Botelho João, Lyra Patrícia, Nascimento Gustavo G, Leite Fábio R M, Mendes José João, Machado Vanessa
Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal.
National Dental Research Institute Singapore, National Dental Centre Singapore, Queenstown, Singapore.
Front Cell Infect Microbiol. 2025 Jun 4;15:1601464. doi: 10.3389/fcimb.2025.1601464. eCollection 2025.
Antimicrobial stewardship envisions the appropriate use of antimicrobials, including antibiotics. Antibiotic therapy in Periodontology has been widely investigated over the years. This umbrella review aimed to appraise the methodological quality and meta-analytical strength and validity of the evidence of systematic reviews (SRs) on systemic and local antibiotics in periodontal therapy.
After registration of the protocol (PROSPERO CRD42024527222), an extensive search, up to March 2024, for SRs that have assessed the effect of antibiotics in periodontal therapy, either nonsurgical and surgical, regardless of the types of patients and type of antibiotic. The methodological quality of SRs was judged using A MeaSurement Tool to Assess systematic Reviews 2. Fail-safe number of Rosenberg explored the number of nonsignificant, unpublished, or missing studies that would be required to change the direction of that evidence.
Forty-four SRs, consisting of 221 meta-analyses, were included. The overall methodological quality was low, with only four and two SRs of high or moderate quality, respectively. Out of 221 meta-analyses, 69 indicated that the effect of systemic or local antibiotics was statistically not significant. Twenty-nine meta-analyses from suggestive-to-strong strength from one high and three low methodological quality SRs indicated that the systemic or local antibiotics had a beneficial, statistically significant effect on periodontal health parameters, such as average clinical attachment loss, bleeding on probing or percentage of pocket closure. Of those, four strong evidence meta-analyses from a low-quality systematic review indicated significant and meta-analytically robust but with negligible effect. About 65.5% of the meta-analyses with suggestive to strong evidence are unlikely to change with more future studies.
There is no robust evidence to support the use of antibiotics for periodontal management. Systemic antibiotics have a minimal effect on periodontitis and additional studies are unlikely to change the level of evidence.
抗菌药物管理旨在合理使用抗菌药物，包括抗生素。多年来，牙周病学中的抗生素治疗已得到广泛研究。本综述旨在评估关于牙周治疗中全身和局部使用抗生素的系统评价（SRs）证据的方法学质量、荟萃分析强度和有效性。
在对方案进行注册（PROSPERO CRD42024527222）后，截至2024年3月，广泛检索评估抗生素在非手术和手术牙周治疗中的效果的SRs，无论患者类型和抗生素类型如何。使用评估系统评价的测量工具2来判断SRs的方法学质量。Rosenberg的失效安全数探讨了改变该证据方向所需的无统计学意义、未发表或缺失研究的数量。
纳入了44项SRs，包括221项荟萃分析。总体方法学质量较低，分别只有4项和2项高质量或中等质量的SRs。在221项荟萃分析中，69项表明全身或局部使用抗生素的效果在统计学上不显著。来自一项高质量和三项低质量方法学SRs的29项从提示性到强强度的荟萃分析表明，全身或局部使用抗生素对牙周健康参数有有益的、统计学上显著的影响，如平均临床附着丧失、探诊出血或袋闭合百分比。其中，来自低质量系统评价的4项有强证据的荟萃分析表明有显著且荟萃分析稳健但效果可忽略不计。约65.5%的有提示性到强证据的荟萃分析不太可能因未来更多研究而改变。
没有有力证据支持在牙周管理中使用抗生素。全身使用抗生素对牙周炎的影响极小，更多研究不太可能改变证据水平。
