Tamashiro N S, Duarte P M, Miranda T S, Maciel S S, Figueiredo L C, Faveri M, Feres M
Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
J Dent Res. 2016 Jul;95(7):829-36. doi: 10.1177/0022034516639274. Epub 2016 Mar 24.
The aim of this study was to assess the changes occurring in subgingival biofilm composition and in the periodontal clinical parameters of subjects with periodontitis and type 2 diabetes mellitus (DM) treated by means of scaling and root planing (SRP) only or combined with systemic metronidazole (MTZ) and amoxicillin (AMX). Fifty-eight subjects were randomly assigned to receive SRP only (n = 29) or with MTZ (400 mg/thrice a day [TID]) and AMX (500 mg/TID) (n = 29) for 14 d. Six subgingival plaque samples/subject were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species at baseline and 3 mo, 1 y, and 2 y posttherapy. At 2 y posttherapy, the antibiotic-treated group harbored lower mean proportions (5.5%) of red complex pathogens than the control group (12.1%) (P < 0.05). The proportions of the Actinomyces species remained stable in the antibiotic group but showed a statistically significant reduction in the control group from 1 to 2 y in subjects achieving a low risk clinical profile for future disease progression (i.e., ≤4 sites with probing depth [PD] ≥5 mm). The test group also had a lower mean number of sites with PD ≥5 mm (3.5 ± 3.4) and a higher percentage of subjects reaching the low risk clinical profile (76%) than the control group (14.7 ± 13.1 and 22%, respectively) (P < 0.05) at 2 y posttreatment. MTZ + AMX intake was the only significant predictor of subjects achieving the low risk at 2 y (odds ratio, 20.9; P = 0.0000). In conclusion, the results of this study showed that the adjunctive use of MTZ + AMX improves the microbiological and clinical outcomes of SRP in the treatment of subjects with generalized chronic periodontitis and type 2 DM up to 2 y (ClinicalTrials.gov NCT02135952).
本研究旨在评估仅通过龈下刮治术和根面平整术（SRP）或联合全身应用甲硝唑（MTZ）和阿莫西林（AMX）治疗的牙周炎和2型糖尿病（DM）患者龈下生物膜组成及牙周临床参数的变化。58名受试者被随机分配，仅接受SRP治疗（n = 29）或接受SRP联合MTZ（400 mg/每日三次[TID]）和AMX（500 mg/TID）治疗（n = 29），为期14天。在基线、治疗后3个月、1年和2年时，对每位受试者的6份龈下菌斑样本进行棋盘式DNA-DNA杂交分析，检测40种细菌。治疗后2年，抗生素治疗组红色复合体病原体的平均比例（5.5%）低于对照组（12.1%）（P < 0.05）。放线菌属的比例在抗生素组中保持稳定，但在未来疾病进展风险较低的临床特征患者（即探诊深度[PD]≥5 mm的位点≤4个）中，对照组从1年到2年出现了统计学上的显著下降。治疗后2年，试验组PD≥5 mm的位点平均数量也低于对照组（3.5±3.4），达到低风险临床特征的受试者百分比高于对照组（分别为76%和22%，对照组为14.7±13.1）（P < 0.05）。服用MTZ + AMX是受试者在2年时达到低风险的唯一显著预测因素（比值比，20.9；P = 0.0000）。总之，本研究结果表明，MTZ + AMX的辅助使用可改善SRP在治疗广泛性慢性牙周炎和2型DM患者时的微生物学和临床效果，长达2年（ClinicalTrials.gov NCT02135952）。
