Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
J Periodontal Res. 2023 Apr;58(2):308-324. doi: 10.1111/jre.13092. Epub 2023 Jan 4.
The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome.
Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear.
A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022).
From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months.
This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual's microbiome affects treatment outcomes after periodontal surgery.
本系统评价和荟萃分析的目的是评估牙周手术对龈下微生物组的影响。
牙周炎是由龈下生物膜的微生态失调引起的牙齿支持组织的慢性炎症。它通过不同的非手术和手术治疗方式进行管理。最近的 EFP S3 指南建议在牙周炎治疗的第 1 步和第 2 步之后,作为第 3 步牙周炎治疗的一部分进行牙周手术,目的是实现持续部位的袋关闭。龈下微生物组的变化可以解释在不同时间点观察到的治疗结果。随着时间的推移,已经开发出各种用于疾病相关病原体的微生物学检测技术,并在文献中进行了描述。然而,不同类型的牙周手术对龈下微生物组的影响仍不清楚。
在 Medline、Embase、LILACS 和 Cochrane 图书馆中进行了系统的文献检索,并辅以手动搜索(2019 年 12 月 23 日,更新于 2022 年 4 月 21 日)。
从最初的 3046 项研究中,根据我们的具体纳入标准,有 28 项研究被纳入。七种微生物学检测技术用于分析龈下菌斑样本中的疾病相关物种:光学显微镜、培养、聚合酶链反应(PCR)、 checkerboard、酶反应、免疫荧光和 16S 基因测序。纳入的研究在其方法的各个方面存在差异,例如龈下菌斑样本采集或治疗方式。临床数据显示,牙周手术后,探测袋深度(PPD)和临床附着丧失(CAL)显著下降。微生物学研究结果总体上存在异质性。对所有使用 checkerboard 作为微生物学检测技术的研究进行了亚组荟萃分析。随机效应模型显示,牙周手术后 3 个月,牙密螺旋体(T. denticola)、牙龈卟啉单胞菌(P. gingivalis)和福赛斯坦纳菌(T. forsythia)的平均计数没有显著影响。值得注意的是,放线共生放线杆菌(A. actinomycetemcomitans)在牙周手术后 3 个月时显著增加。一项纳入的研究使用了 16S 基因测序,报告说牙周手术后 3 个月和 6 个月,与疾病相关的物种减少,与健康相关的物种增加。
本系统评价表明,牙周手术对龈下微生物组变化的影响是异质的,并不总是与疾病相关物种的减少相关。这种可变性可能归因于用于分析的微生物学技术。因此,需要进行精心设计和充分有力的研究,以了解牙周手术如何影响龈下微生物组,以及个体的微生物组如何影响牙周手术后的治疗结果。