Haffajee A D, Uzel N G, Arguello E I, Torresyap G, Guerrero D M, Socransky S S
Department of Periodontology, The Forsyth Institute, Boston, MA, USA.
J Clin Periodontol. 2004 Oct;31(10):869-77. doi: 10.1111/j.1600-051X.2004.00573.x.
The present investigation examined clinical and microbial changes after a combined aggressive antimicrobial therapy in subjects identified as "refractory" to conventional periodontal therapy.
Fourteen subjects were identified as "refractory" based on full-mouth mean attachment loss and/or >3 sites with attachment loss > or =3 mm following scaling and root planing (SRP), periodontal surgery and systemic antibiotics. After baseline monitoring, subjects received SRP, locally delivered tetracycline at pockets > or =4 mm, systemically administered amoxicillin (500 mg, t.i.d. for 14 days)+metronidazole (250 mg, t.i.d. for 14 days) and professional removal of supragingival plaque weekly for 3 months. Subjects were monitored clinically every 3 months post-therapy for 2 years. Subgingival plaque samples were taken at the same time points from the mesial aspect of each tooth and the levels of 40 subgingival taxa were determined using checkerboard DNA-DNA hybridization. Mean levels of each species were averaged within a subject at each visit. Significance of changes in clinical and microbiological parameters over time were evaluated using the Friedman or Wilcoxon signed ranks test.
On average, subjects showed significant improvements in all clinical parameters after therapy. Mean (+/-SEM) full-mouth pocket depth reduction was 0.83+/-0.13 mm and mean attachment level "gain" was 0.44+/-0.12 at 24 months. Clinical improvement was accompanied by major reductions in multiple subgingival species during the first 3 months of active therapy that were maintained for most species to the last monitoring visit. Reductions occurred for three Actinomyces species, "orange complex" species including Campylobacter showae, Eubacterium nodatum, three Fusobacterium nucleatum subspecies, Peptostreptococcus micros, Prevotella intermedia as well as the "Streptococcus milleri" group, Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedus. Subjects differed in their response to therapy; six modest response subjects exhibited less attachment level gain and were characterized by reductions in the microbiota from baseline to 3 months, but re-growth of many species thereafter.
The combined antibacterial therapy was successful in controlling disease progression in 14 "refractory" periodontitis subjects for 2 years.
本研究调查了在被认定为对传统牙周治疗“难治性”的受试者中，联合积极抗菌治疗后的临床和微生物变化。
根据全口平均附着丧失和/或在龈下刮治和根面平整（SRP）、牙周手术及全身使用抗生素后，有超过3个位点的附着丧失≥3mm，确定14名受试者为“难治性”。在基线监测后，受试者接受SRP治疗，在深度≥4mm的牙周袋局部应用四环素，全身给予阿莫西林（500mg，每日3次，共14天）+甲硝唑（250mg，每日3次，共14天），并每周进行专业的龈上菌斑清除，持续3个月。治疗后每3个月对受试者进行一次临床监测，为期2年。在相同时间点从每颗牙齿的近中面采集龈下菌斑样本，使用棋盘式DNA-DNA杂交法测定40种龈下微生物类群的水平。每次就诊时，在受试者个体内对每种微生物的平均水平进行汇总。使用Friedman检验或Wilcoxon符号秩检验评估临床和微生物学参数随时间变化的显著性。
平均而言，治疗后受试者的所有临床参数均有显著改善。在24个月时，全口平均牙周袋深度降低了0.83±0.13mm，平均附着水平“增加”了0.44±0.12。临床改善伴随着在积极治疗的前3个月中多种龈下微生物的大幅减少，且大多数微生物在最后一次监测就诊时仍保持减少状态。以下微生物数量减少：三种放线菌属物种、“橙色复合体”物种，包括昭和弯曲菌、结节真杆菌、具核梭杆菌的三个亚种、微小消化链球菌、中间普氏菌以及“米勒链球菌”组，包括牙龈链球菌、星座链球菌和中间链球菌。受试者对治疗的反应存在差异；6名反应适度的受试者附着水平增加较少，其特征是从基线到3个月微生物群减少，但此后许多物种重新生长。
联合抗菌治疗成功地在14名“难治性”牙周炎受试者中控制疾病进展达2年。
