Palmer R M, Matthews J P, Wilson R F
Department of Periodontology and Preventive Dentistry, United Medical and Dental School of Guy's Hospital, London, UK.
J Clin Periodontol. 1999 Mar;26(3):158-63. doi: 10.1034/j.1600-051x.1999.260305.x.
To determine whether adjunctive metronidazole therapy would compensate for the poorer treatment response to scaling and root planing reported in smokers.
A single-blind, randomised clinical trial of 28 smokers and 56 non-smokers, stratified for periodontitis disease severity and randomly allocated to 3 treatment groups: (1) Scaling and root planing using an ultrasonic scaler with local anaesthesia (SRP), (2) SRP+ metronidazole tabs 200 mg tds for 7 days, (3) SRP + 2 subgingival applications of 25% metronidazole gel. Probing depths (PD) and attachment levels (AL) were recorded with a Florida probe at baseline, 2 months and 6 months post treatment by a single examiner who was unaware of the treatment modality. Results were analysed for all sites with baseline probing depths equal to or greater than Florida probe recordings of 4.6 mm using analysis of variance.
Reductions in probing depth at 6 months were significantly less (p < 0.001) in the smokers (mean 1.23 mm, 95% confidence intervals = 1.05 to 1.40 mm) than in the non-smokers (1.92, 1.75 to 2.09 mm). Attachment level gains were approximately 0.55 mm and there was no statistically significant difference between smokers and non-smokers. There were no differences in any clinical measure in response to the three treatment regimens at 2 or 6 months for either smokers or non-smokers. A reduction in the proportion of spirochaetes was observed at 6 months which was less in smokers than in non-smokers (p = 0.034). Multiple linear regression analysis on probing depth at 6 months demonstrated that smoking was a significant explanatory factor (p < 0.001) for poor treatment outcome, whilst the presence or absence of adjunctive metronidazole was not (p = 0.620).
This study confirms that smokers have a poorer treatment response to SRP, regardless of the application of either systemic or locally applied adjunctive metronidazole.
确定辅助使用甲硝唑治疗是否能弥补吸烟者对龈下刮治和根面平整治疗反应较差的情况。
一项单盲随机临床试验，纳入28名吸烟者和56名不吸烟者，根据牙周炎疾病严重程度分层，随机分为3个治疗组：（1）使用超声洁牙器并局部麻醉进行龈下刮治和根面平整（SRP）；（2）SRP + 甲硝唑片200 mg，每日3次，共7天；（3）SRP + 2次龈下应用25%甲硝唑凝胶。由一名不知道治疗方式的检查者在基线、治疗后2个月和6个月时，使用佛罗里达探针记录探诊深度（PD）和附着水平（AL）。使用方差分析对所有基线探诊深度等于或大于佛罗里达探针记录的4.6 mm的部位进行结果分析。
吸烟者在6个月时探诊深度的减少（平均1.23 mm，95%置信区间 = 1.05至1.40 mm）明显少于不吸烟者（1.92，1.75至2.09 mm）（p < 0.001）。附着水平增加约0.55 mm，吸烟者和不吸烟者之间无统计学显著差异。吸烟者和不吸烟者在2个月或6个月时，对三种治疗方案的任何临床测量结果均无差异。在6个月时观察到螺旋体比例降低，吸烟者低于不吸烟者（p = 0.034）。对6个月时探诊深度的多元线性回归分析表明，吸烟是治疗效果不佳的一个重要解释因素（p < 0.001），而辅助使用甲硝唑与否并非如此（p = 0.620）。
本研究证实，无论全身性或局部应用辅助甲硝唑，吸烟者对SRP的治疗反应均较差。
