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  • 學位論文

貝氏網絡統合分析之應用:一次性全口牙根表面整平術對慢性牙周炎之療效

Application of Bayesian network meta-analysis to full-mouth disinfection for the treatment of chronic periodontitis

指導教授 : 杜裕康

摘要


研究背景 近年來,貝氏網絡統合分析之發展在臨床決策上應用的相當廣泛。傳統統合分析僅能做成對比較,然而慢性牙周炎全口牙根表面整平術在臨床上的處理方式不只兩種,並且非所有治療皆有成對比較,因此傳統統合分析已不足應用於醫療現況。貝氏網絡統合分析突破了傳統統合分析的限制,除了將治療之間的比較延伸至多組比較,並考量到單一試驗有多組治療的情況。貝氏網絡統合分析方法使用貝氏學派的架構整合直接證據和間接證據,進而得到多組治療比較的綜觀結論。 研究目的 象限分次全口牙根表面整平術和一次性全口牙根表面整平術為最常見的慢性牙周炎非手術性治療,兩種不同的治療方式有時還會輔以其他治療,像是使用含有chlorhexidine成分的漱口水療程。本研究針對慢性牙周炎全口牙根表面整平術之隨機分派試驗進行貝氏網絡統合分析,目的在於探討各種全口牙根表面整平術之療效。 資料來源 本研究使用Medline、Pubmed、Cochrane CENTRAL以及Embase資料庫實際進行系統性文獻回顧,文獻蒐集的過程不限制文獻發表時間與發表語言直到2015年5月,以囊袋深度以及附連高度的療效作為結果。 研究結果 共有18篇文獻能進入貝氏網絡統合分析,分析結果發現到全口牙根表面整平術之間的差異沒有統計上以及臨床上的顯著性。而囊袋深度的療效以FM-SRP+CHX+F治療方式為最好;術後三個月附連高度的療效以FM-SRP+CHX Varnish為最好,術後六個月附連高度的療效以FM-SRP+CHX為最好。 結論 本研究結果可以得知各種全口牙根表面整平術對慢性牙周炎患者皆為有效的治療。雖然以FM-SRP+CHX+F其囊袋深度療效為最好;FM-SRP+CHX Varnish和FM-SRP+CHX其附連高度療效為最好,但各種全口牙根表面整平術其療效並沒有明顯的差異。

並列摘要


Background Bayesian network meta-analysis has gained widespread popularity in the synthesis of clinical evidence in the recent years. Traditional meta-analysis is limited to pairwise- comparisons, and when more than two treatments to be compared, multiple pairwise comparisons have to be undertaken. However, some direct comparisons among pairs of treatments may not have been conducted, or only very few studies have undertaken direct comparisons. Bayesian network meta-analysis overcomes the limitations of traditional meta-analysis by combining both direct and indirect comparisons of multiple treatments, giving rise consistent estimates of relative effectiveness of multiple treatments. Objectives Quadrant scaling and root planning (Q-SRP) and full-mouth scaling and root planning (FM-SRP) are two common non-surgical treatments for chronic periodontitis. Both have also been used in conjunction with other supplemented materials, such as antimicrobials and mouth rinse. The aim of this study was to conduct Bayesian network meta-analysis of randomized control trials for comparisons of treatment effects of Q-SRP, FM-SRP and their combination therapies. Source of Data A systematic literature search was conducted, on electronic database Medline, Pubmed , Cochrane CENTRAL and Embase with no time and language restriction up to May 2015. Treatment outcomes were changes in probing pocket depth (PPD) and changes in clinical attachment level (CAL). Results A total of 18 studies were included in Bayesian network meta-analysis. We only found small differences among Q-SRP, FM-SRP and their combination therapies and these differences were neither statistically nor clinically significant. In terms of treatment ranking, full-mouth scaling in conjunction with chlorhexidine and fluoride (FM-SRP+CHX+F) had the best performance on PPD reduction, while full-mouth scaling supplement to chlorhexidine Varnish (FM-SRP+CHX Varnish) achieved the greatest CAL reduction at 3 months than other treatments. Full-mouth scaling in conjunction with chlorhexidine (FM-SRP+CHX) had greater CAL reduction at 6 months than other treatments. Conclusions This study did not find substantial differences in benefits of different non-surgical treatment strategies for chronic periodontitis, although are similar. FM-SRP+CHX+F have the best performance on PPD; FM-SRP+CHX Varnish and FM-SRP+CHX have the best performance on CAL.

參考文獻


1. Farman, M. and R.I. Joshi, Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review. Br Dent J, 2008. 205(9): p. E18; discussion 496-7.
2. Eberhard, J., et al., Full-mouth disinfection for the treatment of adult chronic periodontitis (Review). The Cochrane Collaboration, 2012.
3. Lang, N.P., et al., A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis. J Clin Periodontol, 2008. 35(8 Suppl): p. 8-21.
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