光动力疗法辅助治疗种植体周围炎疗效的meta分析

doi:10.19439/j.sjos.2019.03.022

摘要/Abstract

摘要： 目的系统评价光动力疗法（photodynamic therapy,PDT）联合非手术方法治疗种植体周围炎的疗效。方法通过计算机检索 The Cochrane Library、PubMed 、Embase、Web of Science、中国知网、万方数据库、维普期刊数据库及中国生物医学文献数据库发表的期刊文献、会议论文和学位论文,收集建库至2018年4月1日公开发表的关于光动力疗法联合非手术治疗对比单纯非手术治疗种植体周围炎的随机对照试验,2名评价员按照文献纳入、排除标准,独立进行文献筛选、数据提取、质量评价并相互核对后,应用Revman 5.3软件进行meta分析。结果最终有6篇文献符合纳入条件。Meta分析结果显示,PDT联合非手术治疗和单纯非手术治疗相比,3个月后2组附着水平的差异无统计学意义 [WMD=-1.13,95%CI（-3.51,1.25）,P=0.35];3个月后2组的种植体周探诊深度及6个月后2组之间探诊出血指数的差异有统计学意义,分别为[WMD=-0.81,95%CI（-1.52,-0.11）,P=0.02]和[WMD=-5.15, 95%CI（-6.29,-4.01）,P<0.00001]。结论在种植体周围炎的治疗中,PDT联合非手术治疗相比单纯非手术治疗,可对种植体周探诊深度及探诊出血有更为明显的改善,但两者对附着水平改善效果差别不大。

关键词: 光动力疗法, 种植体周围炎, 非手术治疗, meta分析

Abstract: PURPOSE: This meta-analysis was undertaken to evaluate the efficacy of photodynamic therapy (PDT) in combination with non-surgical therapy compared to non-surgical therapy alone for patients with peri-implantitis. Methods: Bibliographic databases including Cochrane Library, PubMed, EMbase, Web of Science, CNKI, VIP, Wanfang Data and CBM were searched from inception to April 1st 2018 , to collect randomized controlled trials (RCTs) of photodynamic therapy in combination with non-surgical therapy and non-surgical therapy alone for peri-implantitis. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality. Then after cross-checking, meta analyses was performed by using RevMan 5.3 software. Meta analysis of probing depth (PD), bleeding on probing(BOP) and clinical attachment level(CAL) was conducted using weighted mean differences (WMD) for continuous data with 95% confidence intervals(CI). Results: Six studies met the inclusion criteria. Meta analysis results showed that compared to non-surgical therapy alone, PDT in combination with non-surgical therapy showed significant differences in PD(WMD=-0.81,95%CI -1.52 to -0.11, P=0.02), BOP(WMD=-5.15, 95%CI -6.29 to -4.01, P<0.00001), but no significant differences in CAL(WMD=-1.13, 95%CI -3.51 to 1.25, P=0.35). Conclusions: In the treatment of peri-implantitis, compared to non-surgical therapy alone, non-surgical therapy with PDT was more effective in reduction of probing depth and probing bleeding, but it did not significantly improve clinical attachment level. For the quantity and quality limitation of the included studies, the conclusion has to be further proved by performing more well-designed and high quality RCTs.

Key words: Photodynamic therapy, Peri-implantitis, Non-surgical therapy, Meta-analysis

中图分类号:

R781.4

谭建苹, 蒋倩, 谭明凤, 周鹏, 张福军. 光动力疗法辅助治疗种植体周围炎疗效的meta分析[J]. 上海口腔医学, 2019, 28(3): 330-336.

TAN Jian-ping, JIANG Qian, TAN Ming-feng, ZHOU Peng, ZHANG Fu-jun. Efficacy of photodynamic therapy for peri-implantitis: A meta-analysis[J]. Shanghai Journal of Stomatology, 2019, 28(3): 330-336.

参考文献

[1] 孟焕新. 牙周病学[M]. 第4版. 北京: 人民卫生出版社, 2012: 327-333.
[2] Hayek RR, Araújo NS, Gioso MA, et al.Comparative study between the effects of photodynamic therapy and conventional therapy on microbial reduction in ligature-induced peri-implantitis in dogs[J]. J Periodontol, 2005, 76(8): 1275-1281.
[3] 于娜. 种植体周围炎的危险因素及其防治新进展[J]. 牙体牙髓牙周病学杂志, 2017, 27(1): 49-52.
[4] 穆月, 李倩, 赵继志. 激光在口腔种植中的应用[J]. 中国医学科学院学报, 2014, 36(5): 203-208.
[5] Kamel MS, Khosa A, Tawse-Smith A, et al.The use of laser therapy for dental implant surface decontamination: a narrative review of in vitro studies[J]. Lasers Med Sci, 2014, 29(6): 1977-1985.
[6] Romanos GE, Gutknecht N, Dieter S, et al.Laser wavelengths and oral implantology[J]. Lasers Med Sci, 2009, 24(6): 961-970.
[7] Maisch T, Szeimies RM, Jori G, et al.Antibacterial photodynamic therapy in dermatology[J]. Photochem Photobiol Sci, 2004, 3(10): 907-917.
[8] Maisch T.Anti-microbial photodynamic therapy: useful in the future?[J]. Lasers Med Sci, 2007, 22(2): 83-91.
[9] Sharman WM, Allen CM, van Lier JE. Photodynamic therapeutics: basic principles and clinical applications[J]. Drug Discov Today, 1999, 4(11): 507-517.
[10] Sculean A, Aoki A, Romanos G, et al.Is Photodynamic therapy an effective treatment for periodontal and peri-implant infections?[J]. Dent Clin North Am, 2015, 59(4): 831-858.
[11] 罗富琴. 光动力治疗中重度痤疮疗效的meta分析[D]. 重庆: 重庆医科大学, 2017.
[12] de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr, et al. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study[J]. J Periodontol, 2007, 78(6): 965-973.
[13] Dds ASG, Ribeiro MS, Tegos GP, et al.Antimicrobial photodynamic therapy combined with conventional endodontic treatment to eliminate root canal biofilm infection[J]. Lasers Surg Med, 2007, 39(1):59-66.
[14] Higgins JP, Thompson SG.Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2010, 21(11): 1539-1558.
[15] Bassetti M, Wicki B, Eick S, et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial[J]. Clin Oral Implants Res, 2014, 25(3): 279-287.
[16] Abduljabbar T.Effect of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant diseases in prediabetic patients[J]. Photodiagnosis Photodyn Ther, 2017, 17: 9-12.
[17] Karimi MR, Hasani A, Khosroshahian S.Efficacy of antimicrobial photodynamic therapy as an adjunctive to mechanical debridement in the treatment of peri-implant diseases: a randomized controlled clinical trial[J]. J Lasers Med Sci, 2016, 7(3): 139-145.
[18] Al Amri MD, Kellesarian SV, Ahmed A, et al.Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in patients with type 2 diabetes mellitus[J]. Photodiagnosis Photodyn Ther, 2016, 14: 166-169.
[19] 李允允, 法永红, 杨永进, 等. 光动力疗法治疗种植体周围炎[J]. 实用口腔医学杂志, 2013, 29(6): 848-851.
[20] 王焱, 麻颖宜, 刘晓晓, 等. 光动力疗法治疗种植体周围炎的短期效果评价[J]. 河南医学研究, 2017, 26(16):2890-2892.
[21] Renvert S, Samuelsson E, Lindahl C, et al.Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study. I: clinical results[J]. J Clin Periodontol, 2009, 36(7): 604-609.
[22] Marotti J, Tortamano P, Cai S, et al.Decontamination of dental implant surfaces by means of photodynamic therapy[J]. Lasers Med Sci, 2013, 28(1): 303-309.
[23] Louropoulou A, Slot DE, Van der Weijden FA. Titanium surface alterations following the use of different mechanical instruments: a systematic review[J]. Clin Oral Implants Res, 2012, 23(6): 643-658.
[24] Mann M, Parmar D, Walmsley AD, et al.Effect of plastic-covered ultrasonic scalers on titanium implant surfaces[J]. Clin Oral Implants Res, 2012, 23(1): 76-82.
[25] Nishijima S, Namura S, Mitsuya K, et al.The incidence of isolation of methicillin-resistant Staphylococcus aureus (MRSA) strains from skin infections during the past three years (1989-1991)[J]. J Dermatol, 1993, 20(4): 193-197.
[26] Fridkin SK.Vancomycin-intermediate and-resistant Staphylococcus aureus: what the infectious disease specialist needs to know[J]. Clin Infect Dis, 2001, 32(1): 108-115.
[27] Wilson M.Lethal photosensitisation of oral bacteria and its potential application in the photodynamic therapy of oral infections[J]. Photochem Photobiol Sci, 2004, 3(5): 412-418.
[28] Sakellari D, Goodson JM, Kolokotronis A, et al.Concentration of 3 tetracyclines in plasma, gingival crevice fluid and saliva[J]. J Clin Periodontol, 2000, 27(1): 53-60.
[29] Sigusch BW, Pfitzner A, Albrecht V, et al.Efficacy of photodynamic therapy on inflammatory signs and two selected periodontopathogenic species in a beagle dog model[J]. J Periodontol, 2005, 76(7):1100-1105.
[30] Bhatti M, Macrobert A, Henderson B, et al.Antibody-targeted lethal photosensitization of Porphyromonas gingivalis[J]. Antimicrob Agents Chemother, 2000, 44(10): 2615-2618.
[31] 李黎波, 李文敏, 项蕾红, 等. 光动力疗法在中国的应用与临床研究[J]. 中国激光医学杂志, 2012, 21(5): 278-307.
[32] Ferro S, Ricchelli F, Mancini G, et al.Inactivation of methicillin-resistant Staphylococcus aureus(MRSA) by liposome-delivered photosensitizing agents[J]. J Photochem Photobiol B, 2006, 83(2): 98-104.
[33] Bassetti M, Wicki B, Eick S, et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial[J]. Clin Oral Implants Res, 2014, 25(3): 279-287.
[34] Javed F, Binshabaib MS, Alharthi SS, et al.Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial[J]. Photodiagnosis Photodyn Ther, 2017, 18: 331-334.
[35] Albaker AM, ArRejaie AS, Alrabiah M, et al. Effect of antimicrobial photodynamic therapy in open flap debridement in the treatment of peri-implantitis: A randomized controlled trial[J]. Photodiagnosis Photodyn Ther, 2018, 23: 71-74.
[36] 葛琳华, 束蓉. 光动力疗法对慢性牙周炎龈下牙周致病菌的影响[J]. 临床口腔医学杂志, 2008, 24(12): 740-743.
[37] Shibli JA, Martins MC, Jr NF, et al.Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary histologic study in dogs[J]. J Periodontol, 2003, 74(3): 338-345.