- Email: [email protected]
Insufficient evidence to claim that photodynamic therapy as an adjunct to scaling and root planing improves periodontal parameters compared with adjunctive antibiotics
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Tahira Devji, BSc, PhD candidate
INSUFFICIENT EVIDENCE TO CLAIM THAT PHOTODYNAMIC THERAPY AS AN ADJUNCT TO SCALING AND ROOT PLANING IMPROVES PERIODONTAL PARAMETERS COMPARED WITH ADJUNCTIVE ANTIBIOTICS
Akram Z, Hyder T, Al-Hamoudi N, et al. Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2017;19:86-92. http:// dx.doi.org/10.1016/j.pdpdt.2017.05.007. Key words. Periodontics; antibiotics; periodontitis; photodynamic therapy; scaling and root planing; systematic review. Clinical relevance. Scaling and root planing (SRP) is the mainstay for nonsurgical periodontal treatment. However, a primary concern with SRP is disease recurrence, which may result from the inability to completely debride root surfaces in deep periodontal pockets and inaccessible furcation defects, as well as incomplete elimination of periopathogenic bacteria. Of particular clinical importance is whether SRP with adjunct treatment can improve periodontal outcomes. Study summary. The authors conducted a systematic review to compare the effects of antibiotic or antimicrobial agents plus SRP with antimicrobial photodynamic therapy plus SRP in patients with chronic or aggressive periodontitis. They searched for clinical trials in 7 electronic databases and periodontal journals through April 2017. They included 5 randomized controlled trials that were published from 2009 through 2016.* Among the randomized controlled trials, the number of participants ranged from 29 to 35, and the follow-up period ranged from 12 to 48 weeks. Metaanalysis showed that antimicrobial photodynamic
therapy plus SRP had an average of 0.60 millimeters more clinical attachment level gainy but was no different in terms of probing pocket depth reduction than antibiotic or antimicrobial agents plus SRP.z Strengths and limitations. The authors had a focused question and used robust methodology—including explicit selection criteria, a comprehensive search, and a rigorous approach—in the study screening and data extraction. The authors’ approach to assessing the risk of bias was inadequately reported,§ making it difficult to make informed judgments about the impact of the risk of bias of the included studies on the results. Unfortunately, our confidence in this evidence is diminished owing to small sample sizes and clinical heterogeneity{ of included trials, resulting in imprecise pooled estimates# and inconsistent results across trials.** Although clinical attachment level gain and probing pocket depth reduction are important to dentists, these outcomes are not meaningful to patients. In addition, these outcomes were reported up to 12 weeks in 3 of the trials and up to 24 weeks in only 1 trial, limiting the applicability of these results to clinical practice. n http://dx.doi.org/10.1016/j.adaj.2017.06.002 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Ms. Devji at e-mail [email protected]. Disclosure. Ms. Devji did not report any disclosures. * Chronic periodontitis (n ¼ 3 studies); aggressive periodontitis (n ¼ 2 studies). y 95% confidence interval, 0.25 to 0.95; n ¼ 4 studies, 129 patients. z Mean difference, 0.67 millimeters; 95% confidence interval, –0.36 to 1.71; n ¼ 4 studies, 129 patients. § The authors reported that risk of bias was considered low in 1 study and unclear in 4 studies. However, the authors’ description of their approach to assessing risk of bias was unclear. { Among included trials, 2 of 5 included patients with aggressive periodontitis; presence or absence of blood in the periodontal pocket was not reported in any of the trials; photosensitizer parameters such as power density, preirradiation time, concentration of photosensitizer, and frequency of application varied considerably or were not reported in some studies. # The upper and lower limits of the confidence interval for clinical attachment level gain had a magnitude of effect that is likely not clinically important. ** Unexplained high heterogeneity (I2 ¼ 87.5%) for the outcome of periodontal probing depth.
JADA
( )
- -
http://jada.ada.org
-
2017 e1
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Tahira Devji, BSc, PhD candidate
INSUFFICIENT EVIDENCE TO CLAIM THAT PHOTODYNAMIC THERAPY AS AN ADJUNCT TO SCALING AND ROOT PLANING IMPROVES PERIODONTAL PARAMETERS COMPARED WITH ADJUNCTIVE ANTIBIOTICS
Akram Z, Hyder T, Al-Hamoudi N, et al. Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2017;19:86-92. http:// dx.doi.org/10.1016/j.pdpdt.2017.05.007. Key words. Periodontics; antibiotics; periodontitis; photodynamic therapy; scaling and root planing; systematic review. Clinical relevance. Scaling and root planing (SRP) is the mainstay for nonsurgical periodontal treatment. However, a primary concern with SRP is disease recurrence, which may result from the inability to completely debride root surfaces in deep periodontal pockets and inaccessible furcation defects, as well as incomplete elimination of periopathogenic bacteria. Of particular clinical importance is whether SRP with adjunct treatment can improve periodontal outcomes. Study summary. The authors conducted a systematic review to compare the effects of antibiotic or antimicrobial agents plus SRP with antimicrobial photodynamic therapy plus SRP in patients with chronic or aggressive periodontitis. They searched for clinical trials in 7 electronic databases and periodontal journals through April 2017. They included 5 randomized controlled trials that were published from 2009 through 2016.* Among the randomized controlled trials, the number of participants ranged from 29 to 35, and the follow-up period ranged from 12 to 48 weeks. Metaanalysis showed that antimicrobial photodynamic
therapy plus SRP had an average of 0.60 millimeters more clinical attachment level gainy but was no different in terms of probing pocket depth reduction than antibiotic or antimicrobial agents plus SRP.z Strengths and limitations. The authors had a focused question and used robust methodology—including explicit selection criteria, a comprehensive search, and a rigorous approach—in the study screening and data extraction. The authors’ approach to assessing the risk of bias was inadequately reported,§ making it difficult to make informed judgments about the impact of the risk of bias of the included studies on the results. Unfortunately, our confidence in this evidence is diminished owing to small sample sizes and clinical heterogeneity{ of included trials, resulting in imprecise pooled estimates# and inconsistent results across trials.** Although clinical attachment level gain and probing pocket depth reduction are important to dentists, these outcomes are not meaningful to patients. In addition, these outcomes were reported up to 12 weeks in 3 of the trials and up to 24 weeks in only 1 trial, limiting the applicability of these results to clinical practice. n http://dx.doi.org/10.1016/j.adaj.2017.06.002 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Ms. Devji at e-mail [email protected]. Disclosure. Ms. Devji did not report any disclosures. * Chronic periodontitis (n ¼ 3 studies); aggressive periodontitis (n ¼ 2 studies). y 95% confidence interval, 0.25 to 0.95; n ¼ 4 studies, 129 patients. z Mean difference, 0.67 millimeters; 95% confidence interval, –0.36 to 1.71; n ¼ 4 studies, 129 patients. § The authors reported that risk of bias was considered low in 1 study and unclear in 4 studies. However, the authors’ description of their approach to assessing risk of bias was unclear. { Among included trials, 2 of 5 included patients with aggressive periodontitis; presence or absence of blood in the periodontal pocket was not reported in any of the trials; photosensitizer parameters such as power density, preirradiation time, concentration of photosensitizer, and frequency of application varied considerably or were not reported in some studies. # The upper and lower limits of the confidence interval for clinical attachment level gain had a magnitude of effect that is likely not clinically important. ** Unexplained high heterogeneity (I2 ¼ 87.5%) for the outcome of periodontal probing depth.
JADA
( )
- -
http://jada.ada.org
-
2017 e1