de Oliveira Domitilla Marchiori Sant'Anna Leal, de Souza Ana Luiza Magalhães, da Rocha Nogueira Filho Getulio, Martins-Pfeifer Carolina Castro, Stefani Cristine Miron
School of Dentistry, University of Brasilia, Brasilia, Brazil.
Private Practice, Dunedin, New Zealand.
Curr Diabetes Rev. 2025;21(7):86-102. doi: 10.2174/0115733998320667240805045742.
This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D).
Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included.
In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64 mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty).
The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.
本网络荟萃分析（NMA）研究了在2型糖尿病（T2D）患者的血糖控制和牙周袋深度（PPD）降低方面，龈下给药抗菌剂辅助非手术牙周治疗（NSPT）的疗效。
检索了截至2024年2月的七个数据库、灰色文献和注册平台，以识别符合纳入标准的随机临床试验（RCT）。通过Cochrane工具（RoB 2）评估偏倚风险。使用随机效应模型进行了两项频率学派NMA，以计算平均差（MD）作为效应量，并定量评估糖化血红蛋白（HbA1c）和PPD。通过GRADE方法在部分情境化的结果解释框架中评估证据的确定性。纳入了10项RCT。
共有261例患者接受了八种不同的局部抗菌剂辅助NSPT治疗（阿奇霉素凝胶、克拉霉素凝胶、四环素纤维或软膏、氯己定凝胶、强力霉素纳米球、米诺环素凝胶和塞曲硝唑凝胶），而249例患者仅接受NSPT或联合安慰剂治疗。考虑PPD降低情况（纳入8项研究），塞曲硝唑凝胶在6个月后效果最佳（MD -2.64 mm；95%CI -3.56，-1.72；中等证据确定性）。对于HbA1c控制（纳入7项研究），强力霉素凝胶（MD -0.80%；95%CI -1.70，0.10）、氯己定凝胶（MD -0.68%；95%CI -1.34，-0.02）和四环素纤维（MD -0.62%；95%CI -0.85，-0.39）在3个月后显示出有前景的结果（低证据确定性）。
塞曲硝唑凝胶辅助使用可能在6个月随访后降低PPD，而强力霉素凝胶、氯己定凝胶和四环素纤维在3个月随访后可能降低接受NSPT治疗的T2D和牙周炎患者的HbA1c值。
