Werner Nils, Pitchika Vinay, Heck Katrin, Ern Christina, Heym Richard, Al-Ahmad Ali, Cieplik Fabian, Schwendicke Falk, Bumm Caspar Victor, Folwaczny Matthias
Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany.
Private Practice, Munich, Germany.
Front Oral Health. 2025 May 14;6:1578484. doi: 10.3389/froh.2025.1578484. eCollection 2025.
This study aimed to analyse the impact of different antibiotic regimens during non-surgical periodontal therapy on the microbial load of selected periodontitis-associated bacteria (PAB) and the primary therapy outcomes.
For this aim, 259 patients received steps I and II of periodontal therapy and were included in this clinical trial. 202 patients were treated without the adjunctive use of systemic antibiotics, 18 received amoxicillin (AMOX) as well as metronidazole (MET) and 39 only MET. Subgingival biofilm samples were quantitatively analysed for selected PAB using DNA-DNA-hybridisation-based detection assays for microbial loads of PAB before and 6 months after treatment. Changes in the microbial load of PAB and achievement of a "treat-to-target" endpoint (T2T) (≤4 sites with probing depth ≥5 mm) were analysed. Patients' subgingival microbial load was significantly reduced following therapy.
38.2% of the patients achieved T2T. Binary logistic regression adjusted for confounders indicated a relationship between residual PAB levels and not achieving T2T. In patients not receiving systemic antibiotics a 2.4-fold increased risk of not reaching T2T after steps I and II therapy was observed (none vs. MET aOR = 2.38 = 0.44). Linear regression analysis adjusted for T0 PAB concentration and confounders revealed an increased reduction of PAB levels in patients with systemic antibiotics. No difference in PAB reduction or chance of achieving T2T was observed between MET and MET + AMOX.
Microbial loads of PAB were found directly associated with periodontal status. As antibiotic treatment with both MET and MET + AMOX similarly reduced microbial loads of PAB, treatment with MET alone may be sufficiently effective as adjunctive to non-surgical periodontal treatment. To confirm this, further prospective studies with bigger sample size are needed.
本研究旨在分析非手术牙周治疗期间不同抗生素治疗方案对选定的牙周炎相关细菌（PAB）微生物负荷及主要治疗结果的影响。
为此，259例患者接受了牙周治疗的第一和第二阶段，并被纳入该临床试验。202例患者未辅助使用全身抗生素进行治疗，18例接受阿莫西林（AMOX）联合甲硝唑（MET）治疗，39例仅接受MET治疗。使用基于DNA-DNA杂交的检测方法，对治疗前和治疗后6个月的龈下生物膜样本进行定量分析，以检测选定的PAB的微生物负荷。分析PAB微生物负荷的变化以及“治疗至目标”终点（T2T）（探诊深度≥5 mm的位点≤4个）的达成情况。治疗后患者的龈下微生物负荷显著降低。
38.2%的患者达到了T2T。经混杂因素调整的二元逻辑回归表明，残余PAB水平与未达到T2T之间存在关联。在未接受全身抗生素治疗的患者中，观察到在第一和第二阶段治疗后未达到T2T的风险增加了2.4倍（无抗生素治疗组与MET治疗组相比，调整后的优势比aOR = 2.38，95%置信区间CI = 1.04 - 5.46，P = 0.044）。经T0时PAB浓度和混杂因素调整的线性回归分析显示，使用全身抗生素的患者PAB水平降低幅度更大。在MET治疗组和MET + AMOX治疗组之间，未观察到PAB减少或达到T2T的机会存在差异。
发现PAB的微生物负荷与牙周状况直接相关。由于MET和MET + AMOX的抗生素治疗同样降低了PAB的微生物负荷，单独使用MET作为非手术牙周治疗的辅助治疗可能足够有效。为证实这一点，需要进行更大样本量的进一步前瞻性研究。
