Evidence-based dentistry最新文献

{"title":"Do antibiotics prior to dental extractions reduce adverse post-operative outcomes?","authors":"Darshini Ramasubbu, Jonathan Lewney","doi":"10.1038/s41432-024-01093-5","DOIUrl":"https://doi.org/10.1038/s41432-024-01093-5","url":null,"abstract":"<p><strong>Design: </strong>This retrospective cohort study aimed to investigate whether antibiotic prophylaxis reduced or increased post-operative complications following dental extractions.</p><p><strong>Sample selection: </strong>The cohort included 269,003 patients. In terms of participants, this sample consisted of Veteran Affairs Dental patients, who attended for a dental extraction between 01/01/2015- 31/12/2019. The intervention and comparator was whether or not patients had received an antibiotic prescription prior to their extraction, with the primary outcome a specified post-extraction complication (oral infection, dry socket or fever within 7 days of the extraction). Data was collected on patient demographics, medical history, and details regarding the extraction.</p><p><strong>Data analysis: </strong>Multivariable logistic regression models were used to determine the association between antibiotic prescription prior to extraction and outcomes, alongside a sensitivity analysis that excluded antibiotics prescribed by a medical provider.</p><p><strong>Results: </strong>The cohort included 269003 patients, who attended 385,880 dental visits. During 122,810 visits (31.8%), patients received antibiotics prior to extraction, with amoxicillin the most frequently prescribed. Antibiotics were more commonly prescribed in those who received a surgical extraction. In total, 3387 patients experienced a complication. Of these patients, 1272 had received antibiotics, compared with 2115 who had not. The regression analysis determined that diabetes was a statistically significant modifier of an association. For patients without diabetes, receiving antibiotics increased the odds of a post-extraction complication.</p><p><strong>Conclusions: </strong>In this sample of older people, there was no association between being prescribed antibiotics and post-extraction complications.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of pit & fissure sealant retention using cotton roll & rubber dam isolation techniques - a systematic review & meta-analysis.","authors":"Neha Shukla, Zainab Akram, P G Naveen Kumar, Mahesh R Khairnar, Sachin Kumar Jadhav, Savitha Priyadarsini","doi":"10.1038/s41432-024-01092-6","DOIUrl":"https://doi.org/10.1038/s41432-024-01092-6","url":null,"abstract":"<p><strong>Background: </strong>Isolation with cotton rolls does not always provide as complete isolation as rubber dam, especially in procedures where absolute moisture control is critical. Therefore, this review aims to summarize and analyze previous studies evaluating the retention and marginal integrity of pit & fissure sealant using rubber dam and cotton roll isolation techniques during dental treatment in children.</p><p><strong>Material and methods: </strong>In accordance with PRISMA guidelines, search yielded 1361 articles, with seven RCTs and one non-RCT design meeting the inclusion criteria. Data were extracted on study design, sample size, sealant type, follow-up duration, retention rates, and caries incidence.</p><p><strong>Results: </strong>The comparison of retention rate between rubber dam and cotton roll at six months difference was non-significant (OR:1.15; p = 0.64) while there was significant difference at 12 month (OR:2.23; p < 0.001). The difference for the marginal integrity was statistically significant at six months (OR:2.00; p = 0.03) while non-significant difference observed (OR:1.74; p = 0.10) at 12 months.</p><p><strong>Conclusion: </strong>The sealant placed using a rubber dam as an isolation technique showed higher retention than the cotton roll after 12 months. In terms of marginal integrity, the performance of the rubber dam and cotton roll was equivalent at the end of 12 months.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft and hard tissue changes following immediate implant placement and immediate loading in aesthetic zone-a systematic review and meta-analysis.","authors":"Reetika Gaddale, Ramesh Chowdhary, Sunil K Mishra, Kamal Sagar","doi":"10.1038/s41432-024-01091-7","DOIUrl":"https://doi.org/10.1038/s41432-024-01091-7","url":null,"abstract":"<p><strong>Background: </strong>Type I immediate implant placement has its own advantages like reduced treatment time, number of surgeries and post-extraction bone loss, however, the presence of insufficiently keratinized mucosa poses a challenge for flap adaptation and hinders the achievement of primary stability. Additionally, scientific evidence supports the notion that post-extraction bone loss is a natural biological occurrence that can impact the success of treatments.</p><p><strong>Objectives: </strong>The primary outcome was to find out the hard and soft tissues changes around the implant following immediate placement and immediate loading. The secondary outcome was to record the adverse events post implant placement such as infection during the course of healing and after restoration, implant failure which would include surgical and post restoration, and over- all success and survival rate of implant.</p><p><strong>Material and methods: </strong>A detailed electronic literature search of the articles published in English language was undertaken in October 2023 on online search engines Medline/PubMed and Cochrane databases with no restriction on year of search to include studies on immediate implant placement and loading with a mean follow-up time of at least 1 year. Weighted means of soft and hard tissue changes were obtained by the inverse variance method.</p><p><strong>Results: </strong>A total of 16 studies were included. There was no difference in crestal bone levels in immediate or delayed implant placement with immediate provisionalization in the anterior maxilla. The peri-implant margin remained and no differences in papillary loss was seen when compared to the delayed implant placement cases. Papilla were more stable or showed less recession in flapless approach compared to full thickness flap approach. Among the studies which filled the GAP with bone graft materials, no significant changes were found in the bone level changes. In case of recession, immediate implant placement with provisionalization did result in approximately 1 mm less facial gingival recession compared with that in the group that had a socket graft. Implant related complications occurred more in immediate implant placement and provisionalization compared to delayed group. And almost similar implant success and survival rates were seen in comparison to delayed implant placement groups.</p><p><strong>Conclusions: </strong>Despite the similar implant survival rates observed in comparison to delayed implant placement groups, more long-term studies are necessary to determine the success of immediate implant placement and immediate loading. Special attention has to be given to aesthetic outcomes.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of photobiomodulation with low-level lasers on the acceleration of orthodontic tooth movement: an umbrella review.","authors":"Oscar Mauricio Jiménez-Peña, Nestor Ríos-Osorio, Luz Andrea Velandia-Palacio, Gerardo Gómez-Moreno, Marggie Grajales","doi":"10.1038/s41432-024-01090-8","DOIUrl":"https://doi.org/10.1038/s41432-024-01090-8","url":null,"abstract":"<p><strong>Introduction: </strong>Photobiomodulation (PBM) with low-level laser therapy (LLLT) is a non-invasive method for accelerating orthodontic tooth movement (OTM). Several systematic reviews (SRs) have assessed the effectiveness of LLLT on OTM acceleration. However, the interpretations and analysis of the findings of these SRs are inconclusive and inconsistent due to the substantial heterogeneity of their results, mainly due to the wide variety of parameters employed in the primary studies. This umbrella review (UR) aims to (i) Evaluate and summarize the findings of SRs evaluating the effect of LLLT on OTM acceleration. (ii) Suggest an evidence-based protocol with the most predictable application LLLT parameters for OTM acceleration.</p><p><strong>Methods: </strong>Medline (PubMed), Web of Science, and Scopus were searched from inception to December 2023. AMSTAR-2 and ROBIS were used to evaluate methodological quality and risk of bias respectively.</p><p><strong>Results: </strong>Six SRs met the inclusion criteria. All the SRs suggest that PBM with LLLT tends to be effective in accelerating OTM. However, the high heterogeneity of SRs hinders a precise evaluation of the LLLT's effect on OTM acceleration. The parameters most associated with OTM acceleration are LLLT frequency: At least twice a month, irradiation points: 4-10 points, irradiation time per point: 3-50 s, output power: 20-150 mW, energy density: 5.3 J/cm2 and wavelength range:780-810 nm. The risk of bias assessment identified that 50% of the included SR had a risk of bias ranging from uncertain to high. Similarly, three SRs obtained a \"Critically low-quality\" assessment.</p><p><strong>Conclusions: </strong>Although, all the SRs included in this UR suggest that LLLT may accelerate OTM in comparison to control groups. The primary goal of future studies examining the influence of LLLT on the acceleration of OTM should be to create standardised protocols for the use of LLLT, allowing the development of more predictable therapies. The research protocol was registered on the Prospero CRD42024497420.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of AI-based deep learning models for detecting dental caries on intraoral images - a systematic review.","authors":"Ayesha Noor Uddin, Syed Ahmed Ali, Abhishek Lal, Niha Adnan, Syed Muhammad Faizan Ahmed, Fahad Umer","doi":"10.1038/s41432-024-01089-1","DOIUrl":"https://doi.org/10.1038/s41432-024-01089-1","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aimed to assess the effectiveness of Artificial Intelligence (AI)-based Deep Learning (DL) models in the detection of dental caries on intraoral images.</p><p><strong>Methods: </strong>This systematic review adhered to PRISMA 2020 guidelines conducting an electronic search on PubMed, Scopus, and CENTRAL databases for retrospective, prospective, and cross-sectional studies published till 1st June 2024. Methodological and performance metrics of clinical studies utilizing DL models were assessed. A modified QUADAS risk of bias tool was used for quality assessment.</p><p><strong>Results: </strong>Out of 273 studies identified, a total of 23 were included with 19 studies having a low risk and 4 studies having a high risk of bias. Overall accuracy ranged from 56% to 99.1%, sensitivity ranged from 23% to 98% and specificity ranged from 65.7% to 100%. Only 3 studies utilized explainable AI (XAI) techniques for caries detection. A total of 4 studies exhibited a level 4 deployment status by developing mobile or web-based applications.</p><p><strong>Conclusion: </strong>AI-based DL models have demonstrated promising prospects in enhancing the detection of dental caries, especially in terms of low-resource settings. However, there is a need for future deployed studies to enhance the AI models to improve their real-world applications.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition and oral health-related quality of life (OHRQoL) in older adults: a systematic review and meta-analysis.","authors":"Neha Chauhan, Sarah Paul, Bharathi M Purohit, Ritu Duggal, Harsh Priya, Sasidharan S","doi":"10.1038/s41432-024-01088-2","DOIUrl":"https://doi.org/10.1038/s41432-024-01088-2","url":null,"abstract":"<p><strong>Background: </strong>Understanding the interplay between nutrition and oral health-related quality of life (OHRQoL) in older adults is crucial amidst the global aging population. This systematic review and meta-analysis aimed to explore this association, recognizing the growing prevalence of older individuals and the imperative of addressing their health needs for enhanced well-being.</p><p><strong>Materials and methodology: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were identified through electronic database searches and manual screening. Included were studies investigating the relationship between nutritional status, assessed via the Geriatric Oral Health Assessment Index (GOHAI), and OHRQoL in individuals aged 60 years and older. Quality assessment adhered to Joanna Briggs Institute (JBI) criteria, and statistical analysis was conducted using Comprehensive Meta-Analysis Software Version 3.</p><p><strong>Results: </strong>Out of 566 initial records, 14 full-text articles were assessed, with 4 studies meeting the inclusion criteria for meta-analysis. A consistent association emerged between lower nutritional assessment scores and poor OHRQoL among the older adults. Significant relationships were identified between poor oral health indicators, as measured by GOHAI, and an elevated risk of malnutrition. Particularly noteworthy was the role of negative self-perception of oral health as a significant predictor of nutritional deficits, emphasizing the importance of OHRQoL instruments in complementing clinical measurements.</p><p><strong>Discussion: </strong>The findings underscore the predictive capacity of oral health indicators in assessing nutritional well-being in older individuals. Despite previous studies reporting mixed findings, this review contributes to a comprehensive understanding of the association between nutrition and OHRQoL, highlighting the significance of addressing oral health concerns to enhance overall nutritional outcomes in the older adult population.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis emphasize the significant association between nutrition and OHRQoL among older adults. Highlighting the importance OHRQoL instruments that can complement objective clinical measurements and serve as predictors of malnutrition, particularly among this population. Offering vital insights for stakeholders, policymakers, and public health officials to promote the overall well-being and quality of life of older adults.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did the COVID-19 pandemic impact antibiotic prescribing patterns among dentists?","authors":"Akshani Patel,&nbsp;Satish Kumar","doi":"10.1038/s41432-024-01087-3","DOIUrl":"10.1038/s41432-024-01087-3","url":null,"abstract":"Patient records from Wits Oral Health Centre were collected over two years (March 2019–March 2021). The records were divided into two groups: pre-COVID-19 (March 2019–March 2020) and COVID-19 (March 2020–March 2021). The total sample size was 698 systematically selected patient records who received antibiotics. A systematic random sampling method was used to select a sample of patients who received prescriptions for antibiotics. Patients were included based on their treatment time and need for antibiotic prescription. Patients whose records were missing information or treated by independent private practitioners for whom records access was not feasible were excluded. The extracted data contained information regarding the patients’ demographics, medical histories, dental condition, dental procedure, antibiotic type, frequency, dosage, duration of use, and prescribers’ disciplines. The information was categorized and captured in Microsoft Excel to analyze and create figures and tables. Analysis was performed using descriptive statistics, chi-squared, and z-tests to compare pre-COVID-19 and COVID-19 prescription patterns in RStudio. From an initial pool of 44,067 patient consultations, a systematic random sample of 698 records met the eligibility criteria for inclusion in this study. The sample was divided between pre-COVID-19 (n = 350) and COVID-19 (n = 348). A significant increase in antibiotic prescriptions was found during COVID-19 (1571 prescriptions) compared to pre-COVID-19 (1109 prescriptions). The most commonly prescribed antibiotics were amoxicillin and metronidazole. Specifically, amoxicillin was used in most cases before and during COVID-19. The combination of amoxicillin with metronidazole increased from 16.6% pre-COVID-19 to 24.4% COVID-19. It was found that many of the antibiotics prescribed from both periods were not clinically indicated (53.1% pre-COVID-19 and 54.3% COVID-19). The authors concluded that the COVID-19 pandemic significantly increased antibiotic prescriptions despite fewer in-person consultations. This was likely due to insufficient surgical intervention and reliance on antibiotics to treat dental conditions. The lack of proper antibiotic use raises concerns regarding dental practitioners’ appropriate use of antibiotics. There is an urgent need for improved antibiotic stewardship to prevent the misuse and growing public health issue of antimicrobial resistance.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"208-210"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01087-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotics as adjunct to non-surgical periodontal therapy in diabetic patients","authors":"Lata Goyal,&nbsp;Shipra Gupta,&nbsp;Yeshwanth Perambudhuru","doi":"10.1038/s41432-024-01085-5","DOIUrl":"10.1038/s41432-024-01085-5","url":null,"abstract":"A comprehensive literature search was performed via MEDLINE/PubMed, Scopus, and Web of Science, including all relevant publications accessed on March 2023 and subsequently updated up to July 2024. Additionally, grey literature was searched, and there was no restriction on publication data and languages. All randomized clinical trials comparing topical/systemic antibiotics as an adjunct to scaling and root planning (SRP) with SRP alone for the treatment of diabetic patients with periodontitis were included. Literature reviews, case reports and series, preclinical studies or studies lacking periodontal data were excluded. Clinical attachment level was considered as the primary outcome. Bleeding on probing, pocket depth, and gingival index were the secondary outcomes. The risk of bias was evaluated using the Cochrane Collaboration Tool, and for each domain, bias risk was judged as low, unclear and high risk of bias. Selection, removing duplicates, screening, extracting data, and assessing the quality of studies were done by two investigators and findings were tabulated. Meta-analysis was conducted, generating forest plots to compare different treatment modalities, time periods, and antibiotic types. Key periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP) were analysed. Upon screening and further evaluation of 690 articles, 43 were considered for full-text eligibility. Finally, 30 studies were included in the systematic review, and 27 were included in meta-analysis. Out of 30 randomized clinical trials, 9 studies focused on topical and antibiotics, and 21 involved systemic administration of antibiotics. Five of the nine studies focussing on topical administration of antibiotics, were classified as having a low risk of bias and four as having a high risk of bias. Out of 21 studies on systemic antibiotics, eight were classified as having a low risk of bias, two were undefined, and eleven showed a high risk of bias. Authors concluded that adjunctive use of antibiotics could lead to improvement in periodontal clinical parameters The findings showed that the adjunctive use of antibiotics led to slight improvements in clinical outcomes. However, keeping in mind antibiotic resistance, and side effects of antibiotics, their use should be approached cautiously and only when necessary.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"202-203"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01085-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating antibiotic prophylaxis: insights from a network meta-analysis on dry socket and surgical site infections","authors":"Tayebe Rojhanian,&nbsp;Ahmad Sofi-Mahmudi,&nbsp;Amin Vahdati","doi":"10.1038/s41432-024-01067-7","DOIUrl":"10.1038/s41432-024-01067-7","url":null,"abstract":"Three databases (MEDLINE, Cochrane Library, and Scopus) were searched in December 2021 for 16 Randomised Clinical Trials (RCTs). Three reviewers reviewed the articles on oral antibiotic prophylaxis (ABP) for the prevention of surgical site infection (SSI) and dry socket (DS) after lower third molar (L3M) extraction using the PICO framework. From 1999 to 2021, RCTs involving healthy patients undergoing L3M extraction with ABP, placebo, or no therapy were included. Adverse effects (AEs) associated with antibiotic usage, along with the main outcomes (DS and SSI), were also documented. Three independent investigators selected articles based on pre-established inclusion criteria, with any disagreements resolved by consensus or additional researchers. PRISMA guidelines were followed, involving initial title and abstract screening, followed by full-text evaluation. Exclusion reasons were documented, and the most recent report was included when multiple reports on the same patients were found, with no language restrictions applied. Two investigators evaluated studies quality and quality of evidence respectively using the Cochrane Collaboration tool and GRADEpro GDT. They independently extracted data, focusing on the type of extraction and the number of extracted L3M. They also detailed the use of antibiotics, including dosage, dosage regimen, timing, and duration. Among 16 articles, 15 used a parallel arm design, while one used a crossover design. The antibiotics studied included Amoxicillin+Clavulanic acid (7 articles), Amoxicillin (6), Metronidazole (2), Azithromycin (1), and Clindamycin (2), all compared with no treatment or placebo. A pairwise meta-analysis was used to combine studies with equivalent treatment (direct estimation), and a network meta-analysis compared outcome variables across different treatments (indirect comparison). Two included articles had a low risk of bias and the level of evidence was low according to GRADE. Pooled results supported the use of antibiotics to reduce DS and SSI following L3M extraction with a number needed to treat 25 and 18, respectively. Despite the fact that ABP reduces the risk of DS and SSI, it is recommended to consider systemic conditions and individual patient risk factors before prescribing antibiotics, due to global health threat.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"178-179"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01067-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic antimicrobials as an adjunct in the management of periodontitis – which drug is best?","authors":"Ellis Hayes,&nbsp;Ryan McSorley","doi":"10.1038/s41432-024-01084-6","DOIUrl":"10.1038/s41432-024-01084-6","url":null,"abstract":"This study is a systematic review and meta-analysis that assesses systemic antimicrobials: azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ), as adjuvants to subgingival instrumentation in the treatment of periodontitis. The aim is to establish if one antimicrobial is superior as an adjuvant therapy in the management of periodontal disease. This systematic review and meta-analysis included randomised controlled trials (RCTs), controlled clinical trials, and prospective and retrospective human studies. Participants had to be adults (≥18 years of age) with a diagnosis of periodontitis in the categories: chronic/aggressive, stages II/III, grades B/C. All participants completed full mouth subgingival instrumentation (SI) with the use of adjunct systemic antimicrobial therapy: the intervention group: AZT and the control group: AMX/MTZ. A total of 779 studies were retrieved from the data search; following the application of selection criteria and independent review duplicated by two authors, seven studies were eligible for review. Two studies were subsequently excluded due to insufficient information. Therefore five studies were included in the review, all were self-funded and four were conducted in recognised universities. The primary outcome measure was probing pocket depth changes at 1–12 months. Secondary outcome measures were: the number of residual sites with pocket depths ≥5 mm, clinical attachment levels, bleeding on probing, plaque indices (at 1–12 months), and occurrence of adverse events. Review Manager Software (The Cochrane Collaboration, Copenhagen, Denmark) was used to conduct meta-analysis. Heterogeneity between studies was expected, therefore the random-effects model was utilised to pool results from multiple studies. Statistical heterogeneity was assessed by I2 and Cochrane’s test for heterogeneity. The certainty of evidence was assessed and a summary of GRADE criteria: risk of bias, inconsistency, imprecision, indirectness and publication bias. Bias was graded for the five studies included in this meta-analysis and systematic review. Two studies were low risk, two were moderate risk and one was high risk. The study rated high for risk of bias was due to an incomplete description of blinding. Three of the studies were rated low bias for outcome measurement as they reported blinding of data assessors. No studies had deviations from the intended interventions and all outcomes were detected; therefore, all studies were rated as low bias for these domains. All five of the studies demonstrated changing in probing pocket depths at 1–3 months, however, the intervention and control cohorts showed no significant difference. One study showed a statistically significant difference in probing pocket depths at 12 months, in favour of AZT. This systematic review and meta-analysis demonstrates no statistically significant difference between the two cohorts: AZT and AMX/MTZ for mean changes in clinical attachment level, probing pocket depths","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"198-199"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01084-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}