Palmer R M, Matthews J P, Wilson R F
Department of Periodontology and Preventive Dentistry, United Medical School of Guy's Hospital, London.
Br Dent J. 1998 Jun 13;184(11):548-52. doi: 10.1038/sj.bdj.4809695.
To compare clinical and microbiological responses following non-surgical treatment of moderate to advanced adult periodontitis using subgingival scaling with and without adjunctive topical or systemic metronidazole.
A single blind randomised clinical trial of 90 subjects, stratified for periodontitis disease severity and smoking status, divided into three treatment groups: 1. Subgingival scaling using ultrasonic scalers and local anaesthesia; 2. Subgingival scaling using ultrasonic scalers and local anaesthesia plus seven days of systemic metronidazole (200 mg tds); 3. Subgingival scaling using ultrasonic scalers and local anaesthesia plus two applications of 25% metronidazole gel one week apart in all sites with probing depths more than 4 mm. Evaluations were made before treatment, and 8 weeks and 24 weeks post treatment.
Probing depths, probing attachment levels and bleeding on probing were measured using a Florida probe. Bacterial morphotypes were evaluated with darkfield microscopy. Results were analysed for all sites with baseline probing depths equal to or greater than Florida probe recordings of 4.6 mm using analysis of variance.
84 subjects completed the trial and the three treatment groups did not differ at baseline for any clinical parameter. Mean probing depths were reduced following treatment by greater than 1.6 mm (Group 1 = 1.68 mm, Group 2 = 1.62 mm, Group 3 = 1.74 mm at six months post treatment) but no significant differences were detected between treatment groups at any time point. Similarly, no significant differences were detectable between treatments for changes in mean probing attachment levels, bleeding on probing, plaque scores or proportions of bacterial morphotypes.
This study does not support the routine use of adjunctive metronidazole in the non-surgical treatment of periodontitis.
比较采用龈下刮治术（分别联合或不联合局部或全身应用甲硝唑）对中度至重度成人牙周炎进行非手术治疗后的临床和微生物学反应。
一项针对90名受试者的单盲随机临床试验，根据牙周炎疾病严重程度和吸烟状况进行分层，分为三个治疗组：1. 使用超声洁治器和局部麻醉进行龈下刮治；2. 使用超声洁治器和局部麻醉进行龈下刮治加全身应用甲硝唑7天（200毫克，每日三次）；3. 使用超声洁治器和局部麻醉进行龈下刮治加在所有探诊深度超过4毫米的部位每隔一周应用两次25%甲硝唑凝胶。在治疗前、治疗后8周和24周进行评估。
使用佛罗里达探针测量探诊深度、探诊附着水平和探诊出血情况。用暗视野显微镜评估细菌形态类型。使用方差分析对所有基线探诊深度等于或大于佛罗里达探针记录的4.6毫米的部位进行结果分析。
84名受试者完成了试验，三个治疗组在基线时的任何临床参数上均无差异。治疗后平均探诊深度降低超过1.6毫米（治疗后6个月时，第1组为1.68毫米，第2组为1.62毫米，第3组为1.74毫米），但在任何时间点治疗组之间均未检测到显著差异。同样，在治疗组之间，平均探诊附着水平的变化、探诊出血、菌斑评分或细菌形态类型比例的变化也未检测到显著差异。
本研究不支持在牙周炎非手术治疗中常规使用辅助性甲硝唑。
