Yilmaz S, Kuru B, Noyan U, Kadir T, Acar O, Büget E
Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Türkiye.
J Marmara Univ Dent Fac. 1996 Sep;2(2-3):500-9.
The present study describes selected clinical and microbiological results obtained by treatment with local (Elyzol) and systemic (Flagyl) use of metronidazole alone and/or mechanical subgingival debridement in early onset periodontitis (EOP). Twelve patients, with lesions not distributed as in classical localized juvenile periodontitis, were included. They were randomly divided into local and systemic treatment groups each comprising 6 individuals, in each of whom 4 sites (one site/quadrant) with a probing depth of > or = 5 mm were selected and treated with separate treatment modalities. The overall treatment design provided 6 different test groups. Groups of quadrants received 1) scaling and root planing 2) local metronidazole treatment 3) systemic metronidazole treatment 4) local metronidazole combined with scaling and root planing 5) systemic metronidazole combined with scaling and root planing 6) No treatment. The microbiological and clinical effects of treatment modalities were monitored over 42 days. The results demonstrated reductions in mean counts of obligate anaerobic and capnophilic microorganisms coupled with significant improvements in mean clinical measurements (gingivitis, probing depth, attachment level) in all groups, except the untreated. Scaling and root planing provided an initial clinical improvement with a selective reduction of periodontopathogens (92.6% obligate anaerobes, 42.9% capnophilic microorganisms), whereas the combination of local or systemic metronidazole with scaling and root planing were found superior in reducing capnophilic bacteria (93.7% and 93.4%, respectively). It is of critical importance to have a treatment rationale for EOP, since bacterial differences exist in the etiological subforms of periodontitis. Microbial testing may be justified before prescribing the adjunctive antibiotic and selecting the mode of delivery for the successful clinical management of EOP.
本研究描述了在早发性牙周炎（EOP）中单独局部使用（Elyzol）和全身使用（Flagyl）甲硝唑和/或进行机械性龈下刮治所获得的特定临床和微生物学结果。纳入了12例病变分布与经典局限性青少年牙周炎不同的患者。他们被随机分为局部治疗组和全身治疗组，每组6人，每组中选择4个探诊深度≥5mm的部位（每个象限1个部位），采用不同的治疗方式进行治疗。总体治疗设计提供了6个不同的试验组。各象限组接受1）龈上洁治和根面平整；2）局部甲硝唑治疗；3）全身甲硝唑治疗；4）局部甲硝唑联合龈上洁治和根面平整；5）全身甲硝唑联合龈上洁治和根面平整；6）不治疗。在42天内监测治疗方式的微生物学和临床效果。结果表明，除未治疗组外，所有组中 obligate anaerobic 和嗜二氧化碳微生物的平均计数均降低，同时平均临床测量指标（牙龈炎、探诊深度、附着水平）有显著改善。龈上洁治和根面平整带来了初始临床改善，并选择性减少了牙周病原体（92.6% obligate anaerobes，42.9%嗜二氧化碳微生物），而局部或全身甲硝唑与龈上洁治和根面平整联合使用在减少嗜二氧化碳细菌方面更具优势（分别为93.7%和93.4%）。由于牙周炎的病因亚型存在细菌差异，因此为EOP制定治疗原理至关重要。在开辅助抗生素处方和选择给药方式以成功临床管理EOP之前，进行微生物检测可能是合理的。
