Weiss Malte, Weiss Jana, Müller-Hartwich Ralf, Meier Beate, Jost-Brinkmann Paul-Georg
Department of Orthodontics and Dentofacial Orthopedics, Center for Dental and Craniofacial Sciences, Charité-Universitätsmedizin, Berlin, Germany.
J Orofac Orthop. 2005 Sep;66(5):349-62. doi: 10.1007/s00056-005-0508-2.
The aim of this study is to reduce the caries risk in cleft lip and palate (CLP) patients with multibracket appliances via a compliance-independent method.
PATIENTS, MATERIALS AND METHODS: Sixty-eight CLP patients with multibracket appliances were submitted to professional tooth cleaning at 4-week intervals. After randomization, patients in group A wore a splint filled with chlorhexidine (CHX) gel (Chlorhexamed) for 15 minutes (3 x 5 min) every 12 weeks. Patients in group B were treated with CHX varnish (EC40) every 12 weeks. Fluoride varnish (Fluoridin) was applied to all teeth 4 and 8 weeks after the respective CHX treatments. Regular salivary bacteria counts (CRT) were carried out to determine therapeutic effectiveness. Initial DMFS values were compared to the final ones.
Initial findings of the salivary test and DMFS index confirmed the high caries risk. The DMFS value increased dramatically in both groups despite this systematic prophylaxis program. The bactericidal effect of both CHX preparations turned out to be markedly weaker than that described in the literature.
Though the CHX and fluoride application had a limited effect (at least in this test population), one should keep in mind that it is precisely this population that requires very intensive prophylaxis, and that no antibacterial adjuvant is more effective than CHX. However, the application interval should be individually adapted to the bacteria count.
本研究旨在通过一种与依从性无关的方法降低唇腭裂（CLP）患者使用多托槽矫治器时的龋齿风险。
患者、材料与方法：68例使用多托槽矫治器的CLP患者每4周接受一次专业牙齿清洁。随机分组后，A组患者每12周佩戴一次填充有氯己定（CHX）凝胶（Chlorhexamed）的夹板15分钟（3×5分钟）。B组患者每12周接受一次CHX varnish（EC40）治疗。在各自的CHX治疗后4周和8周，对所有牙齿涂抹氟化物 varnish（Fluoridin）。定期进行唾液细菌计数（CRT）以确定治疗效果。比较初始DMFS值与最终值。
唾液检测和DMFS指数的初始结果证实了高龋齿风险。尽管有这个系统的预防方案，两组的DMFS值仍显著增加。两种CHX制剂的杀菌效果明显弱于文献中描述的效果。
尽管使用CHX和氟化物的效果有限（至少在这个测试人群中如此），但应牢记正是这个人群需要非常强化的预防措施，而且没有比CHX更有效的抗菌佐剂。然而，应用间隔应根据细菌计数进行个体化调整。
