Evidence-based dentistry最新文献

{"title":"Reevaluating antibiotic prophylaxis: insights from a network meta-analysis on dry socket and surgical site infections","authors":"Tayebe Rojhanian, Ahmad Sofi-Mahmudi, 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, 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}

{"title":"Does adjunctive phototherapy have better outcomes than adjunctive antibiotic therapy for the management of peri-implantitis?","authors":"Jacqueline Fraser, Vithurran Vijayenthiran","doi":"10.1038/s41432-024-01082-8","DOIUrl":"10.1038/s41432-024-01082-8","url":null,"abstract":"Elsevier’s Scopus, Web of Science and Pubmed through Medline identified 431 articles, which were reduced to 206 when duplicates were removed. 8 articles were screened, and 1 excluded after reading the full-text, leaving 7 studies. 6 of these were randomised controlled trials, and 1 a non-randomised controlled clinical trial. Studies selected were either blinded, double-blinded, split-mouth clinical studies, comparative or controlled clinical studies, or randomised controlled trials in humans. There were no limitations on year of publication or language of studies. Most studies had a control of mechanical debridement (MD) with adjuvant antibiotics; 1 was surgical therapy. The test group was MD with adjuvant phototherapy. Exclusions were in vitro reports, animal studies, treatment with sole laser therapy, treatment with no additional antimicrobial therapy alongside MD. Pre-prints, reviews, abstracts, opinion articles, editorials, case reports and case series were also excluded. Data were extracted electronically by a single author and a senior librarian from the 3 databases. Titles and abstracts of articles were screened by the author if they contained Medical Subject Headings either in free terms or with Boolean operators. Full text studies that met the inclusion criteria were included. Data were also searched manually in 6 journals. For missing or conflicting information, the author of the article was contacted for clarification. Data extracted were country of origin of article, study design, sample size, research groups, diagnostic criteria, frequency of intervention, follow-up visits, and outcome of parameters which included clinically: plaque index (PI), probing depth (PD), bleeding on probing (BOP) and radiographically: crestal bone loss (CBL). Additional data on lasers were also collected, although not all studies had complete data on this. RevMan was used for statistical analysis. Inconsistencies were evaluated using I2 value > 50% and Cochrane’s Q test, with a P value < 0.05 considered. Standard Mean Differences (SMD) were calculated and Confidence Interval was set at 95%. A random effects model was used for each meta-analysis. PI had no statistical difference, with high heterogeneity. PD had no statistical difference, with no heterogeneity. BOP had a statistically significant difference and a high level of heterogeneity, favouring adjunctive phototherapy. MBL had statistically non-significant differences between control and test groups, and no heterogeneity. The findings from the systematic review differed from the meta-analysis, suggesting that application of adjuvant phototherapy was equally as effective as adjunctive antibiotic therapy in outcomes such as PI, PD, BOP and MBL. The meta-analysis found that implants treated with adjuvant phototherapy had superior outcomes in relation to BOP only.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"204-205"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01082-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617447","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":"Pondering the problem of peri-implant pathology","authors":"Ajay S. Kotecha, Amelia Nadia Karim","doi":"10.1038/s41432-024-01083-7","DOIUrl":"10.1038/s41432-024-01083-7","url":null,"abstract":"Randomised control trials were identified via searches of PubMed, Embase, Web of Science and The Cochrane Library. Only randomised control trials involving adults with at least a single dental implant which had experienced peri-implant mucositis or peri-implantitis were considered. Within studies, one cohort must have been treated with a combination of mechanical debridement (MD) and non-surgical strategies, and the other solely by mechanical debridement. Outcomes were measured using periodontal indices such as bleeding on probing, and each group needed to comprise minimum five patients. Extracted information included the name of the lead author, size of patient groups, length of follow-up and the main results from the studies. The results indicated that in peri-implantitis the most effective treatment in reducing periodontal pocketing depths (PPDs) was photo biomodulation therapy and MD, while systemic antibiotics and MD were the most effective in improving clinical attachment loss and marginal bone loss. With regards to peri-implant mucositis; probiotics and MD yielded the best improvement in PPDs and plaque index, whereas systemic antibiotics with MD improved bleeding on probing the most. This analysis gives potentially useful data regarding specific treatment combinations for peri-implant disease. In light of this, it may help in guiding clinical decisions, but should be used in conjunction with recognised guidelines, and further high quality primary research is still required in the field.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"200-201"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01083-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617467","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":"Routine antibiotic prophylaxis and early implant failure: is there a link?","authors":"Mojtaba Mehrabanian, Hassan Mivehchi, Mojtaba Dorri","doi":"10.1038/s41432-024-01086-4","DOIUrl":"10.1038/s41432-024-01086-4","url":null,"abstract":"A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30–1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"206-207"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01086-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617549","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":"Bone graft substitutes and dental implant stability in immediate implant surgery: a systematic review and meta-analysis","authors":"Shanthi Vanka, Fatima Abul Kasem, Tasnem Kailani, Othman Wali, Amit Vanka","doi":"10.1038/s41432-024-01077-5","DOIUrl":"10.1038/s41432-024-01077-5","url":null,"abstract":"Implant dentistry is currently being revolutionized by breakthroughs in techniques, technology, and material, there are few systematic reviews and meta-analyses that examine the effects of utilizing different bone graft substitutes in immediate implant placement surgeries. The purpose of this research is to systematically review and meta-analyze the effect that different bone graft substitutes have on implant stability when concurrently utilized in patients undergoing immediate implant surgeries. The PICO criteria were used to construct the focused question, and the systematic review has been outlined as per the PRISMA guidelines. The revised Cochrane risk-of-bias method for randomized trials was used to assess the risk of bias for the selected articles. To derive estimates for the results, random effects meta-analysis was conducted on the selected articles. The electronic databases were searched and a total of 1583 articles were identified. After title and abstract screening and due to problems in retrieval a further 1358 articles were eliminated. Fifteen articles were finally chosen to be qualified for review. Of which full text evaluation of 5 articles were found to meet the eligibility criteria and were therefore included in the systematic review. This systematic review and meta-analysis on the stability of dental implants and bone graft substitutes in immediate implant surgery, was unable to draw any conclusions and established no statistically significant correlation between the different types of grafts used and implant stability.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"70-70"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617445","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":"A systematic review of the implications of lipocalin-2 expression in periodontal disease","authors":"Diana L. Solís-Suárez, Saúl E. Cifuentes-Mendiola, Ana L. García-Hernández","doi":"10.1038/s41432-024-01070-y","DOIUrl":"10.1038/s41432-024-01070-y","url":null,"abstract":"Evidence suggests that lipocalin-2 (LCN-2), a bone-derived protein, is upregulated in periodontal diseases. This systematic review aimed to evaluate LCN-2 concentrations in individuals with periodontal diseases, identifying the most suitable body fluids for its detection, the type of periodontal disease with the highest LCN-2 expression, its association with other inflammatory markers and systemic diseases, and whether its expression can be modified by periodontal treatment. A systematic search of Google Scholar, PubMed, and ProQuest up to August 2024 was conducted. The studies were screened and selected by the authors according to specific eligibility criteria. Quality assessment of the included studies was performed according to the study type using STROBE statement for observational studies or the modified Jadad scale for experimental studies. The review was registered in PROSPERO (CRD42023458565). In total, three thousand six hundred and thirty-eight reports were identified, of which twenty-seven were full-text assessed for eligibility, including eleven articles. Seven articles were observational, and four were experimental. Significantly elevated LCN-2 levels were reported in patients with periodontal disease across 9 studies, being higher in periodontitis rather than gingivitis. LCN-2 was mainly detected in gingival crevicular fluid (GCF) and saliva. LCN-2 expression is related to the increment of inflammatory markers, and periodontal therapy decreases LCN-2 concentrations. LCN-2 levels were aggravated when periodontitis was accompanied by obesity and type 2 diabetes. LCN-2 is implicated in periodontal diseases, probably through the inflammation process.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"69-69"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01070-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617536","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":"Effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients attending dental clinics - a systematic review and meta-analysis","authors":"Greeshma Unnikrishnan, Abhinav Singh, Bharathi M. Purohit","doi":"10.1038/s41432-024-01081-9","DOIUrl":"10.1038/s41432-024-01081-9","url":null,"abstract":"The study aims to compare the effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients visiting dental clinics. A search was conducted in PubMed, Cochrane databases, Scopus, and Google scholar through August 2024. All the randomized control trials, cohort studies, case control, cross-sectional studies that evaluated the effectiveness of behavioural therapy with inhalational/conscious sedation among children and adults to reduce dental anxiety were included. Outcome assessed was change in the dental anxiety scores as measured by the validated tools. PRISMA guidelines were followed for the meta-analysis. Meta-analysis was conducted using Cochrane Review Manager (Revman) version 5.3. Random effects model was used to compare the two groups in reducing dental anxiety. Quality of the studies included was evaluated using the Risk of Bias Assessment tool and Newcastle-Ottawa tool. Heterogeneity was assessed using I2 values. Certainty of evidence was assessed using GRADE pro software. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024581013. A total of 940 participants were included in the analysis. Behavioural therapy was significantly more effective than inhalational sedation in reducing dental anxiety among patients prior to the dental treatment (SMD: −0.87; 95% CI: −1.29 to −0.45; P < 0.0001; I2:78%). Additionally, behavioural therapy demonstrated more effectiveness than inhalational sedation in reducing the dental anxiety among children (SMD: −0.64; 95% CI: −1.16 to −0.11, P = 0.02%; I2:88%). Certainty of evidence was high among the randomized controlled trials and moderate among the observational studies. The findings of this review and meta-analysis suggests that behavioural therapy is more effective than inhalational sedation in reducing dental anxiety specifically among children.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"70-71"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589636","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 hand and rotary instrumentations during biomechanical preparation in primary teeth: an umbrella review with evidence stratification","authors":"Arun Kumar Patnana, Krupal Joshi, Satya Narain, Shantanu Choudhari, Ashwini Agarwal, Pravin Kumar","doi":"10.1038/s41432-024-01080-w","DOIUrl":"10.1038/s41432-024-01080-w","url":null,"abstract":"Biomechanical preparation (BMP) of primary teeth often involves using hand and rotary instruments. This study aimed to assess the effectiveness of hand and rotary instruments during BMP in primary teeth. A thorough search for relevant systematic reviews and meta-analyses (SRMAs) was conducted in four databases, including MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. The primary outcome assessed was the instrumentation time (IT) for BMP, and the identified SRMAs were qualitatively analysed using the ROBIS tool. Furthermore, quantitative analysis, evidence stratification, and GRADE analysis of eligible SRMAs were performed using the browser-based R package metaumbrella software. Six SRMAs addressing the research question were included, with five being evaluated as having a high risk of bias (ROB). The findings indicated that the IT required for BMP in primary teeth was 3.2 min less (95% CI = 1.52 to 4.93; I2 = 96%; P = < 0.001) using rotary instruments compared to hand instruments, with a ‘class IV’ evidence stratification and ‘very low’ class of evidence. Based on the existing evidence, it can be inferred that there is insufficient quality data to recommend the use of rotary instruments over hand instruments in primary teeth.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"71-71"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575645","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":"What role does antibiotic resistance play in secondary endodontic infections?","authors":"Arunika Nehra, Melissa Sin","doi":"10.1038/s41432-024-01079-3","DOIUrl":"10.1038/s41432-024-01079-3","url":null,"abstract":"The systematic review utilised multiple electronic databases to gather relevant literature, including PubMed, Scopus, EMBASE, Web of Science, and Medline. The search was conducted focusing on clinical studies where Enterococcus strains were isolated to assess their antimicrobial resistance. The search strategy was designed based on the PICO model, targeting patients with secondary/persistent endodontic infections (SPEI) and evaluating the resistance profiles of Enterococci to systemic antibiotics. A total of 584 studies were initially identified through database searches. After removing duplicates, 517 studies were excluded based on title and abstract screening, leading to the final inclusion of 11 clinical trials that met the eligibility criteria. The studies were conducted in various countries, including Brazil, Lithuania, Poland, Germany, Sweden, the United States, and Japan. The focus was on permanent teeth with post-treatment apical periodontitis undergoing endodontic retreatment. Data extraction was performed independently by two reviewers, who compiled details such as authorship, year of publication, country of study, sample groups, bacterial strains tested, antibiotics used, and resistance outcomes. The risk of bias was assessed using the ROB-2 platform, and all studies were considered to have a low risk of bias, with occasional minor deficiencies noted. The analysis revealed fluctuating resistance profiles of Enterococcus faecalis (E. faecalis) and Enterococcus faecium (E. faecium) to various antibiotics over time. E. faecalis isolated from teeth with SPEI showed intermediate resistance to 16 antibiotics. The most effective antibiotics identified were the combination of amoxicillin and clavulanate, followed by amoxicillin and benzylpenicillin. In patients with penicillin allergies, moxifloxacin and azithromycin were suggested as alternatives, albeit with caution due to their varying resistance levels. The antibiotics demonstrating the highest resistance patterns against E. faecalis included clindamycin, gentamicin, metronidazole, and rifampicin, which are contraindicated in SPEI cases. Ongoing monitoring of antibiotic resistance patterns is crucial for effective endodontic treatment protocols. The emergence of resistance among Enterococci, particularly E. faecalis, necessitates regular susceptibility testing to inform clinical decisions and improve treatment outcomes. The findings underscore the need for health professionals to stay informed about the evolving resistance landscape to ensure safe and effective therapeutic regimens in endodontics.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"194-195"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01079-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575647","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}