ABSTRACT
Abstract The aim of this study was to perform a systematic review and meta-analysis to examine the effect of systemic antibiotics in the periodontal treatment of smokers. The selection criteria were as follows: controlled randomized clinical trials; studies published in English; studies with smoker patients diagnosed with chronic periodontitis; patients without systemic diseases; studies that used systemic antibiotic therapy associated with periodontal treatment; studies that presented results for the test and control groups and assessments of clinical periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). The differences in average weights were calculated with a confidence interval (CI) of 95% for PD reduction, CAL gain and BOP. The means of the periodontal clinical parameters were compared between the baseline and post-treatment periods between the test groups and the control groups. The heterogeneity was assessed using the Cochran Q test (Q (df = 3), α = 5%). A total of 67 articles were found, and after the selection process, three randomized controlled trials were included in the meta-analysis. The results indicate that SRP associated with systemic antibiotics promoted additional benefits when compared to SRP alone, with a greater reduction of PD (p = 0.0359, CI = -0.42, -0.01) and a gain of CAL (p = 0.0161, CI = -0.39, -0.04). There was a modest PD reduction (PD, DM -0.21) and a modest CAL gain (CAL, DM -0.22). The results of our meta-analysis reveal the clinical benefits of systemic antibiotics as an adjunct to the non-surgical periodontal treatment of smokers. These clinical improvements, although statistically significant, appeared to be of little clinical relevance.
Subject(s)
Humans , Smoking , Dental Scaling , Root Planing , Chronic Periodontitis/therapy , Anti-Bacterial Agents/therapeutic use , Randomized Controlled Trials as Topic , Treatment Outcome , Chemotherapy, Adjuvant , Periodontal Attachment LossABSTRACT
Objetivo: Este estudo avaliou por meio de análise clínica e microbiológica os efeitos do Metronidazol associado à Amoxicilina (MTZ+AMX) e de múltiplas aplicações da terapia fotodinâmica antimicrobiana (aPDT) como coadjuvantes ao tratamento da periodontite crônica em fumantes. Métodos: Um estudo clínico controlado, randomizado foi conduzido em 51 pacientes fumantes que receberam: Grupo RAR (n=17) - raspagem e aplainamento radicular e placebo; Grupo MTZ+AMX (n=17) - RAR e uso sistêmico de Metronidazol (400 mg 3 X por dia, 7 dias) e Amoxicilina (500 mg 3 X por dia, 7 dias); Grupo aPDT (n=17) - RAR e 3 aplicações de aPDT em dois sítios (1 bolsa moderada e 1 profunda) por quadrante, imediatamente, 48 e 72 horas após a raspagem e placebo durante 7 dias. Os exames clínicos e microbiológicos foram realizados no início, aos 90 e 180 dias após o tratamento. Os parâmetros clínicos de índice de placa visível (IPV), sangramento à sondagem (SS), profundidade de sondagem (PS) e nível de inserção clínico (NIC) foram avaliados. Foram coletadas amostras de biofilme subgengival de uma bolsa ≥ 4 ≤ 6 mm (bolsa moderada) e de outra ≥ 7 mm (profunda) em cada quadrante de cada paciente dos grupos RAR, MTZ+AMX e aPDT. A aPDT foi realizada, utilizando o Azul de metileno e o laser em baixa intensidade após 1 minuto (AsGaAl, 660 nm, 100 mW, 48 segundos, 160 J/cm2) imediatamente, 48 e 72 hs após o tratamento, nos mesmos sítios da coleta. Para análise microbiológica, três patógenos periodontais foram avaliados por Reação de Polimerase em Cadeia em tempo real (PCR-real time): Porphyromonas gingivalis (Pg), Prevotella nigrescens (Pn) e Prevotella intermedia (Pi). Os dados clínicos e microbiológicos foram estatisticamente analisados (α=5%). Resultados: Os tratamentos com MTZ +AMX e aPDT promoveram melhoras nos parâmetros de PS, NIC, SS e IPV após tratamento. Os pacientes que receberam o tratamento com aPDT apresentaram maior redução de PS e NIC nas bolsas coletadas quando comparado a RAR...
Aim: The aim of this study was to evaluate the clinical and microbiological effects of Metronidazolecombined with Amoxicillin (MTZ+AMX) and multiple applications of antimicrobial photodynamic therapy (aPDT) as adjuvant treatment of smokers with chronic periodontitis. Methods:A double-blind controlled, randomized clinical trial was conducted in 51 smoking patients who received: SRP Group (n=17): scaling and root planning and placebo; MTZ+AMX Group (n=17) and SRP with systemic use of Metronidazole (400 mg 3 X per day 7 days) and Amoxicillin (500 mg 3 X per day 7 days); aPDT Group (n=17): SRP and three aPDT applications at two sites (one moderate and one deep pocket) per quadrant, immediately 48 and 72 hours after scaling and MTZ and AMX (placebo) during 7 days. Clinical and microbiologic examinations were performed at Baseline, 3 and 6 months post-therapy. Clinical parameters of visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. Samples were collected from a subgingival pocket ≥ 4mm ≤ 6mm (pocket moderate) and another ≥ 7mm (pocket deep) in each quadrant of each patient, in the groups SRP, MTZ+AMX and aPDT. The APDT was carried out using methylene blue and the laser low level after 1 minute (GaAlAs 660 nm, 100 mW, 48 seconds, 160 J/cm²) 48 and 72 hours immediately after treatment, into the same sites of the collection. For microbiological analysis, three periodontal pathogens were assessed by polymerase chain reaction in real time (PCR-real time): Porphyromonas gingivalis (Pg), Prevotella nigrescens (Pn) e Prevotella intermedia (Pi).The statistical analysis was performed (α=5%). Results: Treatments with MTZ + AMX and aPDT promoted improvements in PD, CAL, BOP and VPI parameters after treatment. Patients who received the treatment with aPDT showed a higher reduction of CAL and PD in pockets collected, when compared to SRP only. The aPDT promoted greater reduction in CAL in moderate...