Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China.
J Periodontal Res. 2017 Feb;52(1):8-20. doi: 10.1111/jre.12361. Epub 2016 Mar 2.
BACKGROUND AND OBJECTIVES: Although low-level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its effectiveness as an adjunct to non-surgical periodontal treatment. This study aimed to evaluate whether an additional benefit exists for the application of LLLT compared with scaling and root planing (SRP) alone. MATERIAL AND METHODS: An extensive search was conducted in the Cochrane Library (Issue 8, 2015), PubMed (1997) and EMBASE (1947) before August 2015 for randomized controlled trials (RCTs). The bias risk was assessed with the Cochrane tool for risk of bias evaluation. A meta-analysis was performed using REVMAN 5.3. RESULTS: After independent screening of 354 initial records, eight publications (seven RCTs) were included. However, six were rated as 'having a high risk of bias' as a result of major methodological weakness in 'allocation concealment' and 'blinding of key personnel'. Meta-analysis showed that LLLT-mediated SRP demonstrated significant short-term benefits over SRP monotherapy in the improvement of the probing pocket depth (p = 0.0009 at 1 mo; p = 0.03 at 2 mo) and the level of interleukin-1β in the gingival crevicular fluid (p = 0.01 at 1 mo). Nevertheless, LLLT failed to show significant additional intermediate-term (3 and 6 mo) effects in terms of clinical parameters and alveolar bone density. CONCLUSION: These findings indicated that LLLT showed only short-term additional benefits after conventional SRP. Its long-term effects remain unclear due to substantial methodological weaknesses and an insufficient number of current studies. Future RCTs with better designs and longer follow-up periods are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.
背景与目的:虽然低水平激光疗法(LLLT)已被证明对牙周组织具有生物调节作用,但尚无专门针对其作为非手术牙周治疗辅助手段的有效性的系统评价。本研究旨在评估与单独进行牙周刮治和根面平整术(SRP)相比,应用 LLLT 是否具有额外的益处。
材料与方法:在 2015 年 8 月之前,我们在 Cochrane 图书馆(第 8 期,2015 年)、PubMed(1997 年)和 EMBASE(1947 年)中进行了广泛的检索,以查找随机对照试验(RCTs)。使用 Cochrane 偏倚风险评估工具评估偏倚风险。使用 REVMAN 5.3 进行荟萃分析。
结果:经过对 354 篇初始记录的独立筛选,有 8 篇文献(7 篇 RCTs)被纳入。然而,由于在“分配隐藏”和“关键人员设盲”方面存在主要的方法学缺陷,其中 6 篇被评为“具有高偏倚风险”。荟萃分析表明,与单独进行 SRP 相比,LLLT 介导的 SRP 在改善探诊袋深度(1 个月时 p = 0.0009;2 个月时 p = 0.03)和龈沟液中白细胞介素-1β水平(1 个月时 p = 0.01)方面具有显著的短期益处。然而,LLLT 在临床参数和牙槽骨密度方面未能显示出显著的中期(3 个月和 6 个月)附加效应。
结论:这些发现表明,LLLT 在常规 SRP 后仅显示出短期的附加益处。由于存在大量的方法学缺陷和当前研究数量不足,其长期效果尚不清楚。需要进行设计更好且随访时间更长的 RCT 来评估 LLLT 作为牙周病患者辅助治疗策略的有效性。
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