Cosyn Jan, De Bruyn H, Sabzevar M Moradi
Vrije Universiteit Brussel (VUB), Ecole de Médecine Dentaire, Département de Parodontologie & d'Implantologie Orale, Avenue du Laarbeek 103, B-1090 Bruxelles, Belgique.
Rev Belge Med Dent (1984). 2007;62(4):176-82.
The clinician is frequently faced with poor treatment outcome of scaling and root planing predominantly in deep pockets and furcations. In an attempt to optimize clinical effects at these weakly responding sites chemo-mechanical treatment strategies have been developed and studied, among those using chlorhexidine as an antimicrobial agent. In this overview the clinical effects of subgingival chlorhexidine irrigation, gel, chip and varnish administration as an adjunct to scaling and root planing in the treatment of periodontitis are discussed. There is little to no evidence indicating treatment outcome will benefit from subgingival irrigation using chlorhexidine solutions. Furthermore, the use of a chlorhexidine solution as a coolant during (ultra)sonic scaling does not result in a clinically superior response when compared to water cooling. Despite the high viscosity of a gel, its use cannot be justified in the treatment of periodontitis as clinical effects are also negligible. Multi-center studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of scaling and root planing and the administration of a chlorhexidine chip. As some studies failed to confirm this finding, more research is needed to elucidate the additional value of the chip. The subgingival administration of a supersaturated chlorhexidine varnish seems promising as additive clinical effects have been reported. Large-scale studies are however lacking on this treatment concept. The clinician should continue treating periodontitis primarily by mechanical means. Supplemental chemical therapy based on subgingival chlorhexidine administration can be considered; yet, solutions and gels are not suitable as compensatory aids when scaling and root planing becomes less effective.
临床医生经常面临着刮治和根面平整术治疗效果不佳的问题，主要出现在深牙周袋和根分叉病变中。为了优化这些反应较弱部位的临床效果，人们已经开发并研究了化学机械治疗策略，其中包括使用洗必泰作为抗菌剂。在这篇综述中，讨论了龈下冲洗、凝胶、药膜和含漱液等不同剂型的洗必泰作为辅助手段，联合刮治和根面平整术治疗牙周炎的临床效果。几乎没有证据表明使用洗必泰溶液进行龈下冲洗能改善治疗效果。此外，与水冷相比，在（超声）洁治过程中使用洗必泰溶液作为冷却剂并不会带来更好的临床反应。尽管凝胶具有高粘性，但由于其临床效果也可忽略不计，因此在治疗牙周炎时使用凝胶并无依据。多中心研究表明，刮治和根面平整术联合使用洗必泰药膜后，牙周袋深度显著降低，临床附着水平明显增加。但由于一些研究未能证实这一结果，因此还需要更多研究来阐明药膜的附加价值。有报道称，龈下使用过饱和洗必泰含漱液作为辅助治疗似乎很有前景，但目前缺乏关于这一治疗理念的大规模研究。临床医生仍应主要通过机械方法治疗牙周炎。可以考虑基于龈下使用洗必泰的辅助化学疗法；然而，当刮治和根面平整术效果不佳时，溶液和凝胶并不适合作为补偿辅助手段。
