Zucchelli G, Sforza N M, Clauser C, Cesari C, De Sanctis M
Department of Periodontology, Faculty of Odontology, Bologna University, Italy.
J Periodontol. 1999 Mar;70(3):239-47. doi: 10.1902/jop.1999.70.3.239.
Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration (GTR) procedures; conversely, flap connective tissue integration on barrier material improves the clinical outcomes. The objective of this study was to evaluate the effect of topical application of antibiotics on: 1) clinical outcomes of GTR surgical procedures using titanium reinforced expanded polytetrafluoroethylene (ePTFE) periodontal membrane; 2) bacterial colonization of membrane material; and 3) flap connective tissue-membrane integration.
Fifty-six deep interproximal bony defects were treated with GTR surgical procedures using titanium reinforced ePTFE periodontal membranes. Patients were randomly assigned to 1 of the 2 antimicrobial treatment groups: the test group received weekly topical application of 25% metronidazole gel and the control group received systemic antibiotics (amoxicillin plus clavulanic acid 1 g/day for 14 days). Clinical outcomes were assessed at 1 year; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological (SEM) method.
No statistically significant difference was found between test and control groups in terms of clinical attachment (CAL) gain (baseline CAL - 12 months CAL; P = 0.2) and probing depth (PD) reduction (baseline PD - 12 months PD; P = 0.6). A greater increase in gingival recession (REC) (12 months REC - baseline REC) was found in the test group compared to the control group (P = 0.003). The SEM analysis revealed no statistically significant (t test) difference between test and control groups in the number of fields positive to integrated connective tissue (P = 0.82), while the number of fields positive to bacteria was statistically higher (P < 0.001) in the control group.
Local antibiotic administration is more effective than systemic use in preventing membrane contamination, but it does not improve clinical outcomes due to an interference of the vehicle (gel) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load.
膜材料的细菌污染会对引导组织再生（GTR）手术后的愈合产生负面影响；相反，瓣结缔组织与屏障材料的整合可改善临床效果。本研究的目的是评估局部应用抗生素对以下方面的影响：1）使用钛增强型膨体聚四氟乙烯（ePTFE）牙周膜的GTR手术的临床效果；2）膜材料的细菌定植；3）瓣结缔组织与膜的整合。
采用钛增强型ePTFE牙周膜，通过GTR手术治疗56例邻面深部骨缺损。患者被随机分配到2个抗菌治疗组中的1组：试验组每周局部应用25%甲硝唑凝胶，对照组接受全身抗生素治疗（阿莫西林加克拉维酸1g/天，共14天）。在1年时评估临床效果；在取出膜时，通过形态学（扫描电子显微镜）方法评估膜材料上的细菌污染量和结缔组织整合情况。
试验组和对照组在临床附着（CAL）增加量（基线CAL - 12个月CAL；P = 0.2）和探诊深度（PD）减少量（基线PD - 12个月PD；P = 0.6）方面无统计学显著差异。与对照组相比，试验组牙龈退缩（REC）的增加量（12个月REC - 基线REC）更大（P = 0.003）。扫描电子显微镜分析显示，试验组和对照组在整合结缔组织阳性区域数量上无统计学显著差异（t检验，P = 0.82），而对照组细菌阳性区域数量在统计学上更高（P < 0.001）。
局部应用抗生素在预防膜污染方面比全身应用更有效，但由于载体（凝胶）对牙龈组织的干扰，可能会降低更好控制细菌载量所带来的潜在益处，因此并未改善临床效果。
