Maze G I, Reinhardt R A, Agarwal R K, Dyer J K, Robinson D H, DuBois L M, Tussing G J, Maze C R
Department of Surgical Specialities/Periodontics, University of Nebraska Medical Center, College of Dentistry, Lincoln 68583-0740, USA.
J Clin Periodontol. 1995 Nov;22(11):860-7. doi: 10.1111/j.1600-051x.1995.tb01785.x.
Controlled local delivery of antibiotics has been shown to reduce periodontopathic micro-organisms with minimal side-effects. Clinical studies in our laboratory have shown that 25% tetracycline HCl delivered from poly(D,L-lactide/glycolide) film strips (25 TTC-PLGA) released therapeutic concentrations of tetracycline for 10 days. The present pilot study compared the intracrevicular delivery of 25% tetracycline HCl incorporated in these biodegradable film strips to scaling and root planing (SRP) in 10 adult periodontitis patients, who in spite of therapy and regular supportive periodontal treatment (SPT), continued to possess 5 bleeding periodontal pockets at least 5 mm deep. Sites were randomly selected to receive the following treatments: (1) 25 TTC-PLGA, (2) control strips without TTC (PLGA), (3) SRP, and (4) untreated control. Film-strip retention was augmented with a suture/cement technique, followed by strip removal after 2 weeks. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were evaluated over time (0, 2.4, 8, 12, 26 weeks). Results indicated that, compared to baseline, 25 TTC-PLGA film strips caused significant (p < or = 0.01): (1) probing depth reduction for 26 weeks, (2) a clinical attachment level gain for 12 weeks, (3) lower %s of spirochetes for 4 weeks and motile rods for 8 weeks (p < or = 0.05), and (4) an accompanying increase in cocci for 4 weeks. In the scaled and root planed sites, probing depth was the only finding that demonstrated a significant change from baseline (p < or = 0.01). Controls and PLGA showed isolated reductions in probing depth and % of motile organisms. From these findings, applications of intracrevicular 25 TTC-PLGA, when compared to scaling and root planing, appears to have an enhanced antibacterial effect and a similar clinical effect in SPT patients. The results of this study indicate further investigation of 25 TTC-PLGA film strips should be undertaken using more subjects and sophisticated microbiological and clinical measurements.
抗生素的局部可控递送已被证明能减少牙周病原菌，且副作用最小。我们实验室的临床研究表明，从聚（D，L-丙交酯/乙交酯）薄膜条（25%盐酸四环素-PLGA）释放的25%盐酸四环素可在10天内维持治疗浓度。本初步研究比较了将25%盐酸四环素掺入这些可生物降解薄膜条后龈沟内给药与10例成人牙周炎患者的龈下刮治和根面平整（SRP）的效果，这些患者尽管接受了治疗和定期的支持性牙周治疗（SPT），但仍有至少5个深度至少为5mm的出血性牙周袋。随机选择部位接受以下治疗：（1）25%盐酸四环素-PLGA，（2）不含盐酸四环素的对照条（PLGA），（3）SRP，以及（4）未治疗的对照。采用缝合/粘结技术增强薄膜条的保留，2周后取出薄膜条。随时间（0、2、4、8、12、26周）评估临床参数和龈下细菌形态类型（暗视野分析）。结果表明，与基线相比，25%盐酸四环素-PLGA薄膜条导致显著（p≤0.01）：（1）26周内探诊深度降低，（2）12周内临床附着水平增加，（3）4周内螺旋体百分比降低，8周内活动杆菌百分比降低（p≤0.05），以及（4）4周内球菌随之增加。在龈下刮治和根面平整部位，探诊深度是唯一显示与基线有显著变化的指标（p≤0.01）。对照组和PLGA显示探诊深度和活动生物体百分比有个别降低。从这些发现来看，与龈下刮治和根面平整相比，龈沟内应用25%盐酸四环素-PLGA在SPT患者中似乎具有增强的抗菌效果和类似的临床效果。本研究结果表明，应使用更多受试者以及更精密的微生物学和临床测量方法对25%盐酸四环素-PLGA薄膜条进行进一步研究。
