Department of Surgery and Integrated Clinic, Division of Periodontology, São Paulo State University (Unesp), School of Dentistry, Araçatuba, SP, Brazil.
Department of Surgery and Integrated Clinic, Division of Periodontology, São Paulo State University (Unesp), School of Dentistry, Araçatuba, SP, Brazil.
J Photochem Photobiol B. 2017 Sep;174:364-369. doi: 10.1016/j.jphotobiol.2017.08.012. Epub 2017 Aug 9.
The aim of this study was to compare the clinical effects of Metronidazole (MTZ) combined with Amoxicillin (AMX) and repeated applications of antimicrobial photodynamic therapy (aPDT) as an adjuvant for the treatment of chronic periodontitis.
A double-blind controlled and randomized clinical trial was conducted in 34 patients. All of the patients were treated with scaling and root planing (SRP) and separated into 2 groups: the MTZ+AMX Group (n=17), who received SRP and the systemic use of MTZ (400mg 3×per day for 7days) and AMX (500mg 3×per day for 7days), and the aPDT Group (n=17), who received SRP and three aPDT applications at all sites with a probing depth≥5mm immediately, at 48 and 96h after scaling and placebo pills over the span of 7days. Clinical examinations were performed at baseline and 90days post-therapy. The clinical parameters of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. The aPDT was conducted using methylene blue and a low-level laser (GaAlAs 660nm, 100mW, 48s, and 160J/cm) in all sites with a probing depth≥5mm. A statistical analysis was also performed (α=5%).
There was a significant improvement in CAL only in the intermediate pocket in the aPDT group compared to the MTZ+AMX group between baseline and 90days post-treatment (p=0.01). There was a reduction of both BOP and the percentage of residual pockets at 90days after treatment compared with baseline in both groups (p<0.05).
Both proposed adjuvant therapies associated with conventional mechanical treatment in patients with chronic periodontitis were equally effective in terms of the gain of clinical insertion, control of inflammation and elimination of residual pockets.
本研究旨在比较甲硝唑（MTZ）联合阿莫西林（AMX）与重复应用抗菌光动力疗法（aPDT）作为慢性牙周炎辅助治疗的临床效果。
采用双盲对照随机临床试验，纳入 34 名患者。所有患者均接受牙周洁治术（SRP），并分为 2 组：MTZ+AMX 组（n=17），接受 SRP 联合全身应用 MTZ（400mg，每日 3 次，连用 7 天）和 AMX（500mg，每日 3 次，连用 7 天）；aPDT 组（n=17），在所有探诊深度≥5mm 的位点接受 SRP 及即刻、洁治后 48h 和 96h 三次 aPDT 治疗，同时在 7 天内给予安慰剂。治疗前后分别进行临床检查，测量探诊出血（BOP）、探诊深度（PD）和临床附着水平（CAL）等临床参数。所有探诊深度≥5mm 的位点均采用亚甲蓝和低水平激光（GaAlAs 660nm，100mW，48s，160J/cm）进行 aPDT。采用统计学分析（α=5%）。
与 MTZ+AMX 组相比，aPDT 组仅在中间袋位的 CAL 治疗后 90 天与基线相比有显著改善（p=0.01）。两组治疗后 90 天与基线相比，BOP 和残留袋比例均减少（p<0.05）。
与常规机械治疗联合使用这两种辅助治疗方法均可有效增加临床附着、控制炎症和消除残留袋，在慢性牙周炎患者中疗效相当。
