Afacan Beral, Çınarcık Serhat, Gürkan Ali, Özdemir Güven, İlhan Harika Atmaca, Vural Caner, Köse Timur, Emingil Gülnur
Department of Periodontology, Faculty of Dentistry, Adnan Menderes University, Aydın, Turkey.
Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey.
J Periodontol. 2020 May;91(5):638-650. doi: 10.1002/JPER.19-0445. Epub 2020 Mar 14.
To compare the effects of full-mouth disinfection (FMD) and full-mouth ultrasonic debridement (FMUD) on clinical, microbiological and biochemical parameters with conventional quadrant-wise scaling and root planning (Q-SRP) in severe chronic periodontitis.
In the present prospective randomized controlled clinical trial with three parallel arms (#NCT04038801), 60 chronic periodontitis patients were randomly assigned to three study groups by a consecutive number in ascending order: FMD (n = 20), FMUD (n = 20), and Q-SRP (n = 20). All measurements and treatments were performed by the same investigator. At baseline, gingival crevicular fluid (GCF) and subgingival plaque were collected and clinical periodontal parameters were recorded. Ultrasonic debridement was completed within 24 hours in FMD and FMUD groups. Chlorhexidine gluconate was used for FMD. Q-SRP was performed by hand instruments per quadrant at 1-week-intervals. Clinical measurements and sampling were repeated at 1, 3, and 6 months after treatment. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Fusobacterium nucleatum, and total bacteria count. GCF Calprotectin, osteocalcin, and N-telopeptide of type I collagen (NTx) levels were analyzed by ELISA. The changes of GCF biomarker levels after treatment between groups were the primary outcomes.
No harm was observed. All treatment strategies resulted in significant improvements in all clinical parameters (P < 0.05), with no significant differences between study groups at all time-points (P ˃ 0.05). Aggregatibacter actinomycetemcomitans was significantly decreased in FMD compared to FMUD and Q-SRP at 6 months (P < 0.05). Although GCF NTx total amounts increased in all groups during the study period, this increase was less prominent in full-mouth groups at three time points after treatment (P < 0.05).
Present results represent the short-term effects. Full-mouth treatment approaches offered limited beneficial effects on microbiological and biochemical parameters over quadrant-wise approach. All three treatment strategies can be recommended in the management of severe chronic periodontitis.
比较全口消毒（FMD）和全口超声清创（FMUD）与传统象限刮治及根面平整术（Q-SRP）对重度慢性牙周炎患者临床、微生物学及生化参数的影响。
在这项具有三个平行组的前瞻性随机对照临床试验（#NCT04038801）中，60例慢性牙周炎患者按升序连续编号随机分为三个研究组：FMD组（n = 20）、FMUD组（n = 20）和Q-SRP组（n = 20）。所有测量和治疗均由同一名研究者进行。基线时，收集龈沟液（GCF）和龈下菌斑并记录临床牙周参数。FMD组和FMUD组在24小时内完成超声清创。FMD组使用葡萄糖酸氯己定。Q-SRP组使用手工器械按象限每隔1周进行一次治疗。治疗后1、3和6个月重复进行临床测量和采样。采用实时聚合酶链反应对伴放线聚集杆菌、牙龈卟啉单胞菌、中间普氏菌、福赛坦纳菌、具核梭杆菌及总细菌计数进行定量分析。通过酶联免疫吸附测定法分析GCF中钙卫蛋白、骨钙素及I型胶原N-末端肽（NTx）水平。各治疗组治疗后GCF生物标志物水平的变化为主要观察指标。
未观察到不良影响。所有治疗策略均使所有临床参数显著改善（P < 0.05），各研究组在所有时间点均无显著差异（P > 0.05）。与FMUD组和Q-SRP组相比，FMD组在6个月时伴放线聚集杆菌显著减少（P < 0.05）。虽然在研究期间所有组GCF中NTx总量均增加，但在治疗后的三个时间点，全口治疗组的增加不太明显（P < 0.05）。
目前的结果代表了短期效果。与象限治疗方法相比，全口治疗方法对微生物学和生化参数的有益影响有限。在重度慢性牙周炎的治疗中，所有三种治疗策略均可推荐使用。
