Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Conservative and Prosthetic Dentistry, Faculty of Dentistry, Complutense University of Madrid (UCM), Madrid, Spain.
J Clin Periodontol. 2023 Jun;50 Suppl 26:336-358. doi: 10.1111/jcpe.13794. Epub 2023 Mar 12.
To answer the following PICOS question: "In adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6 months of follow-up?"
Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603.
Six RCTs-two with moderate, three with high, and one with low risk of bias (RoB)-were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD = 1.44; 95%CI (0.40 to -2.48)] and MBL [MD = 1.21; 95%CI (0.44-1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD = 7.41%; 95%CI (0.81-14.00); p = 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed.
Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline).
回答以下 PICOS 问题：“在患有种植体周围炎的成年患者中，与单独手术或安慰剂去污的手术相比，手术联合化学表面去污对种植体表面的疗效如何，在随机对照临床试验（RCT）和非 RCT 中，至少有 6 个月的随访时间，在探测袋深度（PD）减少、探测出血（BoP）/探测溢脓（SoP）方面有何差异？”
从建立到 2022 年 5 月 20 日，对六个数据库进行了检索。汇总了临床结局变量的数据，并使用均值差（MDs）、风险比（RRs）或风险差（RDs）进行分析，适当情况下使用 95%置信区间（CIs）和预测区间（PIs），在存在显著异质性的情况下。主要结局为 PD 和 BoP/SoP 的变化。次要结局为放射学边缘骨丧失（MBL）、种植体丧失和疾病缓解。PROSPERO 注册号：CRD42022325603。
纳入了 6 项 RCT（其中 2 项为中度、3 项为高度、1 项为低偏倚风险（RoB））。这些研究测试了光动力疗法（PDT）、洗必泰（CHX）和手术期间局部抗生素（LAbs）的辅助作用对临床结果的影响。在一项为期 12 个月的单一研究中，局部抗生素的辅助使用显示出 PD 的临床相关降低[MD=1.44；95%CI（0.40 至-2.48）]和 MBL[MD=1.21；95%CI（0.44-1.98）；一项试验，32 名参与者]。PDT 显示 BoP 有较小但显著的降低[MD=7.41%；95%CI（0.81-14.00）；p=0.028；两项试验；42 名参与者]。与安慰剂（生理盐水）相比，CHX 处理对 PD、BoP 或 MBL 无显著影响。所有干预措施均未影响疾病缓解和种植体丧失。所有评估的结局指标的证据确定性均非常低。
在本系统评价和荟萃分析的限制范围内，手术时联合使用化学物质（如 PDT、CHX 和 LAbs）进行表面去污，不能被推荐为优于标准清创术（机械清创术，有或没有生理盐水）。
