University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland.
Clin Oral Investig. 2020 Jan;24(1):201-209. doi: 10.1007/s00784-019-02949-2. Epub 2019 May 11.
The objective of this study was to evaluate the benefit of repeated subgingival cleaning with a low-concentrated hypochlorite/amino acid gel in subjects in maintenance care with residual pockets ≥ 5 mm.
Examiner masked, randomized two-arm parallel design. Thirty-two adult periodontal patients in maintenance phase, > 3 months after periodontal therapy, with at least one residual periodontal pocket ≥ 5 mm, were randomly assigned to treatment by subgingival ultrasonic debridement with the gel or ultrasonic debridement only. At months 0, 4, and 8, all sites presenting with a probing depth (PD) ≥ 5 mm were treated. Six sites were monitored on each tooth. The primary end point was the presence or absence of PD ≥ 5 mm after 12 months. Secondary clinical outcomes were oral tissue safety; patient acceptance; changes in PD; bleeding on probing; recession after 4, 8, and 12 months; and the presence or absence of six target microorganisms in treated pockets at baseline, after 7 days and 4 months.
A total of 365 sites in 32 patients with PD ≥ 5 mm were treated at baseline. At the final evaluation at month 12, 47% of these sites in the test and 49% in the control group were still in this PD category. The difference between baseline and month 12 was significant in both groups (p < 0.01), whereas the difference between groups was not. Repeated short ultrasonic instrumentation with adjunctive administration of the test product resulted in a clinical attachment level (CAL) gain of 1.02 mm (p < 0.01) and led to - 0.97 mm of pocket reduction (p < 0.01) without inducing further recession. However, repeated short ultrasonic debridement without the gel led to a similar clinical outcome (p < 0.01). No adverse events were recorded.
Short ultrasonic instrumentation of residual pockets with PD ≥ 5 mm during maintenance visits resulted in a clinically relevant CAL gain and PD reduction in the order of 1 mm in 1 year, without inducing further recession.
This study corroborates the benefit of regular maintenance care after periodontal therapy, including short debridement of the residual pockets.
本研究旨在评估在接受维护治疗后，牙周袋仍有≥5mm 残留的患者中，使用低浓度次氯酸钠/氨基酸凝胶进行重复的龈下清洁的益处。
采用盲法、随机、两臂平行设计。选择牙周治疗后>3 个月、有至少一个≥5mm 牙周袋残留的 32 名成年牙周病患者，随机分为使用凝胶的龈下超声洁治组和仅超声洁治组。在 0、4 和 8 个月时，所有探诊深度（PD）≥5mm 的部位均进行治疗。每颗牙监测 6 个位点。主要终点是治疗 12 个月后 PD≥5mm 的存在或缺失。次要临床结局包括口腔组织安全性；患者接受度；PD 的变化；探诊出血；4、8 和 12 个月后的退缩；以及基线时、治疗后 7 天和 4 个月时治疗袋中 6 种目标微生物的存在或缺失。
共治疗了 32 名患者的 365 个 PD≥5mm 的位点。在 12 个月的最终评估时，试验组和对照组中有 47%和 49%的位点仍处于该 PD 类别。两组的基线和 12 个月时的差异均有统计学意义（p<0.01），但两组之间的差异无统计学意义。使用试验产品辅助重复短时间的超声器械治疗导致临床附着水平（CAL）增加 1.02mm（p<0.01），并导致袋深减少-0.97mm（p<0.01），而不会导致进一步退缩。然而，没有使用凝胶的重复短时间超声洁治也导致了类似的临床效果（p<0.01）。未记录到不良事件。
在维护治疗期间，对 PD≥5mm 的残留牙周袋进行短时间的超声器械治疗，在 1 年内可获得约 1mm 的临床相关 CAL 增加和 PD 减少，而不会导致进一步退缩。
本研究证实了牙周治疗后定期进行维护治疗的益处，包括对残留牙周袋进行短时间的清创。
