Quirynen M, Mongardini C, de Soete M, Pauwels M, Coucke W, van Eldere J, van Steenberghe D
Department of Periodontology, Catholic University of Leuven, Belgium.
J Clin Periodontol. 2000 Aug;27(8):578-89. doi: 10.1034/j.1600-051x.2000.027008578.x.
BACKGROUND/AIMS: Recent studies reported significant additional clinical and microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard treatment strategy with consecutive root planings quadrant per quadrant. The one stage full-mouth disinfection procedure involves scaling and root planing of all pockets within 24 h in combination with an extensive application of chlorhexidine to all intra-oral niches such as periodontal pockets, tongue dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one stage full-mouth disinfection protocol.
Therefore, 3 groups of 12 patients each with advanced periodontitis were followed, both from a clinical and microbiological point of view, over a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant. at two-week intervals. The 2 other groups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth root planing) the adjunctive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbiological samples were taken from different intra-oral niches (tongue, mucosa, saliva and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media in order to evaluate the number of CFU/ml for the key-periodontopathogens. At baseline, an anonymous questionnaire was given to the patients to record the perception of each treatment (post operative pain, fever, swelling etc.).
All 3 treatment strategies resulted in significant improvements for all clinical parameters, but the Fdis and FRp patients reacted always significantly more favourably than the control group, with an additional probing depth reduction of +/- 1.5 mm and an additional gain in attachment of +/- 2 mm (for pockets > or = 7 mm). Also from a microbiological point of view both the FRp and Fdis patients showed additional improvements when compared to the control group, as well in the reduction of spirochetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differences between FRp and Fdis patients were negligible.
These findings suggest that the benefits of a "one-stage full-mouth disinfection" in the treatment of patients suffering from severe adult periodontitis probably results from the full-mouth scaling and root planing within 24 h rather than the beneficial effect of chlorhexidine. The raise in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.
背景/目的：最近的研究报告称，与逐象限连续进行根面平整的标准治疗策略相比，采用“一次性全口”消毒治疗重度成人牙周炎时，临床和微生物学方面有显著的额外改善。一次性全口消毒程序包括在24小时内对所有牙周袋进行龈下刮治和根面平整，并在所有口腔部位广泛应用洗必泰，如牙周袋、舌背、扁桃体（在诊室内以及在家中使用2个月）。本研究旨在探讨在一次性全口消毒方案中使用洗必泰的相对重要性。
因此，从临床和微生物学角度对3组各12例晚期牙周炎患者进行了为期8个月的随访。对照组患者逐象限进行龈下刮治和根面平整，每隔两周进行一次。另外两组患者进行一次性全口龈下刮治和根面平整（24小时内完成所有牙周袋治疗），其中一组（Fdis）辅助使用洗必泰，另一组（FRp = 全口根面平整）不使用洗必泰。在基线以及1、2、4和8个月后，记录以下临床参数：菌斑指数、牙龈炎指数、探诊深度、探诊出血和临床附着水平。从口腔内不同部位（舌、黏膜、唾液以及单根牙和多根牙的混合样本）采集微生物样本。将样本接种在选择性和非选择性培养基上，以评估关键牙周病原体的每毫升菌落形成单位（CFU/ml）数量。在基线时，向患者发放一份匿名问卷，记录他们对每种治疗的感受（术后疼痛、发热、肿胀等）。
所有3种治疗策略均使所有临床参数有显著改善，但Fdis组和FRp组患者的反应始终比对照组显著更有利，探诊深度额外减少±1.5毫米，附着水平额外增加±2毫米（对于深度≥7毫米的牙周袋）。从微生物学角度来看，与对照组相比，FRp组和Fdis组患者在减少螺旋体和活动菌数量以及关键病原体的CFU/ml数量方面也有额外改善，尤其是在考虑龈下菌斑样本时。FRp组和Fdis组患者之间的差异可忽略不计。
这些发现表明，“一次性全口消毒”在治疗重度成人牙周炎患者中的益处可能源于24小时内完成的全口龈下刮治和根面平整，而非洗必泰的有益作用。全口龈下刮治和根面平整后第二天体温升高似乎表明存在施瓦茨曼反应。
