Keestra J A J, Grosjean I, Coucke W, Quirynen M, Teughels W
Department of Oral Health Sciences, Periodontology, KU Leuven & University of Leuven, Leuven, Belgium.
Department of Periodontology, University Hospitals Leuven, Leuven, Belgium.
J Periodontal Res. 2015 Dec;50(6):689-706. doi: 10.1111/jre.12252. Epub 2014 Dec 18.
The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) compared to SRP alone in patients with untreated aggressive periodontitis.
In patients with aggressive periodontitis, SRP is often combined with the use of systemic antibiotics. However, the effectiveness of these antibiotics over time and differences in effectiveness between different antibiotics are hardly known.
The MEDLINE-PubMed database was searched from their earliest records until January 20, 2014. Several journals were hand searched and some authors were contacted for additional information. The following outcome measures were analysed: mean probing pocket depth reduction, mean clinical attachment level gain and mean bleeding on probing change. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed.
The search yielded 296 abstracts. Ultimately, 101 articles were selected of which 14 articles met the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (0.36 ± 0.22 mm at 3 mo, 6 mo 0.42 ± 0.22 mm and 12 mo 0.88 ± 0.27 mm) and deep pockets (0.74 ± 0.36 mm at 3 mo, 6 mo 0.85 ± 0.55 mm and 12 mo 1.26 ± 0.81 mm) and a significant clinical attachment gain for moderate (0.26 ± 0.18 at 3 mo, 6 mo 0.52 ± 0.15 and 12 mo 0.83 ± 0.38) and deep pockets (0.59 ± 0.18 at 3 mo, 0.96 ± 0.21 at 6 mo and 1.00 ± 0.80 at 12 mo).
For the treatment of patients with aggressive periodontitis, systemic antibiotics combined with non-surgical periodontal therapy resulted in a significant additional effect compared to non-surgical therapy alone. There is a visible trend that showed metronidazole + amoxicillin is the most potent antibiotic combination.
本荟萃分析的目的是评估在未经治疗的侵袭性牙周炎患者中，与单纯龈下刮治及根面平整术（SRP）相比，不同全身用抗生素联合SRP的有效性。
在侵袭性牙周炎患者中，SRP常与全身用抗生素联合使用。然而，这些抗生素随时间的有效性以及不同抗生素之间有效性的差异尚不清楚。
检索MEDLINE-PubMed数据库，从其最早记录至2014年1月20日。手工检索了几本期刊，并联系了一些作者以获取更多信息。分析了以下结局指标：平均探诊深度减少、平均临床附着水平增加和平均探诊出血变化。使用随机效应模型汇总提取的数据。计算加权平均差异并评估异质性。
检索得到296篇摘要。最终，选择了101篇文章，其中14篇文章符合纳入标准。全身用抗生素在中度牙周袋（3个月时为0.36±0.22mm，6个月时为0.42±0.22mm，12个月时为0.88±0.27mm）和深度牙周袋（3个月时为0.74±0.36mm，6个月时为0.85±0.55mm，12个月时为1.26±0.81mm）的深度减少方面显示出显著（p<0.05）的额外效果，在中度牙周袋（3个月时为0.26±0.18，6个月时为0.52±0.15，12个月时为0.83±0.38）和深度牙周袋（3个月时为0.59±0.18，6个月时为0.96±0.21，12个月时为1.00±0.80）的临床附着增加方面也显示出显著效果。
对于侵袭性牙周炎患者的治疗，与单纯非手术牙周治疗相比，全身用抗生素联合非手术牙周治疗产生了显著的额外效果。有明显趋势表明甲硝唑+阿莫西林是最有效的抗生素组合。
