Berglundh T, Krok L, Liljenberg B, Westfelt E, Serino G, Lindhe J
Department of Periodontology, Faculty of Odontology, Göteborg University, Sweden.
J Clin Periodontol. 1998 May;25(5):354-62. doi: 10.1111/j.1600-051x.1998.tb02455.x.
The present clinical trial was performed to study the effect of systemic administration of metronidazole and amoxicillin as an adjunct to mechanical therapy in patients with advanced periodontal disease. 16 individuals, 10 female and 6 male, aged 35-58 years, with advanced periodontal disease were recruited. A baseline examination included assessment of clinical, radiographical, microbiological and histopathological characteristics of periodontal disease. The 16 patients were randomly distributed into 2 different samples of 8 subjects each. One sample of subjects received during the first 2 weeks of active periodontal therapy, antibiotics administered via the systemic route (metronidazole and amoxicillin). During the corresponding period, the 2nd sample of subjects received a placebo drug (placebo sample). In each of the 16 patients, 2 quadrants (1 in the maxilla and 1 in the mandible) were exposed to non-surgical subgingival scaling and root planing. The contralateral quadrants were left without subgingival instrumentation. Thus, 4 different treatment groups were formed; group 1: antibiotic therapy but no scaling, group 2: antibiotic therapy plus scaling, group 3: placebo therapy but no scaling, group 4: placebo therapy plus scaling. Re-examinations regarding the clinical parameters were performed, samples of the subgingival microbiota harvested and 1 soft tissue biopsy from 1 scaled and 1 non-scaled quadrant obtained 2 months and 12 months after the completion of active therapy. The teeth included in groups 1 and 3 were following the 12-month examination exposed to non-surgical periodontal therapy, and subsequently exited from the study. Groups 2 and 4 were also re-examined 24 months after baseline. The findings demonstrated that in patients with advanced periodontal disease, systemic administration of metronidazole plus amoxicillin resulted in (i) an improvement of the periodontal conditions, (ii) elimination/suppression of putative periodontal pathogens such as A. actinomycetemcomitans, P. gingivalis, P. intermedia and (iii) reduction of the size of the inflammatory lesion. The antibiotic regimen alone, however, was less effective than mechanical therapy with respect to reduction of BoP - positive sites, probing pocket depth reduction, probing attachment gain. The combined mechanical and systemic antibiotic therapy (group 2) was more effective than mechanical therapy alone in terms of improvement of clinical and microbiological features of periodontal disease.
本临床试验旨在研究全身应用甲硝唑和阿莫西林作为晚期牙周病患者机械治疗辅助手段的效果。招募了16名年龄在35 - 58岁之间患有晚期牙周病的个体，其中10名女性，6名男性。基线检查包括对牙周病的临床、影像学、微生物学和组织病理学特征进行评估。这16名患者被随机分为2个不同样本，每个样本8名受试者。一组受试者在积极牙周治疗的前2周接受全身途径给药的抗生素（甲硝唑和阿莫西林）。在相应时期，另一组受试者接受安慰剂药物（安慰剂样本）。在这16名患者中，每个患者的2个象限（上颌1个，下颌1个）接受非手术龈下刮治和根面平整。对侧象限不进行龈下器械操作。因此，形成了4个不同的治疗组；第1组：抗生素治疗但不刮治，第2组：抗生素治疗加刮治，第3组：安慰剂治疗但不刮治，第4组：安慰剂治疗加刮治。在积极治疗完成后2个月和12个月进行临床参数的复查，采集龈下微生物群样本，并从1个刮治象限和1个未刮治象限获取1份软组织活检样本。在12个月检查后，第1组和第3组中的牙齿接受非手术牙周治疗，随后退出研究。第2组和第4组在基线后24个月也进行了复查。研究结果表明，在晚期牙周病患者中，全身应用甲硝唑加阿莫西林导致：（i）牙周状况改善，（ii）消除/抑制如伴放线放线杆菌、牙龈卟啉单胞菌、中间普氏菌等假定的牙周病原体，以及（iii）炎症病变大小减小。然而，仅抗生素治疗在减少探诊出血阳性部位、探诊袋深度降低、探诊附着获得方面不如机械治疗有效。联合机械和全身抗生素治疗（第2组）在改善牙周病的临床和微生物学特征方面比单纯机械治疗更有效。
