Mascarenhas Paulo, Gapski Ricardo, Al-Shammari Khalaf, Hill Roger, Soehren Stephen, Fenno J Christopher, Giannobile William V, Wang Hom-Lay
Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA.
J Periodontol. 2005 Mar;76(3):426-36. doi: 10.1902/jop.2005.76.3.426.
Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers.
Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months.
The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted.
The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.
抗生素治疗可用于非常特定的牙周治疗情况，例如在吸烟者中更常见的牙周病难治性病例。本研究旨在确定阿奇霉素（AZM）与龈上洁治和根面平整（SRP）联合使用治疗吸烟者中度至重度慢性牙周炎的疗效。
31名受试者参加了一项为期6个月的随机单盲试验，以评估单独使用SRP或SRP + AZM时的临床、微生物学（使用苯甲酰-DL-精氨酸萘胺[BANA]检测）和龈沟液（GCF）中I型胶原吡啶啉交联羧基末端肽（ICTP）水平。在基线时，每天吸烟≥1包且至少有五个探诊深度（PD）≥5 mm且探诊出血（BOP）的部位的患者被随机分为试验组或对照组。在基线、3个月和6个月时，进行临床测量（探诊深度[PD]、临床附着丧失[CAL]和探诊出血[BOP]）。在基线、14天、3个月和6个月时进行GCF骨标志物评估（C末端肽[ICTP]以及BANA检测分析）。
结果表明，两组在PD和CAL方面均有临床改善，且持续6个月。采用基于受试者的分析，接受SRP + AZM治疗的患者在中度（4至6 mm）和深度部位（>6 mm）的PD降低和CAL增加更为明显（P <0.05）。此外，与单独使用SRP相比，SRP + AZM导致BANA水平降低更显著（P <0.05），而在6个月评估时对照组的BANA水平出现反弹。在研究过程中，两组在平均BOP和ICTP水平上没有统计学上的显著差异。
AZM与SRP联合使用可提高非手术牙周治疗在减少吸烟者中度至重度附着丧失患者的探诊深度和改善附着水平方面的疗效。
