Leavy P G, Robertson D P
Department of Restorative Dentistry, Charles Clifford Dental Hospital, Sheffield, UK.
Department of Restorative Dentistry, Glasgow Dental School, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Int J Dent Hyg. 2018 Feb;16(1):68-77. doi: 10.1111/idh.12288. Epub 2017 May 22.
To review the evidence for the efficacy of periodontal maintenance (PM) carried out in primary dental care (PDC) compared to the specialist setting for patients previously treated in a specialist setting for chronic (ChP) or aggressive (AgP) periodontitis.
A focused PICO question and search protocol were developed. Online databases including MEDLINE, EMBASE, WEB OF SCIENCE™ and COCHRANE LIBRARY were searched along with specialist journals in the subject area of periodontal research. Selection criteria included studies that investigated delivery of PM in both specialist and PDC settings for patients with ChP or AgP over a minimum 12 months. We looked for studies that reported changes in clinical attachment levels (CAL), tooth loss, pocket probing depths (PPDs) and bleeding on probing (BoP) as outcome measures.
Eight cohort studies were chosen for inclusion. There was considerable heterogeneity found between the eight studies, which did not allow for quantitative (meta) analysis and statistical testing of differences between groups. Clinical attachment levels remained relatively stable in patients who received specialist PM with mean changes of -0.42 mm to +0.2 mm, while for those enrolled in PDC-based PM for periods >12 months, mean CAL losses were between -0.13 mm and -2.80 mm. PPD reduction for those subjects receiving specialist PM was between 0.05 and 1.8 mm for five studies but two cohorts experienced increases of 0.32 and 0.80 mm, respectively. Increases of up to 2.90 mm (range: -0.1 to +2.90) and a higher proportion of deeper pockets were noted among PDC PM cohorts. Higher rates of BoP among those in receipt of PDC PM were reported in half of all studies. There were insufficient long-term data to make any firm conclusions about the effect of the delivery of PM on tooth loss.
Within the limitations of the data available, it appears that specialist PM is effective in sustaining periodontal stability following active specialist intervention. There is limited evidence that PDC provides the same level of care; however, the limited comparative data available suggest that outcomes could be slightly worse in PDC.
回顾在初级牙科保健（PDC）中进行牙周维护（PM）与在专科环境中对先前在专科环境中接受过慢性（ChP）或侵袭性（AgP）牙周炎治疗的患者进行牙周维护的疗效证据。
制定了一个聚焦的PICO问题和检索方案。检索了包括MEDLINE、EMBASE、科学网™和考克兰图书馆在内的在线数据库以及牙周研究领域的专业期刊。选择标准包括调查在专科和PDC环境中对ChP或AgP患者进行至少12个月的PM治疗的研究。我们寻找报告临床附着水平（CAL）、牙齿脱落、探诊深度（PPD）和探诊出血（BoP）变化作为结局指标的研究。
八项队列研究被纳入。八项研究之间存在相当大的异质性，这使得无法进行定量（荟萃）分析和组间差异的统计检验。接受专科PM治疗的患者临床附着水平相对稳定，平均变化为-0.42毫米至+0.2毫米，而对于参加基于PDC的PM治疗超过12个月的患者，平均CAL丧失在-0.13毫米至-2.80毫米之间。五项研究中，接受专科PM治疗的患者PPD减少在0.05至1.8毫米之间，但两个队列分别增加了0.32和0.80毫米。在基于PDC的PM队列中，PPD增加高达2.90毫米（范围：-0.1至+2.90），且较深牙周袋的比例更高。在所有研究的一半中，报告接受基于PDC的PM治疗的患者BoP发生率更高。没有足够的长期数据来就PM治疗对牙齿脱落的影响得出任何确凿结论。
在现有数据的局限性内，专科PM似乎在专科积极干预后维持牙周稳定性方面是有效的。仅有有限的证据表明PDC能提供相同水平的护理；然而，现有的有限比较数据表明，在PDC中结局可能会稍差一些。
