Hu Jiaan, Ruan Yuting, Lin Nanzhen, Zhang Ying, Mao Xinyi, Bai Junyi, Yang Xue, Liu Shan, Lv Xinxin
Department of Stomatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
The First Clinical Medical College of Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e43434. doi: 10.1097/MD.0000000000043434.
Cyclosporin A-induced (CsA-induced) gingival overgrowth (GO) is a common side effect affecting many patients. While surgical intervention is often considered the primary treatment, the effectiveness of nonsurgical periodontal therapy for CsA-induced GO remains unclear. This meta-analysis aimed to assess the efficacy of nonsurgical periodontal treatment in CsA-induced GO.
Articles were retrieved from 7 databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chinese Academic Database, Clinical Trials Database, and Grey Literature Database) until November 5th, 2024. Randomized controlled trials (RCTs) or pre-post studies containing patients with GO caused by cyclosporine who received nonsurgical periodontal treatment were included. The protocol was published in International Prospective Register of Systematic Reviews with the ID CRD42024570280.
A total of 13 studies were included. Five studies were RCTs comparing nonsurgical periodontal treatment groups and control groups among patients with GO; the other 8 studies were single group pre-post studies. Meta-analysis of RCTs demonstrated the hypertrophy index (standardized mean difference [SMD] = -1.14; 95% confidence intervals [CI]: [-1.59, -0.69]) and plaque index (SMD = -1.06, 95% CI: [-2.04, -0.07]) were significantly lower in the nonsurgical treatment groups than those in the control groups. Meta-analysis of single group pre-post studies showed that the levels of hypertrophy index (SMD = -1.49; 95% CI: [-2.92, -0.06]), probing depth (SMD = -1.52, 95% CI: [-2.46, -0.58]) and plaque index (SMD = -1.53, 95% CI: [-2.18, -0.88]) decreased significantly after treatment. Subgroup analyses indicated that antibiotics are important sources of heterogeneity.
This meta-analysis supports the effectiveness of nonsurgical treatments for CsA-induced GO, and comprehensive pre and posttransplant oral care is recommended. Further studies are needed to determine the biological mechanisms and influence of each variable on the efficacy of nonsurgical treatments in reducing drug-induced GO.
环孢素A诱导的（CsA诱导的）牙龈增生（GO）是影响许多患者的常见副作用。虽然手术干预通常被视为主要治疗方法，但非手术牙周治疗对CsA诱导的GO的有效性仍不明确。本荟萃分析旨在评估非手术牙周治疗对CsA诱导的GO的疗效。
从7个数据库（Cochrane图书馆、PubMed、EMBASE、中国知网、中国学术数据库、临床试验数据库和灰色文献数据库）检索文章，直至2024年11月5日。纳入随机对照试验（RCT）或前后对照研究，研究对象为接受非手术牙周治疗的环孢素引起的GO患者。该方案已发表在国际系统评价前瞻性注册库中，注册号为CRD42024570280。
共纳入13项研究。5项研究为RCT，比较了GO患者中非手术牙周治疗组和对照组；另外8项研究为单组前后对照研究。RCT的荟萃分析表明，非手术治疗组的肥大指数（标准化均值差[SMD]=-1.14；95%置信区间[CI]：[-1.59，-0.69]）和菌斑指数（SMD=-1.06，95%CI：[-2.04，-0.07]）显著低于对照组。单组前后对照研究的荟萃分析显示，治疗后肥大指数（SMD=-1.49；95%CI：[-2.92，-0.06]）、探诊深度（SMD=-1.52，95%CI：[-2.46，-0.58]）和菌斑指数（SMD=-1.53，95%CI：[-2.18，-0.88]）水平显著降低。亚组分析表明，抗生素是异质性的重要来源。
本荟萃分析支持非手术治疗对CsA诱导的GO的有效性，建议在移植前后进行全面的口腔护理。需要进一步研究以确定生物学机制以及各变量对非手术治疗减少药物性GO疗效的影响。
