Tomasi Cristiano, Koutouzis Theofilos, Wennström Jan L
Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
J Periodontol. 2008 Mar;79(3):431-9. doi: 10.1902/jop.2008.070383.
The aim of this study was to evaluate if adjunctive, locally delivered controlled-release doxycycline might improve the outcome of reinstrumentation of pathologic pockets persisting after initial periodontal therapy.
Subjects with chronic periodontitis underwent initial treatment including full-mouth ultrasonic debridement and oral hygiene instructions. At the 3-month reexamination, 32 subjects with remaining pathologic sites were assigned randomly to one of two retreatment protocols: ultrasonic instrumentation alone (control) or ultrasonic instrumentation plus application of an 8.8% doxycycline gel (test). Clinical examinations of plaque, probing depth (PD), relative attachment level (RAL), and bleeding on probing were performed before retreatment (baseline) and after 3 and 9 months. Primary efficacy variables were the percentage of closed pockets, i.e., PD < or =4 mm, and changes in PD and RAL.
Baseline examination revealed no significant difference in mean PD between treatment groups. The mean PD reduction at 3 months was 0.9 mm (95% confidence interval [CI]: 0.6 to 1.2) in the control group and 1.0 mm (95% CI: 0.7 to 1.3) in the test group (P >0.05). At 9 months, both treatment groups showed a mean PD reduction of 1.1 mm. The mean RAL gain was 0.6 mm at 3 months and approximately 0.8 at 9 months for both groups. The probability of pocket closure was not improved by the adjunctive antibiotic therapy. Only factors at the tooth site level (plaque presence, furcation involvement, and presence of an intrabony defect) were identified by multilevel analysis as significant for the treatment outcome.
Locally delivered doxycycline failed to improve the healing outcome of reinstrumentation of periodontal pockets showing a poor initial response to pocket/root debridement.
本研究的目的是评估辅助性局部应用控释多西环素是否能改善初始牙周治疗后仍存在的病理性牙周袋再治疗的效果。
慢性牙周炎患者接受初始治疗，包括全口超声洁治和口腔卫生指导。在3个月复查时，32例仍有病理位点的患者被随机分配到两种再治疗方案之一：单纯超声器械治疗（对照组）或超声器械治疗加应用8.8%多西环素凝胶（试验组）。在再治疗前（基线）以及3个月和9个月后进行菌斑、探诊深度（PD）、相对附着水平（RAL）和探诊出血的临床检查。主要疗效变量为闭合牙周袋的百分比，即PD≤4mm，以及PD和RAL的变化。
基线检查显示治疗组间平均PD无显著差异。对照组3个月时平均PD降低0.9mm（95%置信区间[CI]：0.6至1.2），试验组为1.0mm（95%CI：0.7至1.3）（P>0.05）。9个月时，两组平均PD降低均为1.1mm。两组3个月时平均RAL增加0.6mm，9个月时约为0.8mm。辅助抗生素治疗未提高牙周袋闭合的概率。多水平分析仅确定牙位水平的因素（菌斑存在、根分叉病变和骨内缺损的存在）对治疗结果有显著影响。
局部应用多西环素未能改善对牙周袋/牙根清创初始反应不佳的牙周袋再治疗的愈合效果。
