Gapski Ricardo, Hasturk Hatice, Van Dyke Thomas E, Oringer Richard J, Wang Shufang, Braun Thomas M, Giannobile William V
Michigan Center for Oral Health Research and Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48106, USA.
J Clin Periodontol. 2009 Feb;36(2):149-56. doi: 10.1111/j.1600-051X.2008.01351.x.
This multi-centre, prospective, controlled trial was designed to examine the biological response of the matrix metalloproteinase(MMP) inhibitor subantimicrobial dose doxycycline (SDD) combined with access flap surgery on periodontal wound repair in patients with chronic severe periodontitis.
Seventy subjects were enrolled into a 12-month, randomized, placebo-controlled, double-masked trial to evaluate disease response to 6 months therapy and "wash-out" of either placebo+surgery or SDD (20 mg b.i.d.)+surgery. Primary outcome measure included clinical attachment levels (CAL) and secondary outcomes included probing depth (PD), bleeding on probing (BOP), as well as gingival crevicular fluid bone marker assessment [collagen telopeptides (ICTP)]. These measurements were taken at baseline through 12 months post-surgery and drug administration.
Patients treated with SDD and surgery demonstrated stronger reductions in PD in surgically-treated sites of >or=7 mm as well as gains in CAL (p<0.004). Furthermore, SDD+surgery resulted in short-term reductions in ICTP levels compared with placebo. Rebounds in ICTP levels and clinical parameters occurred when SDD was withdrawn.
The results from this multi-centre study suggests that SDD in combination with surgery improves the short-term response of periodontal therapy by reducing PD, increasing CAL gain and inhibiting early stage bone resorption.
本多中心、前瞻性、对照试验旨在研究基质金属蛋白酶（MMP）抑制剂亚抑菌剂量强力霉素（SDD）联合翻瓣手术对慢性重度牙周炎患者牙周伤口修复的生物学反应。
70名受试者参加了一项为期12个月的随机、安慰剂对照、双盲试验，以评估疾病对6个月治疗以及安慰剂+手术或SDD（每日两次，每次20毫克）+手术的“洗脱期”的反应。主要观察指标包括临床附着水平（CAL），次要观察指标包括探诊深度（PD）、探诊出血（BOP）以及龈沟液骨标志物评估[胶原末端肽（ICTP）]。这些测量在基线时以及手术后和给药后12个月内进行。
接受SDD和手术治疗的患者在手术治疗部位（≥7毫米）的PD降低更为明显，CAL也有所增加（p<0.004）。此外，与安慰剂相比，SDD+手术导致ICTP水平短期降低。停用SDD后，ICTP水平和临床参数出现反弹。
这项多中心研究的结果表明，SDD联合手术通过降低PD、增加CAL增益和抑制早期骨吸收，改善了牙周治疗的短期反应。
