ABSTRACT
The aim of this systematic review was to evaluate clinical and microbiological outcomes with the use of azithromycin as an adjunct to non-surgical subgingival professional mechanical plaque removal (PMPR) in the treatment of grade C periodontitis. Online database searches using high-level MeSH terms in a PICO structure were conducted along with hand-searching of relevant periodontal journals. Titles and abstracts of identified studies were independently reviewed by both authors and the full texts of studies meeting the inclusion criteria were independently reviewed. In total, 122 studies were identified through searches, of which 6 were included in the qualitative analysis and 4 in the meta-analysis. Three studies included in the meta-analysis were deemed at low risk of bias and 1 at serious risk. There were conflicting results on whether azithromycin reduced the number of subgingival pathogens or detectable subgingival Aggregatibacter actinomycetemcomitans between the included studies. The meta-analysis revealed a statistically significant probing depth reduction difference in favour of azithromycin compared to the control at 3 months (weighted mean difference [WMD]=-0.39 mm; 95% confidence interval [CI], -0.66 to -0.13 mm; I²=0%) and 12 months (WMD=-1.32 mm; 95% CI, -1.71 to -0.93 mm; I²=0%). The clinical attachment level change was also statistically significant in favour of azithromycin compared to the control at 3 months (WMD=-0.61 mm; 95% CI, -1.13 to -0.10 mm; I²=71%) and 12 months (WMD=-0.88 mm; 95% CI, -1.32 to -0.44 mm; I²=0%). Based upon these results, azithromycin offers additional improvements in some clinical parameters when used in conjunction with subgingival PMPR in patients with aggressive periodontitis over control groups. These improvements appear to be maintained for up to 12 months after treatment completion. However, due to a lack of well-designed studies, the conclusions that can be drawn from the available evidence are limited. Trial Registration: International Prospective Register of Systematic Reviews Identifier: CRD42020168195.
ABSTRACT
Aim To investigate the consistency of commissioning and provision of enhanced NHS endodontic services across England.Methods The level of provision for enhanced endodontic services was sought using two methods. An electronic questionnaire was distributed to each of the thirteen director of commissioning operations (DCO) teams in NHS England to determine the perception from commissioners of what endodontic services are currently provided and commissioned. A systematic search to assess what is advertised by enhanced endodontic providers was also carried out to cross-reference with the information gained from electronic questionnaires.Results A 77% response rate to the questionnaire was achieved. Eight out of the ten DCO teams that replied provided enhanced NHS endodontics to a greater or lesser extent, one did not and one was unsure. Three teams did not respond. Providers of services included dentists with enhanced skills, endodontic specialists, and dentists working within district or dental hospitals. Five out of ten DCO teams commissioned level two services and six commissioned level three services. Dental hospital acceptance criteria for enhanced endodontics differ regionally, but most accept level three and some level two complexity treatments, depending upon capacity at the time.Conclusions This investigation demonstrates that although the majority of NHS commissioning areas within England provide enhanced endodontic services, these are not the same across the country. Therefore, patients are not getting equal access to services and it may vary depending upon location.
