Dhingra Kunaal, Jeng Jiiang-Huei
Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
College of Dental Medicine, Kaohsiung Medical University, & Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Evid Based Dent. 2023 Mar;24(1):12-14. doi: 10.1038/s41432-023-00863-x. Epub 2023 Mar 8.
The electronic databases Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, LILACS BIREME Virtual Health Library from inception to September 2021, along with trial registers and journals (hand searching) were searched to identify the randomized controlled trials (RCTs).
Two reviewers independently identified and selected RCTs of at least three months' duration, comparing the effectiveness of subgingival instrumentation relative to no active intervention or usual care (oral hygiene instruction, education, or supportive interventions, and/or supragingival scaling) in the reduction of glycated haemoglobin (HbA1c) in periodontitis patients with type 1 or 2 diabetes mellitus.
Data extraction and risk of bias assessment were performed by two reviewers independently. Data were synthesized quantitatively with meta-analyses using a random-effects model, and pooled outcomes were expressed as mean differences with 95% confidence intervals. In addition, subgroup analysis, heterogeneity assessment, sensitivity analyses, summary of findings, and assessment of the certainty of the evidence were performed.
Out of 3109 identified records, 35 RCTs were included for qualitative synthesis, and amongst them, 33 studies were included for meta-analysis. Meta-analyses showed that periodontal treatment with subgingival instrumentation, compared to usual care or no treatment, led to a mean absolute reduction of 0.43% in HbA1c at 3 to 4 months, 0.30% at six months, and 0.50% at 12 months. The certainty of the evidence was assessed to be moderate.
The authors concluded that periodontitis treatment by subgingival instrumentation improves glycaemic control in diabetic patients. However, there is insufficient evidence about the effect of periodontal treatment on quality of life or diabetic complications.
检索了电子数据库Cochrane口腔健康试验注册库、Cochrane对照试验中央注册库、MEDLINE Ovid、Embase Ovid、CINAHL EBSCO、LILACS BIREME虚拟健康图书馆（从建库至2021年9月），以及试验注册库和期刊（手工检索），以识别随机对照试验（RCT）。
两名 reviewers 独立识别并选择了持续时间至少为三个月的RCT，比较了龈下器械治疗相对于无积极干预或常规护理（口腔卫生指导、教育或支持性干预，和/或龈上洁治）在降低1型或2型糖尿病牙周炎患者糖化血红蛋白（HbA1c）方面的有效性。
由两名 reviewers 独立进行数据提取和偏倚风险评估。使用随机效应模型通过荟萃分析对数据进行定量合成，汇总结果以95%置信区间的平均差异表示。此外，还进行了亚组分析、异质性评估、敏感性分析、结果总结以及证据确定性评估。
在3109条识别出的记录中，35项RCT纳入定性合成，其中33项研究纳入荟萃分析。荟萃分析表明，与常规护理或不治疗相比，龈下器械治疗的牙周治疗在3至4个月时使HbA1c平均绝对降低0.43%，在6个月时降低0.30%，在12个月时降低0.50%。证据确定性评估为中等。
作者得出结论，龈下器械治疗牙周炎可改善糖尿病患者的血糖控制。然而，关于牙周治疗对生活质量或糖尿病并发症影响的证据不足。
