Abstract：
OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome.
BACKGROUND: Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear.
METHODS: A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022).
RESULTS: From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months.
CONCLUSIONS: This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual\'s microbiome affects treatment outcomes after periodontal surgery.
BACKGROUND: Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear.
METHODS: A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022).
RESULTS: From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months.
CONCLUSIONS: This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual\'s microbiome affects treatment outcomes after periodontal surgery.
摘要：
目的：本系统综述和荟萃分析的目的是评估牙周手术对龈下微生物组的影响。
背景：牙周炎是由龈下生物膜的菌群失调引起的牙齿支持组织的慢性炎症。它通过不同的非手术和手术治疗方式进行管理。最近的EFPS3指南建议在第1步和第2步牙周治疗后，将牙周手术作为第3步牙周炎治疗的一部分，目的是实现持续位点的口袋闭合。牙龈下微生物组的变化可以解释在不同时间点观察到的治疗结果。用于疾病相关病原体的各种微生物检测技术已经随着时间的推移而发展,并且已经在文献中进行了描述。然而,不同类型的牙周手术对龈下微生物组的影响尚不清楚。
方法：在Medline进行了系统的文献检索，Embase,LILACS和Cochrane图书馆补充手动搜索（23DEC2019，更新21APR2022）。
结果：从对3046项研究的初步搜索中，根据我们的具体纳入标准，共纳入28项。七种微生物检测技术用于分析龈下菌斑样品中的疾病相关物种：光学显微镜，文化,聚合酶链反应（PCR），棋盘,酶促反应，免疫荧光和16S基因测序。所包括的研究在其方法的各个方面表现出差异，例如龈下菌斑样品收集或治疗方式。临床数据显示，牙周手术后探查袋深度（PPD）和临床附着丧失（CAL）显着降低。微生物学发现是整体异质性的。对所有使用棋盘作为微生物学检测技术的研究的子队列进行荟萃分析。树突密螺旋体的随机效应模型(T.denticola),牙龈卟啉单胞菌(P.牙龈）和连翘坦菌（T.连翘）对牙周手术后3个月的平均计数没有显着影响。值得注意的是,放线菌聚集杆菌（A.放线菌）在牙周手术后3个月显示出显着增加。在一项纳入研究中使用了16S基因测序，并报告了在牙周手术后3个月和6个月，疾病相关物种减少，健康相关物种增加。
结论：本系统综述表明，牙周手术对牙龈下微生物组变化的影响是异质的，可能并不总是与疾病相关物种的减少有关。可变性可归因于用于分析的微生物技术。因此,有必要进行设计良好且足够有力的研究,以了解牙周手术如何影响龈下微生物组,以及个体的微生物组如何影响牙周手术后的治疗结果.
背景：牙周炎是由龈下生物膜的菌群失调引起的牙齿支持组织的慢性炎症。它通过不同的非手术和手术治疗方式进行管理。最近的EFPS3指南建议在第1步和第2步牙周治疗后，将牙周手术作为第3步牙周炎治疗的一部分，目的是实现持续位点的口袋闭合。牙龈下微生物组的变化可以解释在不同时间点观察到的治疗结果。用于疾病相关病原体的各种微生物检测技术已经随着时间的推移而发展,并且已经在文献中进行了描述。然而,不同类型的牙周手术对龈下微生物组的影响尚不清楚。
方法：在Medline进行了系统的文献检索，Embase,LILACS和Cochrane图书馆补充手动搜索（23DEC2019，更新21APR2022）。
结果：从对3046项研究的初步搜索中，根据我们的具体纳入标准，共纳入28项。七种微生物检测技术用于分析龈下菌斑样品中的疾病相关物种：光学显微镜，文化,聚合酶链反应（PCR），棋盘,酶促反应，免疫荧光和16S基因测序。所包括的研究在其方法的各个方面表现出差异，例如龈下菌斑样品收集或治疗方式。临床数据显示，牙周手术后探查袋深度（PPD）和临床附着丧失（CAL）显着降低。微生物学发现是整体异质性的。对所有使用棋盘作为微生物学检测技术的研究的子队列进行荟萃分析。树突密螺旋体的随机效应模型(T.denticola),牙龈卟啉单胞菌(P.牙龈）和连翘坦菌（T.连翘）对牙周手术后3个月的平均计数没有显着影响。值得注意的是,放线菌聚集杆菌（A.放线菌）在牙周手术后3个月显示出显着增加。在一项纳入研究中使用了16S基因测序，并报告了在牙周手术后3个月和6个月，疾病相关物种减少，健康相关物种增加。
结论：本系统综述表明，牙周手术对牙龈下微生物组变化的影响是异质的，可能并不总是与疾病相关物种的减少有关。可变性可归因于用于分析的微生物技术。因此,有必要进行设计良好且足够有力的研究,以了解牙周手术如何影响龈下微生物组,以及个体的微生物组如何影响牙周手术后的治疗结果.
