Abstract：
While it is well-established that patients that develop signs of relapsing periodontitis in supportive periodontal care (SPC) will need to repeat subgingival instrumentation of the residual pockets, less certainty is available in terms of which protocol should be followed and whether the use of adjunctive therapies or physical agents might provide additional benefits to repeated instrumentation alone. The aim of this systematic review was therefore to assess whether repeating subgingival instrumentation in combination with adjunctive therapies (other than antimicrobials) might provide a significant benefit in terms of pocket closure, probing pocket depth (PPD) reduction or clinical attachment level (CAL) gain in patients during SPC with residual/relapsing pockets. Four databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with a minimum follow-up of 3 months that investigated the use of adjunctive therapies (other than antimicrobials) in case of residual/relapsing pockets in patients in SPC since at least 3 months. Data extraction and risk of bias assessment were performed in the studies meeting the inclusion criteria and meta-analysis was performed when ≥3 studies assessing the same adjunctive therapy were identified. 12 studies (2 CCTs and 10 RCTs) were included for qualitative analysis. Meta-analysis was performed only for 3 studies on the adjunctive use of photodynamic therapy (PDT) and it indicated a nonsignificant benefit compared to the placebo in terms of PPD reduction and CAL gain at 3 months (weighted mean difference 0.07 and -0.03, respectively) and at 6 months of follow-up (weighted mean difference -0.09 and -0.18, respectively). While antiseptics did not provide significant benefits, one study on probiotics and one on the use of vitamin D and calcium supplementation showed significant improvements in periodontal parameters. There is currently insufficient/poor evidence to determine the efficacy of adjunctive strategies (other than antimicrobials) to improve the outcomes of SPC in case of residual/relapsing pockets.
摘要：
虽然公认的是，在支持性牙周护理（SPC）中出现复发性牙周炎迹象的患者将需要重复残袋的龈下器械，对于应遵循哪种方案以及使用辅助治疗或物理治疗是否可能仅对重复治疗提供额外益处,尚不确定.因此，本系统评价的目的是评估重复龈下器械联合辅助治疗（抗菌药物除外）是否可以在口袋闭合方面提供显著的益处。在具有残留/复发口袋的SPC期间，患者的探查口袋深度（PPD）减少或临床附着水平（CAL）增加。搜索了四个数据库，以确定至少3个月随访的随机对照试验（RCT）和对照临床试验（CCT），调查了SPC患者在残留/复发口袋中使用辅助疗法（抗菌药物除外）至少3个月。在符合纳入标准的研究中进行数据提取和偏倚风险评估，并在确定≥3项评估相同辅助治疗的研究时进行荟萃分析。包括12项研究（2项CCT和10项RCT）进行定性分析。仅对3项辅助使用光动力疗法（PDT）的研究进行了荟萃分析，与安慰剂相比，在3个月时（加权平均差分别为0.07和-0.03）和随访6个月时（加权平均差分别为-0.09和-0.18），PPD减少和CAL增加方面无明显益处。虽然防腐剂没有提供显著的好处，一项关于益生菌的研究和一项关于使用维生素D和钙补充剂的研究表明，牙周参数显着改善。目前，在残留/复发口袋的情况下，确定辅助策略（抗菌药物除外）改善SPC结果的有效性的证据不足/不足。
