Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados
Ano de defesa: | 2022 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Universidade Federal de Santa Maria
Brasil Odontologia UFSM Programa de Pós-Graduação em Ciências Odontológicas Centro de Ciências da Saúde |
Programa de Pós-Graduação: |
Não Informado pela instituição
|
Departamento: |
Não Informado pela instituição
|
País: |
Não Informado pela instituição
|
Palavras-chave em Português: | |
Link de acesso: | http://repositorio.ufsm.br/handle/1/25865 |
Resumo: | Periodontitis is a chronic, multifactorial disease of an inflammatory nature, caused by a dysbiosis between the oral myrcobioma and the individual host response, clinically characterized by the destruction of dental support tissues. For its treatment, the academy recommends that first an initial approach of supragingival adjustment is carried out, which mainly aims at initial behavioral changes and, if necessary, the control of risk factors. Next, the second approach (related to the cause) is recommended, with professionally performed scaling and subgingival root planing. However, both stages can be delivered simultaneously by the professional, who will manage the patient's behavioral changes during the therapy process. To our knowledge, there is no systematic review that has evaluated randomized clinical trials comparing these two approaches. Therefore, the aim of this systematic review was to answer the following PICOS questions. Focused Question (QF) 1: Does non-surgical periodontal therapy (NSPT) when performed in different stages (1st stage: supragingival approach; second stage: subgingival approach) produce better resultsthan both stages performed simultaneously? QF2: What isthe effect of the supragingival step performed alone (supragingival step only) compared to full NSPT on clinical indicators and patient-centered outcomes? Medline electronic databases / PubMed, Embase, Web of Science, Lilacs and gray literature sources) were searched by randomized clinical trials until May 08, 2022, without language or date restrictions. After screening and eligibility steps, two studies were included for QF1 totaling 77 participants and for QF2 four studies were included, totaling 362 participants. Direct evidence metaanalyses were performed with random effects models. FQ1: No significant difference was found between performing NSPT in different steps or both steps simultaneously, regardless of the clinical indicator evaluated (mean probing depth (PD), clinical attachment level (CAL), mean proportion (%) of sites with bleeding to probing (BOP) or sites with PS ≥ 5 mm. FQ2: NSPT complete was significantly better compared to the supragingival step performed alone in relation to the improvement of mean PD and CAL indicators, proportion (%) from BOP and from sites with PS 4-6 mm PD > 6mm. There are no patient-centered outcomes comparing both approaches. These findings indicate that both stages (supra and subgingival) are necessary for the treatment of patients with periodontitis and that, so far, there is not enough evidence to indicate the superiority of one or another approach in NSPT. However, given the limited number of primary studies performed and low certainty of evidence, definitive conclusions cannot be drawn until further primary studies are conducted. |
id |
UFSM_be97a41bd34219040efe0877eb3d0310 |
---|---|
oai_identifier_str |
oai:repositorio.ufsm.br:1/25865 |
network_acronym_str |
UFSM |
network_name_str |
Manancial - Repositório Digital da UFSM |
repository_id_str |
|
spelling |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizadosEffect of the supragingival step in periodontal therapy: a meta-analysis of controlled clinical trialsPeriodontiteRaspagem supragengivalRaspagem subgengivalRaspagem supragengival + subgengivalPeriodontitisSupragingival shavingSubgingival scrapingSupragingival + subgingival scalingCNPQ::CIENCIAS DA SAUDE::ODONTOLOGIAPeriodontitis is a chronic, multifactorial disease of an inflammatory nature, caused by a dysbiosis between the oral myrcobioma and the individual host response, clinically characterized by the destruction of dental support tissues. For its treatment, the academy recommends that first an initial approach of supragingival adjustment is carried out, which mainly aims at initial behavioral changes and, if necessary, the control of risk factors. Next, the second approach (related to the cause) is recommended, with professionally performed scaling and subgingival root planing. However, both stages can be delivered simultaneously by the professional, who will manage the patient's behavioral changes during the therapy process. To our knowledge, there is no systematic review that has evaluated randomized clinical trials comparing these two approaches. Therefore, the aim of this systematic review was to answer the following PICOS questions. Focused Question (QF) 1: Does non-surgical periodontal therapy (NSPT) when performed in different stages (1st stage: supragingival approach; second stage: subgingival approach) produce better resultsthan both stages performed simultaneously? QF2: What isthe effect of the supragingival step performed alone (supragingival step only) compared to full NSPT on clinical indicators and patient-centered outcomes? Medline electronic databases / PubMed, Embase, Web of Science, Lilacs and gray literature sources) were searched by randomized clinical trials until May 08, 2022, without language or date restrictions. After screening and eligibility steps, two studies were included for QF1 totaling 77 participants and for QF2 four studies were included, totaling 362 participants. Direct evidence metaanalyses were performed with random effects models. FQ1: No significant difference was found between performing NSPT in different steps or both steps simultaneously, regardless of the clinical indicator evaluated (mean probing depth (PD), clinical attachment level (CAL), mean proportion (%) of sites with bleeding to probing (BOP) or sites with PS ≥ 5 mm. FQ2: NSPT complete was significantly better compared to the supragingival step performed alone in relation to the improvement of mean PD and CAL indicators, proportion (%) from BOP and from sites with PS 4-6 mm PD > 6mm. There are no patient-centered outcomes comparing both approaches. These findings indicate that both stages (supra and subgingival) are necessary for the treatment of patients with periodontitis and that, so far, there is not enough evidence to indicate the superiority of one or another approach in NSPT. However, given the limited number of primary studies performed and low certainty of evidence, definitive conclusions cannot be drawn until further primary studies are conducted.A periodontite é uma doença crônica, multifatorial, de natureza inflamatória, causada por uma disbiose entre a mircobiota oral e a resposta individual do hospedeiro, caracterizada clinicamente pela destruição dos tecidos de suporte dentários. Para seu tratamento, a academia preconiza que primeiramente seja realizada uma abordagem inicial de adequação supragengival, a qual visa principalmente mudanças comportamentais iniciais e, se necessário, o controle dos fatores de risco. Na sequência, é recomendada a segunda abordagem (relacionada a causa), com raspagem e alisamento radiculares subgengivais realizadas profissionalmente. Porém, ambas etapas podem ser entregues simultaneamente pelo profissional, o qual manejará as mudanças comportamentais do paciente durante o processo da terapia. De acordo com nosso conhecimento, não há nenhuma revisão sistemática que tenha avaliado ensaios clínicos randomizados comparando estas duas formas de abordagem. Portanto, o objetivo desta revisão sistemática foi responder as seguintes questões PICOS. Questão Focada (QF) 1: A terapia periodontal não-cirúrgica (TPNC) quando realizada em etapas distintas (1ª etapa: abordagem supragengival; segunda etapa: abordagem subgengival) produz melhores resultados do que ambas etapas realizadas simultaneamente? QF2: Qual é o efeito da etapa supragengival realizada isoladamente (apenas a etapa supragengival) em comparação a TPNC completa nos indicadores clínicos e nos desfechos centrados no paciente? As bases de dados eletrônicas Medline / PubMed, Embase, Web of Science, Lilacs e fontes de literatura cinza foram pesquisadas por ensaios clínicos randomizados até 08 de maio de 2022, sem restrições de língua ou data. Após etapas de triagem e elegibilidade, dois estudos foram incluídos para QF1 totalizando 77 participantes e para a QF2 quatro estudos foram incluídos, totalizando 362 participantes. Metanálises de evidências diretas forma realizadas com modelos de efeitos aleatórios. FQ1: Nenhuma diferença significativa foi encontrada entre realizar TPNC em passos distintos ou ambas etapas simultaneamente, independente do indicador clinico avaliado (médias de profundidade de sondagem (PS), de nível de inserção clínico (NIC), proporção média (%) de sítios com sangramento a sondagem (SS) ou de sítios com PS ≥ 5 mm). FQ2: TPNC completa foi significativamente melhor comparada a etapa supragengival realizada isoladamente em relação a melhora dos indicadores de PS e NIC médios, proporção (%) de SS e de sítios com PS 4-6 mm PS > 6mm. Não há desfechos centrados no paciente comparando ambas abordagens. Estes achados apontam que ambas etapas (supra e subgengival) são necessárias para o tratamento de pacientes portadores de periodontite e que, até o momento, não há evidências suficientes para indicar superioridade de uma ou outra forma de abordagem na TPNC. Contudo, dado o limitado número de estudos primários realizados e baixa certeza das evidências, conclusões definitivas não podem ser elaboradas até que novos estudos primários sejam conduzidos.Universidade Federal de Santa MariaBrasilOdontologiaUFSMPrograma de Pós-Graduação em Ciências OdontológicasCentro de Ciências da SaúdeZanatta, Fabricio Batistinhttp://lattes.cnpq.br/0682875622264684Fiorini, TiagoMoreira, Carlos Heitor CunhaOliveira, Cícero Anghinoni de2022-08-11T13:56:01Z2022-08-11T13:56:01Z2022-06-24info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://repositorio.ufsm.br/handle/1/25865porAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSM2022-08-11T13:56:01Zoai:repositorio.ufsm.br:1/25865Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufsm.br/ONGhttps://repositorio.ufsm.br/oai/requestatendimento.sib@ufsm.br||tedebc@gmail.comopendoar:2024-07-29T10:30:07.185144Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)false |
dc.title.none.fl_str_mv |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados Effect of the supragingival step in periodontal therapy: a meta-analysis of controlled clinical trials |
title |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
spellingShingle |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados Oliveira, Cícero Anghinoni de Periodontite Raspagem supragengival Raspagem subgengival Raspagem supragengival + subgengival Periodontitis Supragingival shaving Subgingival scraping Supragingival + subgingival scaling CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA |
title_short |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
title_full |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
title_fullStr |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
title_full_unstemmed |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
title_sort |
Efeito da etapa supragengival na terapia periodontal: uma meta-análise de ensaios clínicos randomizados |
author |
Oliveira, Cícero Anghinoni de |
author_facet |
Oliveira, Cícero Anghinoni de |
author_role |
author |
dc.contributor.none.fl_str_mv |
Zanatta, Fabricio Batistin http://lattes.cnpq.br/0682875622264684 Fiorini, Tiago Moreira, Carlos Heitor Cunha |
dc.contributor.author.fl_str_mv |
Oliveira, Cícero Anghinoni de |
dc.subject.por.fl_str_mv |
Periodontite Raspagem supragengival Raspagem subgengival Raspagem supragengival + subgengival Periodontitis Supragingival shaving Subgingival scraping Supragingival + subgingival scaling CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA |
topic |
Periodontite Raspagem supragengival Raspagem subgengival Raspagem supragengival + subgengival Periodontitis Supragingival shaving Subgingival scraping Supragingival + subgingival scaling CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA |
description |
Periodontitis is a chronic, multifactorial disease of an inflammatory nature, caused by a dysbiosis between the oral myrcobioma and the individual host response, clinically characterized by the destruction of dental support tissues. For its treatment, the academy recommends that first an initial approach of supragingival adjustment is carried out, which mainly aims at initial behavioral changes and, if necessary, the control of risk factors. Next, the second approach (related to the cause) is recommended, with professionally performed scaling and subgingival root planing. However, both stages can be delivered simultaneously by the professional, who will manage the patient's behavioral changes during the therapy process. To our knowledge, there is no systematic review that has evaluated randomized clinical trials comparing these two approaches. Therefore, the aim of this systematic review was to answer the following PICOS questions. Focused Question (QF) 1: Does non-surgical periodontal therapy (NSPT) when performed in different stages (1st stage: supragingival approach; second stage: subgingival approach) produce better resultsthan both stages performed simultaneously? QF2: What isthe effect of the supragingival step performed alone (supragingival step only) compared to full NSPT on clinical indicators and patient-centered outcomes? Medline electronic databases / PubMed, Embase, Web of Science, Lilacs and gray literature sources) were searched by randomized clinical trials until May 08, 2022, without language or date restrictions. After screening and eligibility steps, two studies were included for QF1 totaling 77 participants and for QF2 four studies were included, totaling 362 participants. Direct evidence metaanalyses were performed with random effects models. FQ1: No significant difference was found between performing NSPT in different steps or both steps simultaneously, regardless of the clinical indicator evaluated (mean probing depth (PD), clinical attachment level (CAL), mean proportion (%) of sites with bleeding to probing (BOP) or sites with PS ≥ 5 mm. FQ2: NSPT complete was significantly better compared to the supragingival step performed alone in relation to the improvement of mean PD and CAL indicators, proportion (%) from BOP and from sites with PS 4-6 mm PD > 6mm. There are no patient-centered outcomes comparing both approaches. These findings indicate that both stages (supra and subgingival) are necessary for the treatment of patients with periodontitis and that, so far, there is not enough evidence to indicate the superiority of one or another approach in NSPT. However, given the limited number of primary studies performed and low certainty of evidence, definitive conclusions cannot be drawn until further primary studies are conducted. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-08-11T13:56:01Z 2022-08-11T13:56:01Z 2022-06-24 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/25865 |
url |
http://repositorio.ufsm.br/handle/1/25865 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Odontologia UFSM Programa de Pós-Graduação em Ciências Odontológicas Centro de Ciências da Saúde |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Odontologia UFSM Programa de Pós-Graduação em Ciências Odontológicas Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Manancial - Repositório Digital da UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Manancial - Repositório Digital da UFSM |
collection |
Manancial - Repositório Digital da UFSM |
repository.name.fl_str_mv |
Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
_version_ |
1814349599014387712 |