Occlusal interventions for periodontitis in adults

 

Abstract

Background

Occlusal interventions may be used in adults with periodontitis. At present there is little consensus regarding the indications and effectiveness of occlusal interventions in periodontal patients.

Objectives

To identify and analyse the evidence for the effect of occlusal interventions on adults who have periodontitis in relation to tooth loss, probing depths, clinical attachment level, adverse effects and patient-centred outcomes.

Search methods

The search was last conducted in April 2008. We searched the Cochrane Oral Health Group's Trials Register (to 30th April 2008); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 1); MEDLINE (1966 to 30th April 2008); and EMBASE (1980 to 30th April 2008). There were no language restrictions.

Selection criteria

We included randomised controlled trials (RCTs) assessing occlusal interventions in patients with periodontitis with a follow up of at least 3 months.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Any disagreements between the review authors were resolved by discussion. The main investigator of the included trial was contacted to obtain missing information. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.

Main results

Abstracts of 54 papers were identified by the search. One paper was eligible for inclusion. This paper studied the effect of occlusal adjustment against no occlusal adjustment in patients who were treated with non-surgical and surgical periodontal therapy. Methodological quality assessment of the included paper revealed that randomisation of the patients into the treatment groups was adequate. Allocation concealment, masking of patients and clinicians were not reported and no response to author contact was received.

Mean change in attachment level and mean pocket depth were reported in the included trial. Mean difference in clinical attachment level between occlusal intervention and control in the non-surgical group amounted to 0.38 mm (95% confidence interval (CI) 0.04 to 0.72) favouring the occlusal intervention group and was statistically significant. In the surgical group the mean difference in clinical attachment level between occlusal intervention and control amounted to 0.40 mm (95% CI 0.05 to 0.75) favouring the occlusal intervention group and was also statistically significant. The difference in mean pocket depth reduction between the occlusal intervention and control in both the surgical and non-surgical groups was less than 0.1 mm and was not statistically significant. Tooth loss, patient-centred affects and adverse effects were not reported. Meta-analysis was not possible due to the inclusion of only one study.

Authors' conclusions

There is only one randomised trial that has addressed this question. The data from this study are inconclusive. We therefore conclude there is no evidence for or against the use of occlusal interventions in clinical practice. This question can only be addressed by adequately powered bias-protected randomised controlled trials.

 

Plain language summary

Occlusal interventions for periodontitis in adults

Occlusal overload occurs when excessive force damages the supporting structure of a tooth. Approximately 15% of the world's adult population have advanced gum disease which causes the supporting structure of teeth to be compromised. When occlusal overload occurs at a tooth with advanced gum disease there is uncertainty about whether this is detrimental to achieving gum health. Interventions to reduce the effect of occlusal overload on periodontally compromised teeth are sometimes used. The evidence to support the effectiveness of these interventions is limited. This systematic review looked at the evidence for occlusal interventions in patients with periodontitis and found one randomised controlled trial that met the inclusion criteria. The results of this one trial were inconclusive. The main conclusion from this systematic review is there is no evidence for or against the use of occlusal interventions in clinical practice. There is a clear need for adequately powered bias-protected randomised controlled trials to answer this research question.

 

摘要

背景

對於成年牙周病患者的咬合介入

咬合介入可能會用在成年牙周病患身上。到目前為止，關於牙周病患者進行咬合介入的適應症以及有效性的共識是很少的。

目標

確認及分析對於成年牙周病患進行咬合介入後有關牙齒喪失、探測深度、臨床附連高度、副作用和以病人為中心結果的影響的證據。

搜尋策略

最新一次的搜尋在2008年4月進行，搜尋的資料庫包括the Cochrane Oral Health Group's Trials Register (到2008年4月30日); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 1); MEDLINE (1966年到2008年4月30日)以及EMBASE (1980年到2008年4月30日)，搜尋時沒有語言上的限制。

選擇標準

我們納入評估對於牙周病患者進行咬合介入並至少追蹤觀察3個月的隨機控制試驗(RCTs)。

資料收集與分析

由兩位文獻回顧的作者獨立在副本上審查合格的研究、評估試驗方法的品質和資料萃取，所有文獻回顧作者間的爭議都經由討論解決。過程中與被納入的試驗的主要研究者聯絡以獲得遺失的資訊，資料分析則遵循考科藍合作組織統計準則。

主要結論

這次搜尋發現了54篇文獻摘要，只有1篇文獻合格而被納入。這篇文獻是研究接受非手術或手術性牙周治療的病患是否進行咬合調整的影響。針對這篇文獻進行方法品質的評估顯示病人被分派進入治療群組的隨機性是足夠的。分配隱藏及掩飾病患和醫生的方式並沒有被提到也沒有得到作者的回應。 被納入的文獻中有提到附連高度的平均改變量和平均囊袋深度。在非手術組別中，進行咬合介入及控制組的臨床附連高度平均差異為0.38公厘(95%信賴區間(CI)為0.04到0.72)，進行咬合介入組別的結果是較好的，而且具有統計上的顯著。在手術組別中，進行咬合介入及控制組的臨床附連高度平均差異為0.40公厘(95% CI為0.05到0.75)，進行咬合介入組別的結果是較好的，而且具有統計上的顯著。是否進行咬合介入在平均囊袋深度減少的差異上，手術及非手術組別都少於0.1公厘，而且不具有統計上的顯著。文獻中沒有提到牙齒喪失、以病人為中心的影響和副作用。只有1篇文獻所以無法進行統合分析。

作者結論

只有1個隨機試驗提到這個問題，但這篇研究中的資料是沒有定論的。因此我們總結，沒有足夠的證據支持或反對臨床上使用咬合介入，這個問題只能藉由適當效力且誤差保護的隨機控制試驗來回答。

翻譯人

本摘要由臺灣大學附設醫院沈泰宇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於成年牙周病患者的咬合介入 咬合超負荷發生在過度的力量傷害牙齒支持結構時。全球大約15%的成年人有造成牙齒支持結構破壞的嚴重牙齦疾病，當咬合超負荷發生在具有嚴重牙齦疾病的牙齒上時，無法確定這對達到牙齦健康是不是不利的。有時候會使用一些方法來降低咬合超負荷對於牙周被破壞的牙齒的影響，但是支持這個方法有效性的證據是有限的。這篇系統性回顧著眼於對於牙周病患進行咬合介入的證據並發現1篇隨機控制試驗符合納入標準，但這篇試驗是沒有定論的。這篇系統性回顧的主要結論是沒有證據支持或反對臨床上使用咬合介入，明顯需要適當效力且誤差保護的隨機控制試驗來回答這個研究問題。