Kolakovic Mirela, Held Ulrike, Schmidlin Patrick R, Sahrmann Philipp
Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
Horten Center, University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
BMC Oral Health. 2014 Dec 22;14:159. doi: 10.1186/1472-6831-14-159.
Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown. However, means and standard deviations of enhanced reductions are difficult to translate into clinical relevant treatment outcomes such as pocket resolution or avoidance of additional surgical interventions. Accordingly, the aim of this systematic review was to calculate odds ratios for relevant cut-off values of PD after mechanical periodontal treatment with and without antibiotics, specifically the combination of amoxicilline and metronidazol, from published studies. As clinical relevant cut-off values "pocket closure" for PD ≤ 3mm and "avoidance of surgical intervention" for PD ≤ 5 mm were determined.
The databases PubMed, Embase and Central were searched for randomized clinical studies assessing the beneficial effect of the combination of amoxicillin and metronidazole after non-surgical mechanical debridement. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. From published means and standard deviations for PD after therapy, odds ratios for the clinically relevant cut-off values were calculated using a specific statistical approach.
Meta-analyses were performed for the time points 3 and 6 month after mechanical therapy. Generally, a pronounced chance for pocket closure from 3 to 6 months of healing was shown. The administration of antibiotics resulted in a 3.55 and 4.43 fold higher probability of pocket closure after 3 and 6 months as compared to mechanical therapy alone. However, as the estimated risk for residual pockets > 5 mm was 0 for both groups, no odds ratio could be calculated for persistent needs for surgery. Generally, studies showed a moderate to high quality and large heterogeneity regarding treatment protocol, dose of antibiotic medication and maintenance.
With the performed statistical approach, a clear benefit in terms of an enhanced chance for pocket closure by co-administration of the combination of amoxicillin and metronidazole as an adjunct to non-surgical mechanical periodontal therapy has been shown. However, data calculation failed to show a benefit regarding the possible avoidance of surgical interventions.
已表明在传统根面清创术后辅助使用抗生素在增强牙周袋深度（PD）减少方面具有相关益处。然而，增强减少的均值和标准差难以转化为临床相关的治疗结果，如牙周袋消退或避免额外的手术干预。因此，本系统评价的目的是从已发表的研究中计算在机械性牙周治疗中使用和不使用抗生素（特别是阿莫西林和甲硝唑联合使用）后PD相关临界值的比值比。确定了作为临床相关临界值的PD≤3mm的“牙周袋闭合”和PD≤5mm的“避免手术干预”。
检索PubMed、Embase和Central数据库，查找评估阿莫西林和甲硝唑联合使用在非手术机械清创术后有益效果的随机临床研究。两名独立研究者仔细审查标题、摘要以及最终的全文，以确定是否可能纳入。评估研究的质量和异质性，并检查研究设计。使用特定的统计方法从已发表的治疗后PD均值和标准差计算临床相关临界值的比值比。
对机械治疗后3个月和6个月的时间点进行了荟萃分析。总体而言，显示出从愈合3个月到6个月牙周袋闭合的显著可能性。与单纯机械治疗相比，使用抗生素在3个月和6个月后牙周袋闭合的概率分别高出3.55倍和4.43倍。然而，由于两组中残留牙周袋>5mm的估计风险均为0，因此无法计算持续手术需求的比值比。总体而言，研究在治疗方案、抗生素药物剂量和维持方面显示出中等至高的质量和较大的异质性。
通过所采用的统计方法，已表明作为非手术机械性牙周治疗的辅助手段，联合使用阿莫西林和甲硝唑在增强牙周袋闭合机会方面具有明显益处。然而，数据计算未能显示在可能避免手术干预方面的益处。
