Tratamiento periodontal de apoyo (TPA) para el mantenimiento de la dentición en adultos tratados por periodontitis
Información
- DOI:
- https://doi.org/10.1002/14651858.CD009376.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 01 enero 2018see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
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Carolina Manresa: drafting of the protocol, search strategy design, search screening and study selection, correspondence with authors of papers if additional information required, data extraction and analysis, 'Risk of bias' and quality assessment, final review drafting
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Elena Sanz‐Miralles: drafting of the protocol, search strategy design, search screening and study selection, data extraction and analysis, 'Risk of bias' and quality assessment, final review drafting
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Joshua A Twigg: study selection, 'Risk of bias' and quality assessment, data extraction and analysis, final review drafting
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Manuel Bravo: data analysis, final review drafting
Sources of support
Internal sources
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No sources of support supplied
External sources
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National Institute for Health Research (NIHR), UK.
This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
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Cochrane Oral Health Global Alliance, Other.
The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (ohg.cochrane.org/partnerships‐alliances). Contributors over the past year have been: American Association of Paediatric Dentistry?, USA; British Association for the Study of Community Dentistry, UK; British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; Centre for Dental Education and Research at All India Institute of Medical Sciences, India; National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; NHS Education for Scotland, UK; Swiss Society of Endontology, Switzerland.
Declarations of interest
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Carolina Manresa: none known
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Elena Sanz‐Miralles: none known
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Joshua A Twigg: none known
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Manuel Bravo: none known
Through a poster competition, Carolina Manresa and Elena Sanz‐Miralles were awarded a scholarship by SEPA to the course "Evidence Based Dentistry" (Prof. Ian Needleman, Madrid, 7 to 8 November 2008).
Acknowledgements
The review authors would like to thank Prof. Dr. José J Echeverría for his mentorship and help and The Spanish Society of Periodontology (SEPA) for their support, especially Dr. Adrian Guerrero and Dr. David Herrera.
We acknowledge Anne Littlewood (Cochrane Oral Health) for her assistance with literature searching; and are grateful to Laura C.I. MacDonald for her support and comments during the preparation of this review. We thank Professor Helen Worthington, Thomas Lamont (editor with Cochrane Oral Health), and external referees Dr. John Zaki and Soodabeh Behboodi for their feedback, and Denise Mitchell for final copy editing. We acknowledge the contribution of Luisa Fernandez Mauleffinch and Phil Riley for their earlier help with preparation of the protocol.
Version history
| Published | Title | Stage | Authors | Version |
| 2018 Jan 01 | Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis | Review | Carolina Manresa, Elena C Sanz‐Miralles, Joshua Twigg, Manuel Bravo | |
| 2011 Oct 05 | Interventions for the maintenance of the dentition in patients treated for periodontal disease | Protocol | Carolina Manresa, Elena Sanz, Manuel Bravo, José Javier Echeverría | |
Differences between protocol and review
The protocol was published in 2011 and we have revised it substantially. We modified the title, rewrote the Background, focused the objective, refined the inclusion criteria, added an outcome (probing pocket depth), reduced the number of planned subgroup analyses and added a plan to conduct sensitivity analyses in future updates if there are sufficient data. We did not conduct the handsearching that we had originally planned.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Aged; Aged, 80 and over; Humans; Middle Aged;
PICO
Study flow diagram
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 1 Bleeding on probing (%).
Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 2 Full‐mouth mean probing depths mm (final scores).
Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 1 Bleeding on probing (one site per patient).
Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 2 Clinical attachment level mm (change scores).
Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 3 Pocket depth mm (final scores).
Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 1 Full‐mouth mean clinical attachment level mm (final scores).
Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 2 Full‐mouth mean probing depths mm (final scores).
| Supportive periodontal therapy (SPT) performed by specialists compared with SPT performed by non‐specialist clinicians | ||||||
| Population: adults treated for periodontitis and receiving SPT Settings: dental clinic Intervention: SPT performed by general dental practitioners under specialist prescription Comparison: SPT performed in a specialist practice | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Non‐specialist | Specialist | |||||
| Tooth loss | Not measured | |||||
| Bleeding on probing (%) at 12‐month follow‐up | Mean BoP 36.7% | Mean BoP was 7.40% higher (8.12 lower to 22.92 higher) | 35 participants | ⊕⊝⊝⊝ | ||
| Clinical attachment loss | Not measured | |||||
| Adverse events | Not measured | |||||
| Probing pocket depth (mm) (final scores) at 12‐month follow‐up | Mean PPD 3.0 mm | Mean PPD was 0.20 higher (0.40 lower to 0.80 higher) | 35 participants | ⊕⊝⊝⊝ | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Low quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
| aSingle study at high risk of bias, small sample size and imprecision in the effect estimate ‐ downgraded three levels | ||||||
| Mechanical debridement plus local antimicrobial compared with debridement only | ||||||
| Population: adults treated for periodontitis and receiving supportive periodontal therapy Settings: dental clinic Intervention: minocycline or doxycycline gel plus mechanical debridement Comparison: mechanical debridement | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Antimicrobial (minocycline) | |||||
| Tooth loss | Not measured | |||||
| Bleeding on probing (ratios) at 12‐month follow‐up | OR 0.45 (0.14 to 1.52) | 1 study | ⊕⊝⊝⊝ | |||
| Clinical attachment level (mm) at 12‐month follow‐up | Change score 4.6 mm | Change score was 0.10 mm higher (from 0.42 lower to 0.62 higher) | 1 study | ⊕⊕⊝⊝ | Tonetti 2012 assessed the effect of adjunctive doxycycline and reported no evidence of a benefit for probing attachment level. | |
| Pocket depth (mm) at 12‐month follow‐up | 4.3 mm | PD was 0.10 mm lower (from 0.59 lower to 0.39 higher) | 1 study | ⊕⊕⊝⊝ | Tonetti 2012 assessed the effect of adjunctive doxycycline and reported no evidence of a benefit for pocket depth reduction. | |
| Adverse events | See comment | 2 studies (251 participants) | Killeen 2016 reported no adverse events at follow‐up examinations in either study arm. Tonetti 2012 reported that there were no serious adverse events. | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Low quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
| aSingle study at high risk of bias, small sample size and serious imprecision in the effect estimate ‐ downgraded three levels bStudy (Killeen 2016) at high risk of bias and small sample size ‐ downgraded two levels | ||||||
| Photodynamic therapy plus mechanical debridement compared with mechanical debridement | ||||||
| Patient or population: adults treated for periodontitis and receiving supportive periodontal therapy Settings: dental clinic Intervention: photodynamic therapy plus mechanical debridement Comparison: mechanical debridement | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Experimental | |||||
| Tooth loss | Not measured | |||||
| Bleeding on probing | Not measured in usable way | |||||
| Clinical attachment level (mm) at 12‐month follow‐up | 7.76 mm | 0.97 mm lower ( from 3.51 lower to 1.57 higher) | 1 study (10 participants) | ⊕⊝⊝⊝ | ||
| Probing pocket depth (mm) at 12‐month follow‐up | 5.9 mm | 0.09 mm lower (from 1.41 lower to 1.23 higher) | 1 study (10 participants) | ⊕⊝⊝⊝ | ||
| Adverse events | Not measured | |||||
| The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Low quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
| aStudy at unclear risk of bias and very small sample size ‐ downgraded three levels | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Bleeding on probing (%) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 12 months | 1 | 35 | Mean Difference (IV, Fixed, 95% CI) | 7.40 [‐8.12, 22.92] |
| 2 Full‐mouth mean probing depths mm (final scores) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.1 12 months | 1 | 35 | Mean Difference (IV, Fixed, 95% CI) | 0.20 [‐0.40, 0.80] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Bleeding on probing (one site per patient) Show forest plot | 1 | 50 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.45 [0.14, 1.52] |
| 2 Clinical attachment level mm (change scores) Show forest plot | 1 | 53 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.42, 0.62] |
| 3 Pocket depth mm (final scores) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 3.1 12 months | 1 | 51 | Mean Difference (IV, Fixed, 95% CI) | ‐0.10 [‐0.59, 0.39] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Full‐mouth mean clinical attachment level mm (final scores) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 12 months | 1 | 10 | Mean Difference (IV, Fixed, 95% CI) | ‐0.97 [‐3.51, 1.57] |
| 2 Full‐mouth mean probing depths mm (final scores) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.1 12 months | 1 | 10 | Mean Difference (IV, Fixed, 95% CI) | ‐0.09 [‐1.41, 1.23] |
