Timmerman M F, van der Weijden G A, van Steenbergen T J, Mantel M S, de Graaff J, van der Velden U
Department of Periodontology, Academic Centre for Dentistry, Amsterdam, The Netherlands.
J Clin Periodontol. 1996 Aug;23(8):707-16. doi: 10.1111/j.1600-051x.1996.tb00599.x.
The objectives of the present study were to establish in a long-term investigation the safety as well as the clinical and microbiological efficacy of scaling and rootplaning combined with local application of 2% minocycline hydrochloride-gel versus placebo-gel in patients with moderate to severe chronic adult periodontitis. This was an 18 months, randomized, double-blind, parallel, comparative study, in which 20 healthy patients with moderate to severe chronic periodontitis participated. At baseline, all patients received professional oral hygiene-instruction and supra- and subgingival scaling and root planing. The minocycline-gel was applied subgingivally baseline, 2 weeks, 1, 3, 6, 9 and 12 months. Microbiological evaluation was carried out using DMDx to identify the following bacteria: Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum and Treponema denticola. In addition standard microbiological techniques were used for the detection of P. gingivalis, P. intermedia, P. micros, A. actinomycetemcomitans, C. rectus, F. nucleatum, C. albicans and Enterobacteriaceae. Results showed a statistically significant improvement for all clinical parameters irrespective of the treatment modality. No differences were observed between test and control with regard to probing depth and attachment level. The DMDx data showed a significant reduction in both the numbers and the prevalence over the 15 months period, but no significant difference between groups. Culture data showed that at baseline two-third were positive for P. gingivalis and P. intermedia. Analysis over the 18 month period showed no significant difference between the two treatment modalities. C. albicans and Enterobacteriaceae were detected only in small proportions at each time interval in a limited number of patients. No adverse reactions were observed during the trial period. The present patient group responded favourably to scaling and rootplaning, but did not benefit from an effect of local of minocycline. Subgingival debridement in combination with oral hygiene instruction by itself has been shown to be effective. It remains to be studied whether local application of minocycline can be effective as an adjunct to mechanical therapy in sites that respond poorly to conventional treatment.
本研究的目的是通过一项长期调查，确定在中度至重度慢性成人牙周炎患者中，龈下刮治和根面平整联合局部应用2%盐酸米诺环素凝胶与安慰剂凝胶相比的安全性以及临床和微生物学疗效。这是一项为期18个月的随机、双盲、平行对照研究，20例中度至重度慢性牙周炎患者参与其中。基线时，所有患者均接受专业口腔卫生指导以及龈上和龈下刮治及根面平整。米诺环素凝胶在基线、2周、1、3、6、9和12个月时龈下给药。使用DMDx进行微生物学评估，以鉴定以下细菌：牙龈卟啉单胞菌、中间普氏菌、伴放线放线杆菌、直肠弯曲菌、具核梭杆菌和齿垢密螺旋体。此外，采用标准微生物学技术检测牙龈卟啉单胞菌、中间普氏菌、微小普氏菌、伴放线放线杆菌、直肠弯曲菌、具核梭杆菌、白色念珠菌和肠杆菌科。结果显示，无论治疗方式如何，所有临床参数均有统计学意义的改善。在探诊深度和附着水平方面，试验组与对照组之间未观察到差异。DMDx数据显示，在15个月期间，细菌数量和流行率均显著降低，但两组之间无显著差异。培养数据显示，基线时三分之二的患者牙龈卟啉单胞菌和中间普氏菌呈阳性。对18个月期间的分析表明，两种治疗方式之间无显著差异。在有限数量的患者中，每次时间间隔白色念珠菌和肠杆菌科的检出比例均较小。试验期间未观察到不良反应。本患者组对刮治和根面平整反应良好，但未从局部应用米诺环素中获益。龈下清创术联合口腔卫生指导本身已被证明是有效的。局部应用米诺环素作为机械治疗的辅助手段，在对传统治疗反应不佳的部位是否有效仍有待研究。
