Serino G, Rosling B, Ramberg P, Hellström M K, Socransky S S, Lindhe J
Department of Periodontology, Institute of Odontology, Göteborg University, Sweden.
J Clin Periodontol. 2001 May;28(5):411-8. doi: 10.1034/j.1600-051x.2001.028005411.x.
Subjects with periodontal disease exist who either (i) respond poorly to initial mechanical therapy ("refractory" periodontitis) or (ii) fail to adopt adequate self-performed plaque control techniques and hence develop recurrent disease ("recurrent" periodontitis) at multiple sites during the supportive treatment phase (SPT). Various systemic antibiotic regimens have been tried as adjuncts to the mechanical (re-) treatment of such "difficult to treat"-patients. While most studies indicated a positive outcome of the adjunctive therapy, some clinical investigators reported that this additional measure provided little or no benefit.
The aim of the present investigation was to study the more long term effect of adjunctive antibiotic therapy in the re-treatment of patients with a well defined history of recurrent periodontitis.
17 subjects with recurrent advanced periodontal disease were, following a baseline examination, subjected to non-surgical therapy including the use of systemic antibiotics (amoxicillin and metronidazole). They were placed in a careful SPT program and re-examined after 1, 3 and 5 years. The examinations included both clinical and microbiological assessments.
It was demonstrated that in subjects with advanced and recurrent periodontitis, re-treatment including (i) comprehensive scaling and root planing (SRP), (ii) systemic administration of antibiotics and (iii) meticulous supragingival plaque control by both mechanical and chemical means established periodontal conditions that in the short term (3 years) and in the majority of subjects could be properly maintained by traditional SPT measures. Between 3 and 5 years, however, only 5 of the 17 subjects exhibited stable periodontal attachment levels.
Some deep pockets and furcations were most likely inadequately instrumented during the active treatment phase. Microorganisms residing in biofilms left in such locations were probably not sufficiently affected by the 2 weeks of adjunctive antibiotic therapy. It is suggested that removal of certain subgingival deposits, therefore, may require surgical intervention.
存在这样一些牙周病患者，他们要么（i）对初始机械治疗反应不佳（“难治性”牙周炎），要么（ii）未能采用足够的自我菌斑控制技术，因此在支持治疗阶段（SPT）多个部位出现复发性疾病（“复发性”牙周炎）。已尝试各种全身抗生素方案作为此类“难治性”患者机械（再）治疗的辅助手段。虽然大多数研究表明辅助治疗有积极效果，但一些临床研究人员报告称，这一额外措施几乎没有益处。
本研究的目的是研究辅助抗生素治疗对有明确复发性牙周炎病史患者再治疗的更长期效果。
17例复发性重度牙周病患者在基线检查后接受非手术治疗，包括使用全身抗生素（阿莫西林和甲硝唑）。他们被纳入精心制定的SPT方案，并在1年、3年和5年后重新检查。检查包括临床和微生物学评估。
结果表明，对于重度复发性牙周炎患者，再治疗包括（i）全面的龈下刮治和根面平整（SRP），（ii）全身应用抗生素，以及（iii）通过机械和化学方法进行细致的龈上菌斑控制，可建立牙周状况，在短期内（3年）且大多数患者中，可通过传统SPT措施适当维持。然而，在3至5年期间，17例患者中只有5例表现出稳定的牙周附着水平。
在积极治疗阶段可能有一些深牙周袋和根分叉未得到充分治疗。存在于这些部位的生物膜中的微生物可能未受到2周辅助抗生素治疗的充分影响。因此，建议去除某些龈下沉积物可能需要手术干预。
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