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Respuestas clínicas Cochrane

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Study flow diagram
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Figure 1

Study flow diagram

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 1 Bleeding on probing (%).
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Analysis 1.1

Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 1 Bleeding on probing (%).

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Comparison 1 Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians, Outcome 2 Full‐mouth mean probing depths mm (final scores).
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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).

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Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 1 Bleeding on probing (one site per patient).
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Analysis 2.1

Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 1 Bleeding on probing (one site per patient).

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Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 2 Clinical attachment level mm (change scores).
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Analysis 2.2

Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 2 Clinical attachment level mm (change scores).

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Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 3 Pocket depth mm (final scores).
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Analysis 2.3

Comparison 2 Antimicrobial + mechanical debridement versus mechanical debridement, Outcome 3 Pocket depth mm (final scores).

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Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 1 Full‐mouth mean clinical attachment level mm (final scores).
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Analysis 3.1

Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 1 Full‐mouth mean clinical attachment level mm (final scores).

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Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 2 Full‐mouth mean probing depths mm (final scores).
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Analysis 3.2

Comparison 3 Photonics + mechanical debridement versus mechanical debridement, Outcome 2 Full‐mouth mean probing depths mm (final scores).

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Summary of findings for the main comparison. Supportive periodontal therapy (SPT) performed by specialists versus SPT performed by non‐specialist clinicians

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
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

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
(1 study)

⊕⊝⊝⊝
very lowa

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
(1 study)

⊕⊝⊝⊝
very lowa

*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).
CI: confidence interval; MD: mean difference

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

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Summary of findings for the main comparison. Supportive periodontal therapy (SPT) performed by specialists versus SPT performed by non‐specialist clinicians
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Summary of findings 2. Mechanical debridement plus local antimicrobial versus mechanical debridement

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
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

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
(50 participants)

⊕⊝⊝⊝
very lowa

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
(53 participants)

⊕⊕⊝⊝
lowa

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
(51 participants)

⊕⊕⊝⊝
lowa

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).
CI: confidence interval; MD: mean difference; OR: odds ratio

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

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Summary of findings 2. Mechanical debridement plus local antimicrobial versus mechanical debridement
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Summary of findings 3. Photonics plus mechanical debridement versus mechanical debridement

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
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

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)

⊕⊝⊝⊝
very lowa

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)

⊕⊝⊝⊝
very lowa

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).
CI: confidence interval; MD: mean difference

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

Figuras y tablas -
Summary of findings 3. Photonics plus mechanical debridement versus mechanical debridement
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Comparison 1. Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians

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]
Figuras y tablas -
Comparison 1. Supportive periodontal therapy (SPT) performed by specialists versus non‐specialist clinicians
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Comparison 2. Antimicrobial + mechanical debridement versus mechanical debridement

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]
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Comparison 2. Antimicrobial + mechanical debridement versus mechanical debridement
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Comparison 3. Photonics + mechanical debridement versus mechanical debridement

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]
Figuras y tablas -
Comparison 3. Photonics + mechanical debridement versus mechanical debridement
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