Department of Periodontology, Oral Medicine and Oral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department of Periodontology, Health Science Center, University of Washington, Seattle, Washington, USA.
J Clin Periodontol. 2022 Jun;49 Suppl 24:149-166. doi: 10.1111/jcpe.13563. Epub 2021 Dec 1.
To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction.
The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up.
From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies.
Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear.
评估牙夹板固定（TS）和咬合调整（OA）与不进行 TS 或 OA 相比，对患有咀嚼功能障碍的牙周炎患者的疗效。
主要结局标准是牙齿缺失（TL），次要结局参数是探诊袋深度（PPD）、临床附着水平（CAL）、牙齿松动度（TM）和患者报告的结果测量（PROMs）的变化。在三个电子数据库中进行了文献检索（1965 年 1 月至 2021 年 4 月），重点是至少有 12 个月随访的临床研究。
从总共 1515 篇出版物中，确定了 51 篇全文阅读的文章，其中包括 2 项关于 TS 的回顾性病例系列研究，其偏倚风险较低，1 项关于 OA 的随机对照研究和 2 项前瞻性研究，其偏倚风险不明确。对于 TS，数据综合表明，在 72 名患者中，311 颗牙齿中有 26 颗（TS 组 TL 加权平均发生率为 8.4%）和 1541 颗牙齿中没有 TS 的牙齿中有 156 颗（非手术牙周治疗后 2 年 TL 加权平均发生率为 10.1%）。随机对照临床试验（RCT）表明，OA 组的 CAL 增加与非 OA 组相比。对于 OA 对 TL、PPD 和 TM 的影响，从纳入的研究中检索到了异质数据。
在本综述的限制内，并基于低水平的证据，得出结论，TS 并不能提高晚期牙周炎患者活动牙齿的存活率。对有活动性和/或过早接触的牙齿进行 OA 可能会导致 CAL 改善，而 OA 对其余牙周参数的影响尚不清楚。
