Kinane D F, Radvar M
Adult Dental Care Department, Glasgow Dental Hospital and School, Scotland, UK.
J Periodontol. 1999 Jan;70(1):1-7. doi: 10.1902/jop.1999.70.1.1.
Currently, several local antimicrobial delivery systems are available to periodontists. The aim of this 6-month follow-up parallel study was to evaluate the efficacy of three commercially available local delivery systems as adjuncts to scaling and root planing in the treatment of sites with persistent periodontal lesions.
Seventy-nine patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized into 4 treatment groups which included: scaling and root planing alone (S) (20 patients), or in conjunction with the application of 25% tetracycline fibers (S+Tet) (19 patients), or 2% minocycline gel (S+Min) (21 patients), or 25% metronidazole gel (S+Met) (19 patients). Clinical measurements were taken at baseline, 6 weeks, 3 months, and 6 months after antimicrobial application. Treatments were applied using the distributors' recommended protocols.
All 4 therapies resulted in significant improvements from baseline in probing depth, attachment level, bleeding on probing, and the Modified Gingival Index (MGI) scores. The improvements in clinical parameters were greater in all 3 adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions at 6 months were: scaling + tetracycline = 1.38 mm; scaling + metronidazole = 0.93 mm; scaling + minocycline = 1.10 mm; and scaling alone = 0.71 mm. The probing depth reduction at all time points was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P<0.01). There was also a significant improvement for scaling plus tetracycline fiber application over scaling and metronidazole at both 6 weeks and 3 months, although this did not remain significant at the 6-month visit. While the frequency of sites with suppuration was markedly reduced following all antimicrobial treatments, the most effective reductions were seen in the scaling plus tetracycline fiber group, followed by the minocycline group.
Although all 3 locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber placement gave the greatest reduction in probing depth over the 6 months after treatment.
目前，牙周病医生可使用多种局部抗菌递送系统。这项为期6个月的随访平行研究旨在评估三种市售局部递送系统作为刮治和根面平整辅助手段治疗持续性牙周病变部位的疗效。
79例有4个深度≥5mm且探诊出血和/或有溢脓牙周袋的患者被随机分为4个治疗组，包括：单纯刮治和根面平整（S组）（20例患者），或联合应用25%四环素纤维（S+Tet组）（19例患者），或2%米诺环素凝胶（S+Min组）（21例患者），或25%甲硝唑凝胶（S+Met组）（19例患者）。在应用抗菌药物后的基线、6周、3个月和6个月进行临床测量。治疗按照经销商推荐的方案进行。
所有4种治疗方法均使探诊深度、附着水平、探诊出血和改良牙龈指数（MGI）评分较基线有显著改善。所有3个辅助治疗组的临床参数改善均大于单纯刮治和根面平整组。6个月时探诊深度的平均减少量为：刮治+四环素=1.38mm；刮治+甲硝唑=0.93mm；刮治+米诺环素=1.10mm；单纯刮治=0.71mm。在所有时间点，刮治加四环素纤维组的探诊深度减少量均显著大于单纯刮治和根面平整组（P<0.01）。在6周和3个月时，刮治加四环素纤维治疗组相对于刮治加甲硝唑组也有显著改善，但在6个月随访时这种差异不再显著。虽然所有抗菌治疗后溢脓部位的频率均明显降低，但最有效的降低见于刮治加四环素纤维组，其次是米诺环素组。
虽然所有3种局部应用的抗菌系统似乎都比单纯刮治和根面平整有一定益处，但在治疗后的6个月内，刮治和根面平整加四环素纤维放置的治疗方案使探诊深度减少最多。
