Cochrane · intervention · CD009376
Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis
Manresa, C, Sanz‐Miralles, EC, Twigg, J, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
18
current version
GRADE rated
7
No studies
9
Included studies
4
as reported
No studies 9 · 50%Ungraded 2 · 11.1%Very low 5 · 27.8%Low 2 · 11.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult participants (18 years or older) previously treated for periodontal disease and now in the maintenance phase; treatment of active disease should have been concluded at least six months prior to randomisation to ensure participants were periodontally stable and compliant | Four studies with 307 participants aged 31 to 85 years, previously treated for moderate to severe chronic periodontitis and recruited from an SPT programme (Preshaw 2005 at least 31 years; Tonetti 2012 at least 35 years; Lulic 2009 and Killeen 2016 at least 40 years) |
| Intervention | SPT performed by periodontal specialists versus non-specialist dental professionals; SPT versus monitoring only, or alternative interventions that do not include mechanical debridement; SPT with and without adjunctive interventions delivered by dental professional or self-administered; SPT performed using different techniques and appliances for mechanical root debridement; SPT provided at different time intervals | SPT performed by specialists (n=1, Preshaw 2005); Mechanical debridement plus local antibiotic (n=2; Killeen 2016 minocycline microspheres, Tonetti 2012 doxycycline gel); Photodynamic therapy as an adjunct to mechanical debridement (n=1, Lulic 2009) |
| Comparison | Non-specialist dental professionals; Monitoring only; Alternative interventions that do not include mechanical debridement; With and without adjunctive interventions; Different techniques and appliances for mechanical root debridement; Different time intervals of SPT | SPT performed by non-specialist clinicians / general dental practitioners (n=1); Mechanical debridement alone (n=3) |
| Outcomes | Primary outcomes: Tooth loss; Bleeding on probing (BoP); Clinical attachment level (CAL); Adverse events. Secondary outcomes: Probing pocket depth (PPD); Patient-reported outcome measures (e.g. satisfaction with treatment); Cost-effectiveness of SPT related to overall dental care with or without SPT; Cost-effectiveness of SPT related to the frequency of SPT | Tooth loss (n=0, not measured); Bleeding on probing (n=2 usable); Clinical attachment level (n=2); Probing pocket depth (n=4); Adverse events (n=2) |
| Study designs | Randomised controlled trials (RCTs) with at least 12 months of follow-up; split-mouth studies with a risk of contamination were excluded | Randomised controlled trials (n=4) |
| Timing | At least 12 months of follow-up. Follow-up was considered as the period of SPT in which the interventions were compared; it started following completion of active periodontal therapy or when participants had already been enrolled in a periodontal maintenance programme | All four studies had a follow-up of at least 12 months |
Search date: 2017-05. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Show all 2 versionsSPT performed by non-specialist clinicians (general dental practitioners under specialist prescription) vs SPT performed by specialists (specialist practice)
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding on probing (%) 12 months | MD 7.40 [-8.12, 22.92] Mean BoP 36.7% (non-specialist) vs Mean BoP was 7.40% higher (8.12 lower to 22.92 higher) | 1 study · 35 participants | Very low Downgraded: risk of bias, imprecision |
Tooth loss | Not measured | 0 studies | No studies |
Probing pocket depth (mm) 12 months | MD 0.20 [-0.40, 0.80] Mean PPD 3.0 mm vs Mean PPD was 0.20 higher (0.40 lower to 0.80 higher) | 1 study · 35 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment loss | Not measured | 0 studies | No studies |
Adverse events | Not measured | 0 studies | No studies |
Supportive periodontal therapy (SPT) including mechanical debridement vs Monitoring only, or alternative interventions that do not include mechanical debridement
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
SPT provided at one time interval vs SPT provided at a different time interval
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
SPT using one technique or appliance for mechanical root debridement vs SPT using a different technique or appliance for mechanical root debridement
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Mechanical debridement plus local antimicrobial (minocycline microspheres or doxycycline gel) vs Mechanical debridement alone
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pocket depth (mm) 12 months | MD -0.10 [-0.59, 0.39] 4.3 mm (control) vs PD was 0.10 mm lower (from 0.59 lower to 0.39 higher) | 1 study · 51 participants | Low Downgraded: risk of bias, imprecision |
Bleeding on probing (ratios) 12 months | OR 0.45 [0.14, 1.52] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events 12 months | See comment. Killeen 2016 reported no adverse events at follow-up examinations in either study arm. Tonetti 2012 reported that there were no serious adverse events. | 2 studies · 251 participants | Ungraded |
Clinical attachment level (mm) 12 months | MD 0.10 [-0.42, 0.62] Change score 4.6 mm (control) vs Change score was 0.10 mm higher (from 0.42 lower to 0.62 higher) | 1 study · 53 participants | Low Downgraded: risk of bias, imprecision |
Tooth loss | Not measured | 0 studies | No studies |
Photodynamic therapy plus mechanical debridement vs Mechanical debridement alone
Population: Adults treated for periodontitis and receiving supportive periodontal therapy (SPT)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding on probing 12 months | Not measured in usable way (Lulic 2009 reported only the percentage of sites with bleeding, with no participant-based measures) | 1 study | Ungraded |
Clinical attachment level (mm) 12 months | MD -0.97 [-3.51, 1.57] 7.76 mm (control) vs 0.97 mm lower (from 3.51 lower to 1.57 higher) | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Tooth loss | Not measured | 0 studies | No studies |
Adverse events | Not measured | 0 studies | No studies |
Probing pocket depth (mm) 12 months | MD -0.09 [-1.41, 1.23] 5.9 mm (control) vs 0.09 mm lower (from 1.41 lower to 1.23 higher) | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |