Vest T M, Greenwell H, Drisko C, Wittwer J W, Bichara J, Yancey J, Goldsmith J, Rebitski G
Department of Periodontics, Endodontics and Dental Hygiene, School of Dentistry, University of Louisville, KY 40292, USA.
J Periodontol. 1999 Aug;70(8):878-87. doi: 10.1902/jop.1999.70.8.878.
The purpose of this randomized, controlled, blinded, clinical investigation was to determine the effect of postsurgical antibiotics on osseous healing in Class II furcation defects.
Twenty-four Class II furcation defects in 24 patients were treated with either a polylactide bioabsorbable membrane, demineralized freeze-dried bone allograft (DFDBA) plus antibiotics (GBA or test group) or with a polylactide membrane and DFDBA alone (GB or control group). Twelve patients were included in each group. The antibiotic regimen consisted of ciprofloxacin 250 mg twice daily and metronidazole 250 mg tid for 1 week followed by a 7-week regimen of doxycycline hyclate 50 mg daily. Treatment was performed on either mandibular buccal or lingual, or maxillary buccal Class II furcation defects. Defects were randomly selected by a coin toss for treatment and all open and closed measurements were performed by a blinded examiner. Final open and closed measures from a stent were repeated at the 9-month second stage surgery. Power analysis to determine superiority of antibiotic treatment showed that a 12 per group sample size would yield 93% power to detect a 1.5 mm difference and 64% power to detect a 1 mm difference.
Mean open horizontal probing depth reductions at 9 months were greater for the GBA group than for the GB group (2.92+/-1.78 versus 2.50+/-1.62 mm); however, these differences were not statistically significant. Seven of 12 furcations (58%) in the GBA group demonstrated >50% vertical defect fill at 9 months compared to 8 of 12 furcations (67%) in the GB group. There were no significant differences in mean open horizontal probing depth reduction between smokers and non-smokers in either the GBA or GB groups. Membrane exposure did not appear to affect regenerative healing in either the GBA or GB groups.
The administration of postsurgical antibiotics did not produce statistically superior osseous healing of Class II furcation defects. This result may be attributable to membrane design which facilitates connective tissue ingrowth, thereby preventing bacterial downgrowth and contamination of the newly regenerated tissues.
这项随机、对照、双盲临床研究的目的是确定术后抗生素对Ⅱ类根分叉病变骨愈合的影响。
24例患者的24个Ⅱ类根分叉病变，分别采用聚乳酸生物可吸收膜、脱矿冻干骨同种异体移植物（DFDBA）加抗生素（GBA或试验组）或仅采用聚乳酸膜和DFDBA（GB或对照组）进行治疗。每组纳入12例患者。抗生素治疗方案为环丙沙星250mg，每日2次，甲硝唑250mg，每日3次，共1周，随后7周每日服用50mg盐酸多西环素。治疗在下颌颊侧或舌侧或上颌颊侧Ⅱ类根分叉病变处进行。通过抛硬币随机选择病变进行治疗，所有开放和闭合测量均由一位盲法检查者进行。在9个月的二期手术中，重复对来自支架的最终开放和闭合测量。确定抗生素治疗优越性的效能分析表明，每组12例的样本量将有93%的效能检测出1.5mm的差异，有64%的效能检测出1mm的差异。
9个月时，GBA组平均开放水平探诊深度减少量大于GB组（2.92±1.78对2.50±1.62mm）；然而，这些差异无统计学意义。GBA组12个根分叉中有7个（58%）在9个月时垂直缺损填充>50%，而GB组12个根分叉中有8个（67%）。GBA组或GB组中吸烟者与非吸烟者之间平均开放水平探诊深度减少量无显著差异。在GBA组或GB组中，膜暴露似乎均未影响再生愈合。
术后使用抗生素并未在统计学上使Ⅱ类根分叉病变的骨愈合更优。这一结果可能归因于膜的设计，其有利于结缔组织向内生长，从而防止细菌向下生长和新再生组织的污染。
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