支持性牙周治疗（SPT）用于维持接受牙周炎治疗的成人牙列
Referencias
References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
Additional references
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Methods | Design: 2‐arm, parallel‐group, single‐masked RCT Location: USA Number of centres: 1 (University of Nebraska Medical Center (UNMC) College of Dentistry, Omaha, Nebraska clinics) Recruitment period: not specified. Study conducted from October 2012‐December 2014 Clinical exam performed with a manual UNC15 tip (Hu‐Friedy) probe at experimental sites. No information provided about rounding of measurements. Inflammatory markers were analysed in GCF (gingival crevicular fluid) through enzyme‐linked immunosorbent assay | |
| Participants | Adults (40‐85 years old) with a history of regular PMT ≥ twice a year before enrolment with ≥ 1 posterior ≥ 5 mm interproximal pocket with BoP. Diagnosis of moderate‐severe chronic periodontitis. Men n = 35; women n = 16. Smokers n = 12. Mean number of teeth per participant: 23.5 ± 5.1 (test group) and 25.3 ± 3.9 (control group) Experimental site of the individuals was assigned from screening data (most posterior interproximal ≥ PD with history of BOP). Only 6 participants had an experimental site with 7 mm pockets. Number of participants: 270 individuals screened; 60 randomised and 51 finished study (24 test, 27 control) and results analysed (12‐month evaluation) | |
| Interventions | Test group: application of 1 mg of minocycline HCl microspheres (MM) according to the instructions of the manufacturer (Arestin, OraPharma, Bridgewater, NJ) + SRP (at baseline and 6 months) n = 30 allocated; and n = 24 analysed at 12 months (3 participants excluded due to inadequate experimental site after randomisation; 3 participants withdrawn due to having the tooth extracted, presenting with conflicting medical treatment and the last one due to failed appointments) Control group: mechanical debridement (at baseline and 6 months) n = 30 allocated; n = 27 analysed at 12 months (2 participants excluded due to inadequate experimental site after randomisation; 1 participant withdrawn due to having the tooth extracted) The adjacent site to the experimental/control site was also treatment according to randomisation (debridement + MM if adjacent site was assigned to the experimental group) or debridement only (if adjacent site was assigned to the control group) Participants underwent routine periodontal maintenance with full‐mouth debridement and root planing of the inflamed pockets (provided by a dental student and revised by a faculty member). In order to ensure standardisation of the experimental sites, a single dental hygienist finished the root planing (< 5 min) and applied the MM in the test and adjacent sites. | |
| Outcomes | Two calibrated examiners without knowledge of the experimental group assignment Outcomes measured at 6‐ and 12‐month follow‐up Primary outcome: improvement in CAL (mm). CALs were calculated as recession plus PPDs. Secondary outcomes: PPD (mm), plaque (%), and BoP (%) and inflammatory markers (inflammation index ratio of interleukin (IL)‐1b/IL‐1 receptor antagonist (ra)) All the results were based on the examination of experimental site (1 site per participant) (not full‐mouth results provided for any of the outcome measures) See Additional Table 1 for further details of indices used in trials to measure outcomes Clinical and inflammatory biomarker outcomes were presented at baseline, 6 months and 12 months and expressed as means ± SD or n (%). Change after 6 months and change after 12 months presented as means (means ± SD for the post‐treatment change or n (%) of participants/sites experiencing reduction in the clinical parameter/biomarker) and ratios (the mixed model or generalised linear mixed models with autoregressive correlation for repeated measures were fitted from the same participants were fitted) Information regarding adverse events was also gathered and a subanalysis of number (%) of sites improving PPD and CAL (mm) in ≥ 2 mm presented | |
| Notes | No sample calculation performed but 2 power analyses presented: 1. taking into account the largest SD of CAL change after 6 or 12 months in either treatment group‐based data 2. the mean of SD of change in the four CAL change results (at 6 and 12 months in either group). The sample size available at the end of the study deemed an 80% power to detect a difference in the CAL post‐treatment of: a) a minimum difference of 0.7‐0.8 mm using a 2‐sided Wilcoxon signed‐rank test at a significance level of 0.025 (when using the first model of power analysis) b) a minimum difference of 0.6 mm post‐treatment (when using the second model of power analysis) No information available regarding the way the data were entered and stored Funding source: the Dr. D.H. Reinhardt Scholar Program. Additional funding was provided by the late Dr. Mick Dragoo and his wife, Mary, and the Nebraska Dental Association Foundation CONSORT flow diagram recording reasons for loss to follow‐up Details about randomisation and blinding provided Per‐protocol analysis of data | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomisation provided by a coin toss. Randomisation stratified by sex and smoking status |
| Allocation concealment (selection bias) | Unclear risk | No information provided about the allocation concealment |
| Blinding of participants and personnel (performance bias) | High risk | Single‐blinded study ‐ examiners only. Non‐blinded therapist. Participants not blinded |
| Blinding of outcome assessment (detection bias) | Unclear risk | Two calibrated and blinded‐to‐treatment examiners. Manual probe used. No information about who analysed the data, masking and statistical programme used |
| Incomplete outcome data (attrition bias) | Unclear risk | CONSORT flow diagram fully explains the reasons for participant withdrawal/drop‐outs and the number of participants included in the analysis No ITT principle applied No full‐mouth data provided |
| Selective reporting (reporting bias) | Low risk | Primary and secondary outcomes reported |
| Other bias | Unclear risk | Experimental sites determined from screening data. Sites assigned to a group at baseline |
| Methods | Design: double‐blind design RCT Location: Switzerland Number of centres: 1 (Department of Periodontology and Fixed Prosthodontics of University of Berne) Recruitment period: during regular SPT visits, March 2005‐July 2006 | |
| Participants | Adults (40‐74 years old) in maintenance previously treated for chronic periodontitis and displaying residual PPD 20% of the participants were active smokers (≤ 10 cigarettes/day) Presence of 24 remaining teeth during SPT and with ≥ 1 residual pocket with PPDs of ≥ 5 mm, with or without concomitant BoP Number of participants: 10 participants screened; 10 examined; 10 analysed | |
| Interventions | Group 1 (test): photodynamic therapy (PDT) + mechanical debridement n = 5 participants with 39 residual pockets Group 2 (control):mechanical debridement (with hand instruments) + placebo n = 5 participants with 31 residual pockets It is not specified who performed the intervention On day 0, all participants were re‐instructed in oral hygiene practices. Debridement of all sites with PPD ≥ 5 mm was performed under local anaesthesia using hand instruments. Additionally, all experimental sites were treated with the set‐up for PDT including the dye/photosensitiser. In the randomly assigned control sites, the laser was set in a light mode that was no compatible with the photosensitiser. The procedure was repeated in the same manner after 1, 2, 7 and 14 days. | |
| Outcomes | A single examiner blind to intervention undertook the outcome assessment in this study. Outcomes measured at day 0 (baseline) and at days 7 and 14 as well as at months 1, 3, 6 and 12 Primary outcome: PPD Secondary outcomes: CAL, BoP See Additional Table 1 for further details of indices used in trials to measure outcomes Plaque: PlI (Silness 1964) Bleeding: BoP Probing depth: PPD Clinical exam (PPD, CAL, BoP) performed with a calibrated periodontal probe (HAWE Click Probe(R), KerrHawe SA, Bioggio TI, Switzerland) with a point diameter of 0.45 mm and standardised to a probing pressure of 0.25 N. Measurements performed at residual pockets | |
| Notes | Sample size calculation Funding source: in part supported by HIELBOs Photodynamic Systems GmbH, Grieskirchen, Austria, and by the Clinical Reaserch Foundation (CRF) for the Promotion of Oral Health, Brienz BE, Switzerland No CONSORT flow diagram of participants No intra‐examiner calibration data provided No ITT analysis of data Number of participants recruited based on sample calculation (if an effect of change in PPD of 1 mm is expected, assuming that the common SD is 0.5 mm) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | The allocation to either the test or the control group was performed by random assignment using a randomisation table |
| Allocation concealment (selection bias) | Low risk | The determination of whether photosensitiser was applied or not was performed by a dental nurse, who was unaware of the study objectives, on the basis of the randomisation table |
| Blinding of participants and personnel (performance bias) | Low risk | Both the participant and the treatment provider were blinded through masked switching of the power setting of the laser |
| Blinding of outcome assessment (detection bias) | Low risk | The examiner was blinded to treatment |
| Incomplete outcome data (attrition bias) | Low risk | All participants completed the 12‐month follow‐up period |
| Selective reporting (reporting bias) | Unclear risk | Primary and secondary outcomes reported, but not at all time points assessed by the examiner as stated in the text. No clinical outcome data are reported for days 7, 14 and the first month. |
| Other bias | Unclear risk | No intra‐examiner calibration data provided although a calibrated periodontal probe (HAWE Click Probe, KerrHawe SA) was used. The study authors declare no conflict of interest, although the study was in part supported by HIELBOs Photodynamic Systems GmbH. |
| Methods | Design: 2‐arm, parallel‐group, single‐masked RCT Location: Newcastle, UK Number of centres: several (specialist clinic and unspecified number of referring general dental practices) Recruitment period: not specified | |
| Participants | 35 participants (15 men and 20 women) with moderate‐severe chronic periodontitis | |
| Interventions | Group A: periodontal maintenance provided within the specialist clinic n = 18 Group B: periodontal maintenance provided by the referring general dentist under specialist prescription n = 17 Interventions were matched between groups, although compliance of GDPs with specialist prescription was not monitored. Independent variable was person performing the intervention. | |
| Outcomes | A single, calibrated examiner blind to allocation undertook the outcome assessment in this study. Outcomes measured at baseline, 6 and 12 months Primary outcome: PPD See Additional Table 1 for further details of indices used in trials to measure outcomes Plaque: full‐mouth plaque index (Silness 1964) Bleeding: full‐mouth BoP Probing depth: full‐mouth and test site PPDs Clinical exam (PPD, BoP) performed with a True Pressure Sensitive Probe (VivaCare) with 20 g probing force Examination at months 0 (corresponding to 6 months after completion of | |
| Notes | Compliance not evaluated for group B | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "...subjects were randomly allocated to one of two groups" No mention of method of randomisation |
| Allocation concealment (selection bias) | Unclear risk | No mention of allocation concealment |
| Blinding of participants and personnel (performance bias) | High risk | Participant blinding not mentioned and unlikely |
| Blinding of outcome assessment (detection bias) | Unclear risk | Clinical assessments ‐ "all measurements were recorded by one calibrated individual (dental hygienist), who was blind to the group allocation." Radiographic assessments ‐ unclear |
| Incomplete outcome data (attrition bias) | Low risk | Group A ‐ 1 dropout Group B ‐ 2 dropouts Low number of participants lost to follow‐up, similar between groups |
| Selective reporting (reporting bias) | Unclear risk | No compliance data for group B. No measures used to deal with truncated data (e.g. ITT analysis) |
| Other bias | Low risk | Nothing remarkable |
| Methods | Design: 2‐arm, parallel‐group, multicentre RCT Location: Switzerland, Belgium, Germany, Greece and the Netherlands Number of centres: 5 (Periodontology, Centre for Dental, Oral, and Maxillofacial Medicine (Carolinum), Johann Wolfgang Goethe‐University, Frankfurt; Department of Periodontology School of Dentistry, Athens; Private Practice, Munster; Private Practice, Den Haag; Private Practice, Langenthal) Recruitment period: 3 months Clinical exam performed with a manual pressure sensitive probe at 0.3 N (Brodontic(R) pressure sensitive device (Dentramar), equipped with a PCP ‐ UNC 15 tip (Hu‐Friedy)) at 6 sites per tooth. Values rounded up to the nearest mm | |
| Participants | Adults (≥ 35 years old) undergoing regular SPT for ≥ 6 months and suffering from persistent or recurrent moderate to severe periodontitis. The areas in need of treatment did not undergo periodontal treatment in the previous 12 months. Participants included had ≥ 4 teeth with residual PPD ≥ 5 mm and positive BoP Number of participants: 203 enrolled; 202 randomised; 181 examined and 200 analysed (12th month) | |
| Interventions | Group 1 (test): doxycycline (SRD: Ligosan Slow Release®; Heraeus Kulzer GmbH, Germany) hyclate gel (equivalent to 14% doxycycline base) (single application) + debridement ((mechanical instrumentation; ultrasonic/sonic instruments (USI)) n = 100 allocated; n = 89 examined and n = 100 analysed at 12 months Group 2 (control): mechanical debridement (USI) n = 102 allocated; n = 92 examined and n = 100 analysed at 12 months "Two trained and calibrated investigators were available at each trial site. One investigator performed the actual treatment according to the randomisation scheme therapist. The second investigator was blind to treatment and acted as examiner." All sites presenting PPD ≥ 4 mm at 3, 6 and 9 months were retreated by SRP | |
| Outcomes | A trained, calibrated and blinded investigator in each site acted as examiner. Outcomes measured at 3‐, 6‐ and 12‐month follow‐up Primary outcome: inter‐group difference in absolute change of probing pocket depth (PPD) 3, 6 and 12 months after intervention See Additional Table 1 for further details of indices used in trials to measure outcomes Plaque: FMPS Bleeding: FMBS Probing depth: PPD, rate of healing (transitions of sites with PPD ≥ 5 mm or 4 mm with BOP to nonbleeding sites with ≤ 4 mm), ORs of rate of healing Manual pressure‐sensitive probe used with a force of 0.3 N (Brodontic® pressure sensitive device, Dentramar, the Netherlands, equipped with a PCP‐UNC 15 tip; Hu‐Friedy, Leimen, Germany) Probing attachment level: changes in PAL All parameters recorded at 6 sites/tooth Adverse events: recorded following the MedDRA specifications Treatment time Need for re‐treatment Number and frequency distribution of sites with different baseline probing depths in the test and control groups. Adjusted mean changes in PPD reduction between both groups by baseline pocket depth at the different follow‐up appointments (at 3, 6 and 12 months). Adjusted OR for treatment difference in rate of healing of sites with PPD ≥ 5 mm or 4 mm + BOP to a category of non‐BOP with PPD ≤ 4 mm. Adjusted OR and frequency of healing for treatment difference in pockets ≥ 5 mm at 3‐, 6‐, 12‐month follow‐up | |
| Notes | Sample calculation: yes. Sample size adjusted after a planned interim analysis (2‐stage sequential adaptive design) Data entered into the database using double data entry techniques Funding source: European Reserch Group on Periodontology (ERGOPerio) and Ivoclar Vivadent, Schaan, Liechtenstein CONSORT flow diagram recording reasons for loss to follow‐up Details about randomisation and blinding provided ITT analysis of data | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation provided by computer‐generated table |
| Allocation concealment (selection bias) | Low risk | Treatment allocation at baseline (administration of SRD test vs. no further intervention ‐ control) was revealed to the therapist after completion of supragingival and subgingival ultrasonic/sonic instrumentation and was applied in test cases in pockets depths 4 mm or deeper |
| Blinding of participants and personnel (performance bias) | Low risk | Two trained and calibrated investigators were available at each trial site. One investigator (therapist) performed the treatment according to the randomisation scheme and the other one performed the exam and collection of data blinded to treatment |
| Blinding of outcome assessment (detection bias) | Low risk | The examiner was blinded to treatment. Calibrated. Clinical examination performed at 3, 6, 12 months. Manual pressure‐sensitive probe used |
| Incomplete outcome data (attrition bias) | Low risk | Consort flow diagram fully explains the reasons for participant withdrawal/dropouts and the number of participants included in the analysis |
| Selective reporting (reporting bias) | Low risk | Primary and secondary outcomes reported. |
| Other bias | Low risk | Nothing remarkable |
BoP: bleeding on probing; CAL: clinical attachment level; FMBS: full‐mouth bleeding scores; FMPS: full‐mouth plaque scores; GDP: General Dental Practitioner; ITT: intention‐to‐treat; MM: 1mg of minocycline HCl microspheres (MM) according to the instructions of the manufacturer (Arestin, OraPharma, Bridgewater, NJ; SRP (scaling and root planing); OR: odds ratio; PAL: probing attachment level; PD: probing depth; PDT: photodynamic therapy; PlI: Plaque Index; PMT: periodontal maintenance therapy; PPD: probing pocket depth; RCT: randomised controlled trial; SD: standard deviation; SPT: supportive periodontal therapy; VAS: visual analogue scale
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| RCT in which the intervention was given as part of active treatment phase. 3 months after mechanical treatment, participants who presented with pockets and bleeding on probing were enrolled in the study. This split‐mouth study evaluates the effect of the application of tetracycline‐loaded fibres after 12 months. | |
| RCT where participants finished the periodontal active phase just 45 days prior to the initial examination and allocation of participants into two modalities of SPT. | |
| This multicentre RCT included healthy periodontal participants with gingivitis and moderate periodontitis (basic periodontal examination score 0‐3). The aim of the study was to assess the relative effectiveness of oral hygiene advice and periodontal instrumentation in a primary dental care setting. | |
| Length of follow‐up < 12 months | |
| Not an RCT. Retrospective cohort study | |
| None of the primary outcomes specified in our review were measured in this study. | |
| Not an RCT. Participants were classified according to their level of compliance with past maintenance visits as complete compliance, irregular compliance or noncompliance. | |
| Not an RCT | |
| Length of follow‐up less than 12 months | |
| Not an RCT ‐ questionnaire‐based survey | |
| Unclear if randomised. The authors refer to an earlier paper (Miley 2009) for further details. The same cohort was studied over a 1‐year period. In Miley 2009 study, participants had previously completed questionnaires to determine their levels of oral supplementation to determine the group to which they would be assigned. | |
| None of the primary outcomes specified in our review were measured in this study. This study evaluated the effectiveness of SDD versus placebo in the reduction of periodontal disease progression in 2 random groups of postmenopausal osteopenic women as adjunct to periodontal maintenance therapy over 2 years. Results are given in terms of serum bone biomarkers, dental radiographs, microbiological samples and gingival crevicular fluid. The authors refer to an earlier paper (Payne 2007) for further details about materials and methods. | |
| RCT that compared the effect of scaling and root planing in combination with an adjunctive therapy (systemic antibiotics, local antibiotics, and/or periodontal surgery), during periodontal active therapy phase in participants with moderate periodontitis. Different periodontal treatments were evaluated longitudinally at 3, 6, 12, 18 and 24 months. Intervention was given during periodontal active treatment phase and the participants were followed up for 24 months (that included a 12‐month period of periodontal maintenance phase). | |
| Not an RCT and insufficient follow‐up period | |
| Length of follow‐up < 12 months | |
| Split‐mouth RCT with risk of contamination | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months | |
| Intervention was given during periodontal active treatment phase although the results were evaluated up to 12 months. This RCT evaluated the effect of an individually tailored oral health educational programme for oral hygiene self care vs. standard approach, during periodontal active therapy phase in patients with moderate‐advanced chronic periodontitis. The effects of both programmes were evaluated at 3 and 12 months. | |
| This study is an “interim report” from the previous RCT conducted by Jönsson 2009. In this article the aim was to compare cost‐effectiveness of an individually tailored oral health educational programme based on cognitive behavioural strategies integrated in non surgical periodontal treatment compared with the standard treatment programme. | |
| Length of follow‐up < 12 months | |
| Split‐mouth RCT evaluating laser versus scaling and root planing | |
| Study that compared, after 12 months, the effect of scaling and root planing in combination with and without adjunctive therapy (different irrigation solutions) during periodontal active therapy phase in patients with moderate chronic periodontitis. Participants never entered in a periodontal maintenance programme. | |
| RCT evaluating minocycline only versus subgingival mechanical debridement. Participants had completed active treatment less than six months before the RCT began | |
| Not an RCT. Prospective cohort study | |
| Length of follow‐up < 12 months | |
| Split‐mouth RCT evaluating air polishing with erythritol versus SRP ‐ risk of contamination | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months | |
| RCT without control group or SPT alone. Participants were randomly assigned to experimental groups to evaluate short‐term and long‐term clinical and microbiological effect of systemic Sitafloxacin or Azithromycin on active periodontal pockets during SPT. | |
| Length of follow‐up < 12 months | |
| Both groups received an active intervention (antimicrobial mouthrinse) | |
| None of the outcomes specified in our review were measured in this RCT. This study evaluated the effectiveness of SDD versus placebo in the reduction of periodontal disease progression in two random groups of post‐menopausal osteopenic women as an adjunct to periodontal maintenance therapy over 2 years. Results were measured in terms of serum biomarkers of bone formation and radiological alveolar bone height change. The authors refer to an earlier paper (Payne 2007) for further details about materials and methods. | |
| Length of follow‐up < 12 months | |
| None of the primary outcomes specified in our review were measured in this RCT. It evaluated the effectiveness of SDD versus placebo in the reduction of periodontal disease progression in two random groups of postmenopausal osteopenic women as adjunct to periodontal maintenance therapy lasting 2 years. Results were measured in terms of gingival crevicular fluid (GCF) and its correlation with periodontal attachment and bone loss (radiography measurements). The authors refer to an earlier paper (Payne 2007) for further details about materials and methods. | |
| Not an RCT. This cohort study was conducted based on participants of the Swedish National Study on Aging and Care (SNAC). Four centres in Sweden were involved; the participants were invited by mail to take part in medical, psychological and dental examination. | |
| Length of follow‐up < 12 months | |
| Not an RCT. Cross‐sectional study | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months | |
| The aim of this RCT was to determine the rate of attachment loss in periodontal healthy participants in a prevention regimen and the rate of disease progression in periodontitis participants enrolled in a maintenance programme. | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months | |
| Length of follow‐up < 12 months |
RCT: randomised controlled trial; SDD: subantimicrobial‐dose of doxycycline; SPT: supportive periodontal therapy
Characteristics of studies awaiting assessment [ordered by study ID]
| Methods | Design: 4‐arm, single‐masked, multicentre RCT (2 arms reported) Location: Skövde and Göteborg, Sweden; and The Forsyth Institute, Massachusetts, USA Number of centres: 3 specialist clinics Recruitment period: January 2000‐February 2002 |
| Participants | 128 adult periodontal maintenance patients (≥ 1 year enrolment in SPT programme) |
| Interventions | Experimental group: mechanical debridement with adjunctive 8.8% doxycycline gel administered to all test sites at baseline only n = 63 Control group: mechanical debridement only n = 65 Loss to follow‐up for 2 participants at 12 months (1 test, 1 control) and 4 participants (3 test, 1 control) at end of study (3 years) |
| Outcomes | Calibrated examiners (reproducibility and inter‐examiner correlation data reported) who were blinded to intervention allocation assessed clinical outcome data Outcomes measured at 3 months and 1, 2 and 3 years Primary outcome: PPD measurements (mm) and CAL (reported as relative attachment level gain) in mm Plaque: FMPS BoP: FMBS Microbiological findings: mean counts of a panel of 40 bacterial species |
| Notes | Study is part of a 4‐arm RCT, but overall study design and outcome measures not clear from published data alone. |
| Methods | Design: 4‐arm, single‐masked, multicentre RCT (2 arms reported) Location: Skövde and Göteborg, Sweden; and The Forsyth Institute, Massachusetts, USA Number of centres: 3 specialist clinics Recruitment period: January 2000‐February 2002 |
| Participants | 128 adult periodontal maintenance patients (≥ 1 year enrolment in SPT programme) |
| Interventions | Experimental group: mechanical debridement with home use of a rotating‐oscillating powered toothbrush (Oral‐B, Gillette, Boston, MA, USA) and a triclosan/copolymer/fluoride‐containing dentifrice (Colgate Total, Piscataway, NJ, USA) n = 65 Control group: mechanical debridement with soft, multi‐tufted manual toothbrush and fluoride‐containing dentifrice (Colgate Protection Caries) n = 63 Loss to follow‐up for 2 participants at 12 months (0 test, 2 control) and 4 participants (1 test, 3 control) at end of study (3 years) |
| Outcomes | Calibrated examiners (reproducibility and inter‐examiner correlation data reported) who were blinded to intervention allocation assessed clinical outcome data Outcomes measured at 3 months and 1, 2 and 3 years Primary outcome: PPD measurements (mm) and CAL (reported as relative attachment level gain) in mm Plaque: FMPS BoP: FMBS Change in % sites with PPD < 4 mm, 4 mm‐5.5 mm or ≥ 6 mm Microbiological findings: mean counts of a panel of 40 bacterial species |
| Notes | Study is part of a 4‐arm RCT, but overall study design and outcome measures not clear from published data alone |
CAL: clinical attachment level; FMBS: full‐mouth bleeding scores; FMPS: full‐mouth plaque scores; RCT: randomised controlled trial; PPD: probing pocket depth; SPT: supportive periodontal therapy
Data and analyses
| 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 | |
| Analysis 1.1  Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 1 Bleeding on probing (%). | ||||
| 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 | |
| Analysis 1.2  Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 2 Full‐mouth mean probing depths mm (final scores). | ||||
| 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] |
| Analysis 2.1  Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 1 Bleeding on probing (one site per patient). | ||||
| 2 Clinical attachment level mm (change scores) Show forest plot | 1 | 53 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.42, 0.62] |
| Analysis 2.2  Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 2 Clinical attachment level mm (change scores). | ||||
| 3 Pocket depth mm (final scores) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 2.3  Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 3 Pocket depth mm (final scores). | ||||
| 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 | |
| Analysis 3.1  Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 1 Full‐mouth mean clinical attachment level mm (final scores). | ||||
| 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 | |
| Analysis 3.2  Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 2 Full‐mouth mean probing depths mm (final scores). | ||||
| 2.1 12 months | 1 | 10 | Mean Difference (IV, Fixed, 95% CI) | ‐0.09 [‐1.41, 1.23] |
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] |
