Rovai Emanuel S, Souto Maria Luisa S, Ganhito Juliana A, Holzhausen Marinella, Chambrone Leandro, Pannuti Claudio M
Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil.
Unit of Basic Oral Investigation, El Bosque University, Bogota, Colombia.
J Periodontol. 2016 Dec;87(12):1406-1417. doi: 10.1902/jop.2016.160214. Epub 2016 Jul 29.
Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM).
Only randomized controlled trials with: 1) at least 6 months of follow-up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment.
Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well-controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain.
In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well-controlled individuals and deep sites.
糖尿病患者对牙周治疗的反应较差。局部抗菌药物作为龈下刮治和根面平整（SRP）的辅助手段，在健康患者的牙周炎治疗中可带来额外益处。本综述旨在评估局部抗菌药物作为SRP辅助手段（与单纯SRP相比），对慢性牙周炎（CP）和糖尿病（DM）患者牙周临床参数的影响。
仅纳入符合以下条件的随机对照试验：1）至少6个月的随访；2）SRP联合局部抗菌药物；3）牙周炎和DM患者。检索MEDLINE、EMBASE和LILACS数据库，查找截至2016年1月发表的文章。对治疗后的临床附着水平（CAL）、探诊深度（PD）、探诊出血和牙龈指数变化进行随机效应荟萃分析。
在153篇可能与本综述相关的论文中，纳入了6篇。大多数试验表明，1型和2型DM患者使用局部抗菌药物与PD显著降低和CAL增加相关。只有纳入控制良好的患者且在最深部位或基线PD≥5mm的部位应用抗菌药物的研究，才出现显著的PD降低和CAL增加。
在DM和CP患者中，与单纯SRP相比，使用局部抗菌药物作为SRP的辅助手段在降低PD和增加CAL方面可能带来额外益处，尤其是在控制良好的个体和深部部位。
