Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
J Periodontol. 2023 Apr;94(4):498-508. doi: 10.1002/JPER.21-0171. Epub 2023 Jan 30.
Despite the body of evidence supporting the clinical benefits of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of young patients with periodontitis, the microbiological outcomes of this antibiotic protocol have been less explored. This study evaluated the microbiological effects of adjunctive MTZ+AMX in the treatment of young patients with periodontitis.
Subjects with periodontitis Stages III or IV and ≤30 years old were randomly allocated to receive scaling and root planing (SRP) with placebo (n = 15) or with MTZ (400 mg) and AMX (500 mg) three times a day for 14 days (n = 15). Nine subgingival biofilm samples per subject (three samples from each probing depth (PD) category: ≤3, 4-6, and ≥7 mm) were collected at baseline and 3-, 6-, and 12-months post-treatment and individually analyzed for 40 bacterial species by checkerboard DNA-DNA hybridization.
Thirty subjects (15/group) with mean ages 27.6 ± 3.5 (control) and 26.8 ± 3.9 (test) were included. At 12 months post-therapy, the antibiotic group harbored lower proportions of red complex (1.3%) than the placebo group (12.5%) (p < 0.05). SRP + MTZ+AMX was more effective than mechanical treatment in reducing levels/proportions of several pathogens and increasing proportions of Actinomyces species (p < 0.05). Levels/proportions of Aggregatibacter actinomycetemcomitans were only reduced in the antibiotic group (p < 0.05). This group also exhibited greater reduction in the number of sites with PD ≥5 mm and higher percentage of subjects reaching the clinical end point for treatment (≤4 sites with PD ≥5 mm) than the control group (p < 0.05).
SRP+MTZ+AMX allowed for establishing a long-term healthier subgingival biofilm community and periodontal clinical condition, than SRP only.
尽管有大量证据表明甲硝唑（MTZ）和阿莫西林（AMX）在治疗年轻牙周炎患者方面具有临床益处，但这种抗生素方案的微生物学结果尚未得到充分探索。本研究评估了辅助使用 MTZ+AMX 治疗年轻牙周炎患者的微生物学效果。
将牙周炎 III 或 IV 期且年龄≤30 岁的受试者随机分配，接受牙周刮治和根面平整术（SRP），并分别给予安慰剂（n=15）或 MTZ（400mg）和 AMX（500mg），每天三次，共 14 天（n=15）。每个受试者采集 9 个龈下生物膜样本（每个样本来自三个探诊深度（PD）类别：≤3、4-6 和≥7mm），分别在基线和治疗后 3、6 和 12 个月进行分析，采用斑点杂交 DNA-DNA 杂交技术分析 40 种细菌。
30 名受试者（每组 15 名）纳入研究，平均年龄为 27.6±3.5（对照组）和 26.8±3.9（实验组）。治疗后 12 个月，抗生素组的红色复合体比例（1.3%）低于安慰剂组（12.5%）（p<0.05）。与机械治疗相比，SRP+MTZ+AMX 更能有效降低几种病原体的水平/比例，并增加放线菌属物种的比例（p<0.05）。仅在抗生素组中，牙龈卟啉单胞菌的水平/比例降低（p<0.05）。该组在 PD≥5mm 的位点数量减少和达到治疗临床终点（PD≥5mm 的位点数≤4 个）的受试者百分比均高于对照组（p<0.05）。
与单独 SRP 相比，SRP+MTZ+AMX 更能建立长期更健康的龈下生物膜群落和牙周临床状况。
