other antibiotics, chlorhexidine, and a group of antimicrobials. Primary outcomes considered are reductions in probing depth (PD) and gains in clinical attachment level (CAL).
RTI-UNC Evidence-Based Practice Center staff searched MEDLINE (1966 through December 2002) and EMBASE (through February 2002) to identify clinical trials published in English that 1) involved adults with chronic periodontitis but no serious comorbidities; 2) tested one or more chemical antimicrobial agents as an adjunct to SRP alone or with a placebo; 3) had a concurrent control group that received the same SRP as the treatment group; 4) reported outcomes for specified, fixed time periods; and 5) if multiple antimicrobials were tested, reported outcomes for each agent separately. We performed qualitative analyses and meta-analyses of PD and CAL effect sizes when the necessary data were available from at least three studies at 6-month follow-up.
Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels. Differences between treatment and SRP-only groups in the baseline-to-follow-up period typically favored treatment groups but usually only modestly (e.g., from about 0.1 mm to nearly 0.5 mm) even when the differences were statistically significant. Effects for CAL gains were smaller and statistical significance less common. The marginal improvements in PD and CAL were a fraction of the improvement from SRP alone.
Whether such improvements, even if statistically significant, are clinically meaningful remains a question. A substantial agenda of future research to address this and other issues (e.g., costs, patient-oriented outcomes) is suggested.
在美国，慢性牙周炎影响着许多成年人，其中一些病情严重到足以威胁牙齿脱落。特别具有临床重要性的是，与单纯的龈下刮治和根面平整术（SRP）相比，伴有局部辅助治疗剂的龈下刮治和根面平整术随着时间的推移是否能改善治疗效果。所研究的辅助治疗剂包括：四环素、米诺环素、甲硝唑、一组其他抗生素、氯己定和一组抗菌剂。所考虑的主要结果是探诊深度（PD）的降低和临床附着水平（CAL）的增加。
RTI-UNC循证实践中心的工作人员检索了MEDLINE（1966年至2002年12月）和EMBASE（至2002年2月），以确定用英文发表的临床试验，这些试验1）涉及患有慢性牙周炎但无严重合并症的成年人；2）测试一种或多种化学抗菌剂作为单独SRP或与安慰剂联合使用的辅助剂；3）有一个与治疗组接受相同SRP的同期对照组；4）报告特定固定时间段的结果；5）如果测试了多种抗菌剂，则分别报告每种药剂的结果。当在6个月随访时至少有三项研究可获得必要数据时，我们对PD和CAL效应大小进行了定性分析和荟萃分析。
在局部应用的辅助抗菌剂中，四环素、米诺环素、甲硝唑和氯己定的结果最为积极。辅助局部治疗通常会降低PD水平。在基线至随访期间，治疗组与单纯SRP组之间的差异通常有利于治疗组，但即使差异具有统计学意义，通常也只是适度的（例如，从约0.1毫米到近0.5毫米）。CAL增加的效果较小，统计学意义也不太常见。PD和CAL的边际改善只是单纯SRP改善的一小部分。
即使这些改善具有统计学意义，它们在临床上是否有意义仍是一个问题。建议制定一个庞大的未来研究议程来解决这个问题和其他问题（例如，成本、以患者为导向的结果）。
