Kotsakis Georgios A, Javed Fawad, Hinrichs James E, Karoussis Ioannis K, Romanos Georgios E
Division of Periodontology, University of Minnesota, Minneapolis, MN.
J Periodontol. 2015 Feb;86(2):254-63. doi: 10.1902/jop.2014.140452. Epub 2014 Oct 9.
Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non-smokers. The aim of the present systematic review and meta-analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures.
A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta-analyses were done separately for changes in the two primary outcomes of PD and CAL.
The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non-smokers versus smokers. The reduction in PD in smokers and non-smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non-smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta-analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies).
Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non-smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non-smokers.
牙周翻瓣手术常用于清除龈下沉积物，从而使牙龈炎症和探诊深度（PD）相应降低，临床附着水平（CAL）增加，以治疗重度牙周疾病。然而，临床研究报告称，与不吸烟者相比，吸烟者的牙周愈合情况较差。本系统评价和荟萃分析的目的是评估吸烟对牙周翻瓣手术后临床疗效的影响。
采用预先定义的优化检索策略，对1977年至2014年3月期间与吸烟者牙周翻瓣手术相关的文章进行系统的电子检索。对PD和CAL这两个主要结局的变化分别进行荟萃分析。
初步检索得到390个标题和摘要。筛选后，最终选取了8项对照临床研究。3项研究被评估为偏倚风险低，2项为中度偏倚风险，3项为高度偏倚风险。对这些文章的定性评估一致显示，与吸烟者相比，不吸烟者的治疗效果更好。吸烟者和不吸烟者的PD降低范围分别为0.76至2.05毫米和1.27至2.40毫米。对于CAL，不吸烟者与吸烟者的增加范围分别为0.29至1.6毫米和0.09至1.2毫米。对8项涉及363名研究参与者的研究进行的荟萃分析表明，平均（95%置信区间）PD降低增加了0.39（0.33至0.45）毫米。CAL的平均增加也有类似结果（0.35[0.30至0.40]毫米，n = 4项研究）。
考虑到现有信息相对同质，作者得出结论，吸烟者可能是牙周翻瓣手术的候选对象。然而，与不吸烟者相比，吸烟者的治疗效果会受到影响。因此，应鼓励吸烟者：1）戒烟；2）术前充分告知其与不吸烟者相比临床疗效会大幅降低。
