Carvalho L H, D'Avila G B, Leão A, Haffajee A D, Socransky S S, Feres M
Department of Periodontology, Federal University of Rio de Janeiro, RJ, Brazil.
J Clin Periodontol. 2004 Dec;31(12):1070-6. doi: 10.1111/j.1600-051X.2004.00605.x.
The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis.
Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova.
A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm.
The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.
本研究评估了单纯龈下刮治术和根面平整术（SRP），或联合全身应用甲硝唑和/或反复进行专业的龈上菌斑清除术，对慢性牙周炎患者的临床疗效。
44名成年牙周炎患者（平均年龄：45±6岁）被随机分为四组；对照组（C，n = 10）接受SRP和安慰剂，三个试验组的治疗如下：试验1（T1）（n = 12）接受SRP和甲硝唑（400mg，每日三次，M）治疗10天；试验2（T2）（n = 12）接受SRP、为期三个月的每周一次专业龈上菌斑清除术（专业清洁（PC））和安慰剂；试验3（T3）（n = 10）接受SRP、M和PC。在基线时以及治疗后90天，测量每颗牙齿六个位点的牙周袋深度（PD）、附着水平（AL）、探诊出血（BOP）以及可见菌斑和化脓情况。使用Wilcoxon检验确定随时间变化差异的显著性，使用协方差分析确定组间差异的显著性。
所有治疗后90天，全口平均临床参数均有降低。基线PD<4mm的位点，对照组平均PD增加，所有治疗组平均AL增加。接受PC作为治疗一部分的患者（T2、T3）中，基线PD为4 - 6mm的位点，PD、AL以及BOP位点百分比均显著降低。接受甲硝唑治疗的患者（T1和T3）在初始PD>6mm的位点显示出最佳临床反应。当联合使用SRP、M和PC时临床获益最大。T3组在初始较浅牙周袋中附着丧失最少。该组在基线PD>4mm的位点，BOP和化脓位点百分比以及平均PD和AL的降低幅度也最大。
数据表明，联合应用SRP、全身应用甲硝唑和每周一次专业龈上菌斑清除术治疗慢性牙周炎具有显著的临床益处。
