不同程度牙周炎自然发展进程与IL-1RN基因多态性的关系

目的 了解慢性牙周炎病程的自然发展及其与IL-1RN（INTRON2）VNTR基因多态性的关系。方法对110例慢性牙周炎患者，其中轻度18例，中度34例，重度58例进行为期6个月的自然病程观察，分别在基线、6个月对全口余留牙牙周袋深度PD、临床附着丧失量AL进行检查，每个牙检查6个位点并检测其IL-1RN（INRON2）VNTR的基因多态性。结果110人平均牙周袋深度增加PD=0．23mm，平均附着丧失量增加AL=0．50mm。其中36例患者44个牙位出现了△AL≥2mm。6个月后PDAL的改变在IL-1RN（INTRON2）VNTR基因型1／1携带者与基因型1／2携带者间无明显差异（P〉0．05）。6个月后IL-1RN（INTRON2）VNTR基因型及等位基因频率在△AL≥2mm组和病情无明显改变组无统计学差异（P〉0．05），重度牙周炎组较轻中度牙周炎组更易出现快速进展（P〉0．05）。结论不同个体、不同程度其牙周病变的发展是不一样的，还不能认为IL-1RN（INTRON2）vNTR基因多态性会影响汉族人群慢性牙周炎的发展。     

200例慢性牙周炎患者的病情调查

目的 调查城区职工中未经治疗的慢性牙周炎患者的疾病状况。方法 从北京城区某单位职工中筛选出未经治疗的慢性牙周炎患者200例，检查除第三磨牙外的全口牙、6个住点／牙的牙周情况，指标为探诊深度、附着丧失、探诊后出血。结果 附着丧失程度随患者的年龄增长而加重，男性的附着丧失重于女性，探诊出血位点的附着丧失重于不出血住点。在全口牙中，下切牙和上颌第一磨牙的附着丧失最多。结论 慢性牙周炎的程度与年龄、性别、牙龈炎症有关，病变的分布有牙位特异性。     

中老年人骨密度与慢性牙周炎的相关性研究

目的：研究中老年人骨密度降低及骨质疏松与牙周炎之间的关系。方法：选取122名进行体格检查的中老年人，女104名，男18名，进行骨密度测定及口腔检查。根据骨密度值（T值）分为观察组（T＜-1.0）与对照组（T＞-1.0）。根据附着丧失（CAL）、余留牙数目分为轻、中、重度牙周炎。运用统计学软件进行骨密度与慢性牙周炎分级间的χ2检验，并与牙周附着丧失进行相关性分析。结果：观察组较对照组，中、重度牙周炎的患病率显著增高（χ2=4.41, P＜0.05）。中老年人群的骨密度值与CAL值显著负相关（tr=-3.88,P＜0.001），即随着骨密度降低，CAL呈增加趋势。结论：中老年人群中，骨量减少及骨质疏松与慢性牙周炎的严重程度相关；骨密度降低可能是中老年人中、重度慢性牙周炎进展的促进因素。     

慢性重度牙周炎松动前牙的非手术治疗评价

目的：观察牙周基础治疗联合牙松动固定和维护治疗,对慢性重度牙周炎松动下前牙的治疗效果。方法15例慢性重度牙周炎患者,每例患者选出1~2颗松动Ⅱ度以上的下颌切牙,共20颗。按牙周基础治疗、树脂夹板牙周固定、牙周袋深部刮治、维护治疗的顺序进行治疗。治疗后3、6、12个月对治疗效果进行评价。观察患牙龈沟出血指数、探诊深度、附着丧失的变化。结果治疗后所有患者均感觉咬合功能得到提升。3、6、12个月复查,患牙出血指数、探诊深度、牙周附着水平较基线有明显改善（P<0.01）。结论慢性重度牙周炎松动前牙经非手术治疗,症状缓解,外观明显改善。     

白细胞介素-1B-511基因多态性与牙周炎进展的关系

目的 了解不同程度慢性牙周炎病程的自然发展及其与白细胞介素-1B-511（IL-1B-511）基因多态性的关系。方法 选取慢性牙周炎患者100例,分别在基线、6个月、12个月时检查全口余留牙的临床附着丧失量（AL）,每个牙检查6个位点。棉拭子刮取患者颊黏膜脱落细胞,采用聚合酶链反应检测IL-1B-511基因型分布。结果 1年内,100例患者平均AL增加1.43 mm;病情进展缓慢（全口年平均AL增加不超过1.0 mm）的16例,进展快速（全口年平均AL增加超过1.0 mm）的84例;IL-1B-511基因型分布及等位基因分布频率在病情进展缓慢和快速的患者间未发现统计学差异（P>0.05）。基线检查时为轻中度牙周炎的患者在1年的观察期内出现全口年平均AL增加超过1.0 mm的人数多于重度牙周炎患者（P<0.05）;从患牙部位看,两次复查时AL增加均超过2.0 mm的牙位以磨牙为多,多于前牙和前磨牙;且在重度牙周炎患者中更易出现,多于轻中度牙周炎患者（P<0.05）。结论 不同个体牙周炎的进展程度不一致;AL改变与白细胞介素-1基因多态性尚未发现有相关性。     

慢性牙周炎自然病程1 年观察及其与IL-1基因多态性的关系

目的:了解慢性牙周炎病程的自然发展及其与IL-1基因多态性的关系。方法:对166位慢性牙周炎患者进行为期1年的自然病程观察,分别在基线、12个月检查全口余留牙的牙周袋深度(PD)、临床附着丧失量(AL)、探诊出血(B0P),每个牙检查6个位点,对其中的111例牙周炎患者,分析其IL-1A-889、IL-1B 3954的基因多态性。结果:166人平均牙周袋深度增加1.12 mm,平均附着丧失量增加1.628 mm;有94位患者249个牙位出现了AL≥2 mm。没有发现IL-1A-889基因型分布及等位基因分布频率在快速进展组(至少1个部位AL增加≥2 mm)和非快速进展组间有显著性差异;IL-1B 3954基因型1/2的分布和等位基因2的频率在快速进展组高于非快速进展组(P<0.05)。1年后PD的改变和AL的改变在IL-1A-889和IL-1B 3954不同基因型携带者间无明显差异(P>0.05)。结论:不同个体其牙周病变的发展是不一样的;虽然IL-1B 3954等位基因2的频率在快速进展组高于非快速进展组,但分布频率很低,实际意义可能不大;没有发现PD和AL的改变与IL-1基因多态性有相关性。     

牙周疾病对全身健康的影响之一：牙周疾病对心血管疾病和糖尿病的影响

牙周疾病是严重危害人类口腔健康的两大口腔疾病之一，其发病率高，是造成我国成人牙齿丧失的首位原因。牙周疾病是由菌斑微生物所引起的牙齿周围支持组织的慢性感染性疾病，包括牙龈炎和牙周炎。牙周疾病都表现出牙龈的炎症，牙周炎时还有深层牙周组织的病变，轻到中度牙周炎患者往往无明显症状，重度牙周炎患者才出现脓肿、不适、牙齿松动和移位等症状，在检查时会发现牙周的炎症和破坏表现，如牙龈红肿、易出血，探诊时可发现有牙周袋形成、牙周附着丧失，X线片上可显示患牙的牙槽骨吸收，牙槽骨高度降低，重度患者会有牙的松动或脱落，从而造成咀嚼等功能的丧失。     

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目的研究孕妇牙周炎与早产儿、小于胎龄儿之间的相关性。方法将2009年1-4月来湖北省妇幼保健院口腔科进行孕期常规口腔检查的3251名妊娠中期孕妇的资料输入数据库,牙周检查项目包括软垢指数、龈沟出血指数、牙周袋探诊深度及临床附着丧失水平等,随访妊娠结局（新生儿体重、分娩时孕周）。运用χ2检验及logistic回归分析数据。结果3251名孕妇中最终符合调查要求2702名,妊娠中期诊断为牙周炎301例,其中重度牙周炎61例;早产儿、小于胎龄儿的发生率,在重度牙周炎孕妇分别为11。5％和9．8％,在牙周健康孕妇分别为6．0％和6．6％,差异均有统计学意义（P〈0．001）;重度牙周炎孕妇终止妊娠的孕周平均为35．2周、新生儿体重平均2478g,而牙周健康孕妇平均为39.3周和3512g,差异均有统计学意义（P〈0．001）;重度牙周炎孕妇发生早产儿和小于胎龄儿的OR值分别为2．45和3.47。结论孕妇重度牙周炎是引起早产儿、小于胎龄儿等不良妊娠的主要危险因素之一。     

快速进展性牙周炎牙骨质表面形貌观察及微区成分分析

目的　观察快速进展性牙周炎患牙牙骨质的表面形貌并分析其微区成分 ,以明确快速进展性牙周炎患牙是否存在牙骨质异常。方法　用扫描电镜观察 1 0颗快速进展性牙周炎患牙、1 0颗慢性牙周炎患牙及 1 0颗牙周健康牙齿的牙骨质表面形貌 ,通过能谱分析测定牙骨质表面的微区成分 (Ca、P、Mg) ,着重对前两组患牙进行比较。结果　快速进展性牙周炎患牙牙骨质的表面形貌和慢性牙周炎患牙牙骨质的表面形貌基本相似 ,Ca(64 60 %± 2 2 9% ,63 54 %± 2 97% ,P >0 0 5)、P(32 54 %± 1 2 9% ,32 97%± 2 40 % ,P >0 0 5)、Mg(2 86 %± 1 2 9% ,3 48%± 1 0 2 % ,P >0 0 5)含量及Ca/P(2 0 0± 0 1 7,1 95± 0 2 5 ,P >0 0 5) ,差异均无显著性。结论　部分快速进展性牙周炎患牙可能不存在牙骨质异常     

肥胖与慢性牙周炎相关性临床研究

目的:探讨肥胖与慢性牙周炎的关系。方法:纳入2 136例受试者,男1 091例,女1 045例。计算体重指数(BMI);将全口牙列按四分法分区,随机选择上、下颌相对侧分区作为检查牙位区,对每个牙位的6个位点进行牙周检查,记录牙龈指数(GI)、牙周袋探诊深度(PD)、附着丧失(AL),判定牙周炎程度,采用Spearman分析肥胖与慢性牙周炎及牙周临床指标的相关性。结果:BMI与慢性牙周炎程度呈显著正相关;男性人群BMI与GI、PD无相关性,但与AL呈正相关,女性人群BMI与GI、PD、AL呈显著正相关。结论:肥胖与慢性牙周炎的发生发展可能存在相关性,女性肥胖对牙周炎的影响可能更为显著。     

重度广泛型侵袭性牙周炎患者非手术治疗的临床疗效观察

目的 观察重度广泛型侵袭性牙周炎(generalized aggressive periodontitis,GAgP)患者牙周非手术治疗后临床指标的变化,并评价其治疗效果.方法 19例GAgP患者在洁治后1个月内完成刮治和根面平整,每2个月进行1次牙周维护,纵向观察6个月.在基线和维护期各时间点记录全口探诊深度(probing depth,PD)、探诊出血(bleeding on probing,BOP)、附着丧失(attachment loss,AL)和牙齿松动度,磨牙记录根分叉病变的程度,其中7例患者在基线和治疗后6个月进行白细胞计数、中性粒细胞百分比和甘油三酯的检测.结果 在基线时患者的平均PD为(5.1±2.1)mm,BOP阳性位点占98.0%,AL(3.9±1.9)mm.治疗后6个月平均PD为(3.0±1.1)mm,BOP阳性位点减少至11.9%,AL(3.2±1.2)mm,其中重度位点治疗后PD减少[(4.0±1.6)mm]大于中度位点[(2.2±0.9)mm,P<0.001],切牙治疗后PD减少大于磨牙,中性粒细胞百分比治疗后6个月[(55.4±9.3)%]较治疗前[(65.7±9.9)%]明显减少(P<0.05).结论 GAgP患者经牙周非手术治疗和定期牙周维护能取得良好的治疗效果,磨牙可能需要进一步的刮治和根面平整或手术治疗.     

Outcome variables in periodontal research: means and threshold-based site changes

BACKGROUND: The exclusive use of mean measurements in periodontal research might at times be misleading, as changes in different sites in the same individual might nullify each other. The purpose of the present study was to compare disease progression and response to periodontal therapy using both individual site activity with thresholds and mean patient changes. METHODS: Seventy-nine (79) subjects with established periodontitis were monitored for 1 year (no treatment [NTx] group); 108 subjects who received scaling, root planing, and quarterly prophylaxis were observed in a similar time interval (treatment [Tx] group). Probing depth (PD), attachment level (AL) and alveolar crestal height (ACH) were measured at baseline and 1 year using pressure-sensitive probes and computer-assisted image analysis of radiographs. RESULTS: Mean reduction in PD (0.50 mm) was observed in the Tx group compared to a small increase (-0.04 mm) in the NTx group (P= 0.0001). Treatment resulted in mean AL gain (0.44 mm) compared to net AL loss (-0.21 mm) in the NTx group (P= 0.0001). Subjects in the Tx group had twice as many sites with AL gain (beyond the threshold) compared to NTx subjects (16.64+/-1.07% versus 8.11+/-0.68%) which was highly significant (P = 0.0001, Student t test). Similarly, although in the opposite direction, percentage of sites with AL loss beyond threshold was 6.21+/-0.47% (Tx group) and 14.02+/-1.15% (NTx group) which was also highly significant (P = 0.0001, Student t test). Change in ACH was minimal for the Tx group (-0.07+/-0.03 mm) while NTx subjects experienced greater bone loss throughout the year (-0.16+/-0.02 mm); percentage of sites with ACH loss was similar for both groups, while the Tx group had 3 times the number of sites with ACH gain (11.76% versus 3.42%), suggesting that the reduction in mean bone loss in the Tx group did not result from a reduction in losing sites, but rather from an increase in gaining sites. The use of both means and binary data seems to supplement the information regarding the nature and mechanism of disease progression and arrest. CONCLUSIONS: The characteristics of periodontal disease with its multifactorial patient, local, and site-related etiology support the use of both mean and site-based changes in clinical studies of periodontal disease and treatment.     

GCF IL-1beta profiles in periodontal disease

OBJECTIVES: Studies suggest a genetic influence on levels of interleukin-1beta (IL-1beta) in gingival crevicular fluid (GCF). Levels of IL-1beta in GCF, however, are also dependent upon the clinical parameters at the site of collection, including probing depth (PD) and level of attachment (AL). To examine this issue, IL-1beta in GCF was evaluated from patients with varying degrees of periodontal disease. The influence of both the status of the patient and the probing depth at the sampled sites were considered in the analysis. MATERIAL AND METHODS: GCF IL-1beta was determined by ELISA at 6-8 molar sites from 29 non-smoking adults with mild, moderate, or severe periodontal disease at baseline, 2 weeks, and 24 weeks following scaling and root planing. For later analysis, patients were dichotomized on the basis of disease severity (mild/moderate vs severe). Sampled sites were classified at baseline by PD as, shallow (<4 mm), intermediate (4-6 mm), or deep (>6 mm). RESULTS: PD and AL were each strongly correlated with IL-1beta levels at baseline. However, patients with severe disease had higher levels of IL-1beta in each PD category than those with mild/moderate disease. As compared to patients with mild/moderate disease, IL-1beta levels in shallow sites from patients with severe disease was elevated nearly 2 fold (p<0.001). IL-1beta levels were reduced in all groups at 2 weeks and were still significantly reduced in patients with mild/moderate disease at 24 weeks. At 24 weeks IL-1beta returned to near baseline levels in patients with severe disease. CONCLUSION: While PD and AL are each associated with increased GCF IL-1beta, patients with severe disease show higher IL-1beta GCF levels in shallow sites, suggesting that high GCF IL-1beta expression is in part a host trait, and not strictly a function of clinical parameters.     

2007年辽宁省2型糖尿病患者牙周炎患病情况调查

目的 调查2007年辽宁省2型糖尿病患者牙周炎患病率,分析此人群牙周炎发病的影响因素,以期为牙周病的预防和研究提供依据.方法 选取辽宁省2007年糖尿病流行病学研究普查出的2型糖尿病患者182例,进行问卷调查,并检查6颗指数牙的牙周探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、龈沟出血指数(sulcus bleeding index,SBI)、简化口腔卫生指数(simplified oral hygiene index,OHI-S)的情况.体格和生化指标检查:测量身高、体质量、血压、心电图等.患者检查前24 h内禁食油腻食物,取上午8:00到10:00的空腹静脉血及口服75 g葡萄糖后2 h的静脉血,全自动血生化仪分析血清生化指标.结果 182例2型糖尿病患者牙周炎患病率为96.7%(176/182),其中轻度牙周炎20例,占11.0%,中、重度牙周炎156例,占85.7%.182例患者共检测6552个位点,平均PD为(2.92±0.67)mm,平均AL为(2.87±1.31)mm.男性患者的平均AL、SBI明显大于女性,口腔卫生状况较女性差;城市患者的SBI重于农村患者,农村患者的口腔卫生状况较城市患者差.57.1%(104/182)的患者至少有1颗牙脱落(不包括第三磨牙).年龄、性别、吸烟、城乡差异、糖耐量实验2 h血糖与牙周指标具有相关性(P＜0.05或P＜0.01).结论 2007年辽宁省2型糖尿病患者牙周炎患病率高且牙周破坏严重,口腔卫生教育及防病、治病意识亟待加强.     

202例牙周炎患者患病情况的调查

目的　调查和分析202例牙周炎患者全口余留牙的患病情况及相关因素。方法　从成都地区630名人群 中按要求选取202例牙周炎患者,年龄25~60岁,男65例,女137例,进行问卷调查,并检查全口余留牙的牙周探诊 深度(PD)、临床附着丧失(CAL)、牙龈探诊出血(BOP)、牙龈退缩(GR)的情况。每个牙检查6个位点(近颊、正中颊、 远颊、近舌、正中舌、远舌)。结果　202例患者平均PD为(3·20±0·31)mm,平均CAL为(3·50±0·10) mm,平均GR 为(0·30±0·02) mm,BOP阳性位点占全部检测位点的21·16%,有59%的患者至少有1颗牙脱落。轻、中度牙周炎 129例,占63·9%,重度牙周炎73例,占36·1%。受检患者中接受过高中和中专教育者86例,占43%;初中文化程 度者55例,占27%;受过大专以上教育者40例,占19·8%;只有小学文化程度者21例,占10%。患者受教育程度与 牙周破坏的严重程度无明显的相关性。202例患者中142例从未接受过治疗,占66%;曾洁牙者60例,占30%,接 受过正规的牙周治疗者仅8例,占4%。在近2个月内,66例患者有较重的精神压力,占33%。202例中吸烟者36 例,占18%;饮茶或咖啡者135例。结论　成都地区口腔卫生教育及防病、治病意识应加强。     

Five‐Year Changes in Periodontal Disease Measures Among Postmenopausal Females: The Buffalo OsteoPerio Study

Background: Understanding of longitudinal characteristics of periodontal disease in older females is limited. This study examined 5‐year changes in periodontal disease measures among postmenopausal females. Methods: Participants were 1,025 postmenopausal, 53‐ to 83‐year‐old females who completed baseline (1997 to 2001) and 5‐year follow‐up (2002 to 2006) whole‐mouth oral examinations in a study ancillary to the Women's Health Initiative. Periodontal disease was characterized using probing depth (PD), clinical attachment level (CAL), alveolar crest height (ACH), and tooth loss. Differences in measures between examinations were used to characterize patterns of change. Results: Baseline prevalence of none/mild, moderate, and severe periodontal disease defined using criteria of the Centers for Disease Control and Prevention was 27%, 58%, and 15%, respectively. Tooth loss attributable to periodontitis occurred in 13% of females. Mean ± SD changes in whole‐mouth mean measures showed progression when based on ACH (?0.19 ± 0.49 mm) yet relatively stable disease when based on PD (0.11 ± 0.42 mm) and CAL (0.06 ± 0.58 mm). Mean change in worst‐site ACH was greater (P <0.001) in females with severe periodontitis and osteoporosis at baseline and with tooth loss during follow‐up. Periodontal changes did not differ according to baseline age, hormone therapy use, smoking status, or age at menopause. Conclusions: Five‐year changes in periodontal measures among generally healthy postmenopausal females were, on average, small and did not suggest a consistent pattern of disease progression. Females with history of severe periodontitis or osteoporosis may experience accelerated oral bone loss despite stability or small improvement in routine probing measures.     

Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study

目的 比较牙周内窥镜辅助龈下刮治和根面平整（SRP）与传统SRP对慢性牙周炎患者基础治疗后残留牙周袋的临床疗效。方法 将牙周基础治疗后口内每个区至少有1个位点探诊深度（PD）≥5 mm的患者纳入研究,随机分为内窥镜组和SRP组,分别对残留牙周袋位点进行内窥镜辅助SRP治疗和传统SRP治疗。在治疗前（基线）、治疗后3、6个月检查PD、探诊出血（BOP）和附着丧失（AL）,采用SPSS 20.0统计学软件对数据进行统计分析。结果 与基线相比,治疗后3、6个月内窥镜组及SRP组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）。治疗后6个月与3个月相比,内窥镜组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）,而SRP组差异无统计学意义（P>0.05）。与SRP组相比,内窥镜组治疗后3及6个月PD≥5 mm位点百分比、PD均降低,治疗后6个月AL、BOP阳性位点百分比降低（P<0.05）。结论 牙周内窥镜辅助SRP对于基础治疗后的残留牙周袋（PD≥5 mm）的临床疗效优于传统SRP,尤其具有更好的远期预后。     

Comparison of conventional periodontal maintenance versus scaling and root planing with subgingival minocycline

BACKGROUND: Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline. METHODS: Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all > or = 5 mm pockets over a 6-month period (RP/M; n = 24 patients); or 2) conventional 3-month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal > or = 5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi-square analysis, and correlation coefficients. RESULTS: Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 +/- 0.1 versus 0.4 +/- 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining > or = 2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 +/- 0.05 mm; 12.5%) than PM (0.09 +/- 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross-sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters. CONCLUSIONS: Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance.     

慢性牙周炎维护治疗期临床纵向观察

目的:了解慢性牙周炎维护治疗期临床指标变化规律。方法:对牙周非手术基础治疗后进入维护治疗期的22名慢性牙周炎病人进行9个月的纵向观察。每3个月给予口腔卫生宣教,龈上下洁刮治和根面平整。并在基线和每次复查时记录临床检查指标,包括探诊深度(PD)、临床附着水平(CAL)、探诊出血(BOP)。结果:后牙较前牙更易出现牙周袋加深,>6 mm深袋的比例6个月后显著下降,CAL改善在邻面及舌侧更加明显,BOP比例持续下降。结论:非手术基础治疗配合定期维护,可使临床指标在较短期内获得明显改善。     

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis

BACKGROUND: In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP. METHODS: Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline RESULTS: In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events. CONCLUSIONS: The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.