The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies.

BACKGROUND: Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. OBJECTIVES: This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. MATERIALS AND METHODS: Placebo-controlled RCTs with ≥6 months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified. RESULTS: Fifty eight studies met the inclusion criteria. After 6 months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83 mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. CONCLUSIONS: Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safety need to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of other host modulators.

Quantifying the outcome of surgical treatment of temporomandibular joint ankylosis: A systematic review and meta-analysis.

INTRODUCTION: Temporomandibular joint ankylosis results in restricted mouth opening due to a fibrous or bony (non-neoplastic) union of the mandibular head to the glenoid fossa. Early surgical treatment is recommended, but the ideal surgical technique is debated. Our objective was to quantify the effect of different surgical interventions on maximal (interincisal) mouth opening. METHODS: The systematic literature search (1960-2015) was based on PubMed, Web of Science and the Cochrane Library. Pooled mean differences and 95% confidence intervals between pre-operative and post-operative maximal mouth opening (in mm) were calculated with random-effects meta-analyses. The surgical interventions were grouped according to increasing complexity: gap arthroplasty, interposition arthroplasty and reconstruction arthroplasty. RESULTS: Thirty-eight articles were identified (1993-2015), including 1215 patients who underwent operations; 84% of the cases were caused by trauma, and 8% by infection. Gap arthroplasty (n=463), interposition arthroplasty (n=409) and reconstruction arthroplasty (n=293) resulted in improved maximal mouth opening of 26.2 mm (95% CI, 24.1-28.2), 26.7 mm (95% CI, 24.6-28.8) and 30.6 mm (95% CI, 28.7-32.5), respectively, and 28.7 mm overall (95% CI, 26.7-29.2). The mean pooled post-operative maximal mouth opening ranged between 33.0 and 36.1 mm. CONCLUSIONS: The maximal mouth opening improved most after reconstruction arthroplasty, and least after gap arthroplasty. However, the post-operative maximal mouth opening was similar for all techniques.

Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.

BACKGROUND: We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults. METHODS: Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I(2) test. FINDINGS: 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98). INTERPRETATION: This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients. FUNDING: None.