阿莫西林与甲硝唑联合龈下刮治和根面平整术治疗侵袭性牙周炎的短期疗效观察

目的观察龈下刮治和根面平整术（scaling and root planing,SRP）联合应用阿莫西林和甲硝唑治疗侵袭性牙周炎的短期临床疗效。方法采取随机法将30例侵袭性牙周炎患者分为单纯机械洁刮治的对照组与机械洁刮治联合药物治疗的试验组。分别在治疗前、治疗后3个月检查记录探诊出血（bleeding on probing,BOP）、探诊深度（probing depth,PD）及临床附着丧失（clinical attachment loss,CAL）情况,对所得数据进行统计学分析。结果 2组治疗3个月后BOP阳性率、PD、CAL均较治疗前明显改善。对照组患牙的平均PD值为（3.2±0.6）mm,试验组为（2.7±0.5）mm,2组比较差异有统计学意义（P〈0.05）;30例患者治疗后CAL均有改善,平均改善0.96 mm;试验组PD〈5 mm的平均位点百分比的增加值明显高于对照组,差异有统计学意义（P〈0.05）。结论 SRP联合应用阿莫西林和甲硝唑治疗侵袭性牙周炎短期效果显著优于单纯SRP治疗,临床指标得到明显改善。     

Vector超声系统对牙周炎维护期患者的疗效观察和疼痛感受评价

目的本研究应用Vector超声系统、手工刮治和常规超声系统对慢性牙周炎患者维护期的牙周袋进行治疗,以比较不同治疗方法的临床疗效和患者的疼痛程度。方法选择26例慢性牙周炎维护期的患者,其全口四个象限每个象限至少各有2颗牙齿,其邻面至少有一位点探诊深度≥4mm,有探诊出血,根据随机表将四个象限随机分入手工刮治组、传统超声治疗组（赛特力组）、Vector摩擦剂组和Vector抛光剂组进行龈下刮治。记录基线和治疗后3个月时,入选位点的菌斑指数、牙周探诊深度、临床附着丧失、出血指数及刮治当时的疼痛程度VAS值。结果对于牙周炎维护期患者,Vector摩擦剂组、Vector抛光剂组的治疗效果和手工刮治组、赛特力组相同,牙周探诊深度、临床附着丧失和出血指数在治疗后都有明显改善,同时患者在治疗中的疼痛程度明显小于常规的手工刮治和超声刮治。结论Vector超声系统为牙周炎维护期患者的复查复治提供了一个新的有效手段,有利于增加患者的依从性。     

六味地黄丸在牙周炎维护治疗中的作用

目的　观察六味地黄丸治疗慢性成人牙周炎的临床疗效。方法　选择120例曾接受过牙周治疗的慢性成人牙周炎患者,随机分为2组,对照组仅做洁治刮治根面平整(SRP),试验组在行SRP治疗后连续口服六味地黄丸5 个月,复诊检查患者牙周情况。结果　试验组用药5个月后,牙周探诊牙周袋减少0·43 mm,牙周附着增加 0·22 mm,与对照组相比差异有显著性(P<0·01)。结论　SRP加六味地黄丸治疗在减少牙周袋深度和增加牙周附着方面优于单纯的SRP,六味地黄丸是一种安全有效持久的牙周炎维护治疗的全身药物。     

二次牙周龈下刮治与牙周翻瓣术短期临床疗效比较

目的比较二次牙周龈下刮治和根面平整（scaling and root planning,SRP）与牙周翻瓣术治疗慢性牙周炎的短期临床疗效。方法选取牙周基础治疗3个月后牙周探诊深度为5～7mm的前牙或前磨牙共52颗作为研究对象,随机分为2组,二次SRP组行龈下刮治和根面平整术,翻瓣组进行改良Widman翻瓣术。分别在治疗前、治疗后3个月和6个月,检查记录探诊出血（bleeding on probing,BOP）、探诊深度（probing depth,PD）、牙龈退缩（gingival recession,GR）及临床附着水平（clinical attachment level,CAL）,并比较分析。结果二次SRP组和翻瓣组患牙的BOP阳性率、PD、GR、CAL治疗前分别为91.30%、（5.60±0.99）mm、（0.37±0.49）mm、（5.98±1.17）mm和92.13%、（5.87±1.02）mm、（0.30±0.47）mm、（6.03±1.30）mm,治疗后6个月分别为17.39%、（2.87±0.78）mm、（2.00±0.62）mm、（5.07±1.01）mm和11.23%、（2.53±0.51）mm、（2.36±0.68）mm、（4.89±0.84）mm,2组治疗后6个月各项指标与治疗前比较差异均有统计学意义（P〈0.01）。治疗后6个月2组间BOP阳性率、PD及CAL比较差异无统计学意义（P〉0.05）,但翻瓣组GR明显高于二次SRP组（P〈0.05）。结论对于前牙或前磨牙,二次SRP与牙周翻瓣术可达到相同的治疗效果,翻瓣术后牙龈退缩较二次牙周龈下刮治和根面平整后明显。     

Vector和P5治疗仪行龈下刮治术对疗效及牙科畏惧水平的影响

目的为临床选择牙周基础治疗龈下刮治术的方式提供参考。方法将35例轻中度慢性牙周炎患者随机分为2组,行口腔卫生宣教及全口超声龈上洁治,并填写牙科畏惧量表（dental fear survey,DFS）评估患者畏惧水平。2组患者分别使用Vector治疗仪和P5治疗仪进行龈下刮治术,术后再次填写DFS。治疗前及治疗后1个月监测菌斑指数（plaque index,PLI）、探诊出血（bleeding on probing,BOP）和探诊深度（probing depth,PD）等各项临床指标,监测治疗前后临床指标及患者心理畏惧水平的变化。结果患者使用Vector系统和P5系统进行龈下刮治后各项临床指标均较术前明显改善（P〈0．05）,2组间BOP和PD变化的差异无统计学意义（P〉0．05）,PLI的改善Vector组优于P5组（P〈0．05）。Vector组治疗后患者DFS得分由51．28±19．61降低为49．16±17．21,差异无统计学意义（P〉0．05）;P5组治疗后患者DFS得分由49．41±16．14增加至50．82±15．86,差异有统计学意义（P〈0．05）。2组DFS得分变化的差异有统计学意义（P〈0．05）。结论在轻中度慢性牙周炎龈下刮治术中,Vector系统与P5系统均可获得确切的临床疗效,均不会增加患者在龈下刮治过程中的畏惧水平,而保持患者心理状态的稳定性。     

牙周基础治疗对伴2型糖尿病的中、重度牙周炎患者牙周炎症控制、血清炎症指标及代谢水平影响

目的 探讨牙周基础治疗对伴 2型糖尿病的中、重度牙周炎患者牙周炎症控制、血清炎症指标以及糖代谢水平的影响。方法 将前期临床试验人群中的 56例中、重度牙周炎患者（平均临床附着水平> 3 mm）纳入本研究进行亚组分析,采用重复测量的方差分析比较治疗组和对照组牙周指数（包括平均探诊深度、临床附着水平和探诊出血指数）、超敏 C反应蛋白（ hsCRP）、糖化血红蛋白（ HbA1c）、空腹血糖在基线、 1.5个月、 3个月、 6个月连续 4次的变化。结果 伴2型糖尿病的中、重度牙周炎患者在牙周治疗后平均探诊深度（ F=62.898,P=0.000）、临床附着水平（ F=51.263,P=0.000）和探诊出血指数（ F=75.164,P=0.000）在治疗后逐渐改善,其中平均探诊深度（t=-2.050,P=0.045）和探诊出血指数（ t=-4.538,P=0.000）显著优于对照组;治疗后 hsCRP（F=6.391,P=0.010）、 HbA1c（F=4.536,P=0.011）、空腹血糖（ F=3.073,P=0.031）降低,其中 hsCRP显著低于对照组（ t=-2.261,P=0.028）。结论 牙周基础治疗有助于改善伴 2型糖尿病的中、重度牙周炎患者的牙周炎症和血清炎症指标以及糖代谢水平。     

浅析中药对慢性牙周炎的辅助治疗作用

目的：探讨中药治疗慢性牙周炎的临床疗效。方法：20例慢性牙周炎女性患者,随机分为2组,牙周基础治疗后,实验组给予补肾清火的中药治疗,对照组不服中药,3个月后复查各项牙周指数的变化。结果：2组患者服药前,菌斑指数（PLI）、牙周探诊深度（PPD）、附着水平测定（PAL）,无显著性差异（P〉0．05）,3个月后复查,2组各项牙周指数有显著性差异（P〈0．01）。结论：中药对慢性牙周炎症有明显的改善作用。     

老年糖尿病患者牙周翻瓣术治疗对血糖水平的影响

目的：探讨牙周翻瓣手术治疗对老年糖尿病患者牙周炎症控制及血糖水平的影响。方法：选择24例已行牙周洁、刮治术的患有2型糖尿病的老年牙周炎患者,随机分成两组,每组12例,治疗组行牙周翻瓣术治疗,对照组不行翻瓣术治疗,测量并比较两组治疗前及12周后的探诊出血、探诊深度及糖化血红蛋白水平。结果：治疗组所有患者治疗后探诊出血、探诊深度明显减少。糖化血红蛋白从（7.96±1.37）%降低为（7.11±1.05）%,差异有统计学意义（P〈0.05）,对照组此三项指标变化差异无统计学意义,并且在治疗12周后治疗组三项指标均低于对照组,差异有统计学意义。结论：糖尿病患者牙周炎症控制能在一定程度上改善糖代谢水平,且改善的效果可能与牙周炎症控制有关。     

Vector治疗仪在慢性牙周炎非手术治疗中的疗效观察

目的：比较Vector治疗仪与Hu—Friedy刮治器在慢性牙周炎非手术治疗中的疗效。方法：临床随机选择68例慢性牙周炎患者,随机分成Vector治疗仪组及Hu—Friedy刮治器组,在基点及治疗6个月后,分别记录：牙周探针出血（BOP）,牙周探诊深度（PD）,临床附着丧失（CAL）。结果：在基点及6个月,各临床参数两组间无统计学差异。结论：Vector治疗仪与传统的手工刮治器在慢性牙周炎非手术治疗短期疗效相似。     

牙周炎症与心血管系统健康的临床研究

目的研究牙周炎症与心血管系统健康状况间的关系。方法选择遵义医学院附属医院体检中心常规体检者233人,检查其6颗Ramfjord指数牙牙周探诊深度和探诊出血情况,并采用12导联心电图仪检查记录受检者心电图,根据心电图表现分为心电图异常与正常二组进行牙周指数及全身情况的比较分析。结果心电图异常组牙周炎症程度显著高于正常组（P〈0.01或P〈0.05）,牙周探诊深度和探诊出血与心电图异常显著相关;牙周炎症是心电图异常的危险因素（OR=1.96,P〈0.05）。结论牙周炎症与心电图异常相关,可能是心血管疾病的危险因素之一。     

单独龈下超声刮治与结合人工刮治两种方法的临床效果比较

目的 比较单独应用龈下超声刮治与结合人工刮治两种治疗方式的临床效果.方法 选取36例慢性牙周病患者,采用半口对照的方法将患牙分为对照组(左半口)和实验组(右半口),先对所有患牙进行龈上洁治术,一周后对照组实行龈下超声刮治术,实验组实行龈下超声刮治结合人工刮治术.治疗前后1个月、3个月分别检查受试牙,并记录各项临床指标( BOP、PD、CAL).结果 在治疗结束后1个月和3个月,两组各项牙周临床指标均有明显改善(P＜0.05),实验组的改善优于对照组,且有显著性差异(P＜0.05).结论 龈下超声刮治后使用人工刮治,可以获得一个更加平整的根面,取得良好的临床效果.     

Effects of scaling and root planing on clinical parameters and bacterial flora in periodontal pockets. 1. Changes in clinical parameters and subgingival bacterial flora after treatment

The purpose of this study was to clinically and microbiologically evaluate the effects of supragingival plaque control, scaling and root planing on periodontal therapy. Six patients affected with moderate or severe periodontitis were selected. The clinical status of each patient was recorded with such clinical parameters as probing pocket depth (PD), probing attachment level (PAL), gingival crevicular fluid flow (GCF), gingival index (GI), gingival bleeding index (GBI), suppurative index (SI), and mobility (Mo). After the patients had learned to perform their own oral prophylaxis, they were treated by scaling and root planing. Microbiological status was assessed by phase contrast microscopy and bacterial forms were classified into following six groups: coccoid cells, rods, filaments, fusiforms, motile rods, spirochetes. The number and the relative proportion of each group were compared statistically. Clinical and microbiological status from baseline to 5 months after scaling and root planing were re-examined. The results obtained were as follows. 1. The most significant change in clinical and microbiological status was observed one month after scaling and root planing. In particular, the total number of the microorganisms and the number and relative proportion of motile organisms were reduced. 2. Thereafter clinical and microbiological status was maintained during experimental period by means of supragingival plaque control.     

全口超声龈下刮治两次法对轻中度慢性牙周炎老年患者的近期疗效观察

目的:观察全口超声龈下刮治两次法对轻中度牙周炎的治疗效果。方法:按病例纳入标准选择年龄60岁以上、轻中度牙周炎患者42例,经口腔卫生宣教、超声龈上洁治术后,进行基线检查:牙龈出血指数(GBI),探针出血(BOP)阳性位点,牙周探诊深度(PD)及附着水平(AL),然后进行两次全口超声龈下刮治。术后1个月、3个月复查。所得数据进行配对t检验,统计学分析各临床指标治疗前后的变化。结果:术后1个月的PD由治疗前平均3.18 mm减少至平均2.45 mm(P<0.05),附着水平由平均4.51 mm提高至平均3.34mm(P<0.05),术后3个月的PD及AL分别为2.37 mm(P<0.05)及3.27 mm(P<0.05)。GBI术前平均为3.17,术后一个月及三个月分别减少至1.67(P<0.05)及1.82(P<0.05)。BOP阳性率由术前的37.2%,在术后一个月及三个月分别下降至13.2%(P<0.05)和16.8%(P<0.05)。结论:全口超声龈下刮治两次法短期可改善老年轻中度牙周炎患者的牙龈出血及附着水平,牙周袋探诊深度也有减少的趋势,同时相对于传统的分区龈下刮治及根面平整术,可减少患者复诊次数。     

Does temporary splinting before non-surgical therapy eliminate scaling and root planing-induced trauma to the mobile teeth?

The objective of this study was to determine whether temporary splinting of periodontitis-affected mobile teeth, prior to non-surgical mechanical therapy, affects treatment outcome by eliminating scaling and root planing-induced trauma to the teeth. Mandibular anterior teeth of 29 patients (15 females; 14 males; age range 30 to 48 years) with adult periodontitis were evaluated. Clinical measurements were performed at 4 sites per tooth including mesial, distal, buccal and lingual aspects at baseline, 3 and 6 months after treatment. The following clinical parameters were analyzed: plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), probing attachment level (PAL), gingival margin level (GML) and tooth mobility (TM). Patients were randomly divided into 3 groups: i) group 1 (n = 8) received scaling and root planing (SRP) only, ii) group 2 (n = 10) received scaling and root planing before splinting and iii) group 3 (n = 11) received scaling and root planing after splinting. Statistical analysis revealed that there were no significant differences among the groups for either bleeding on probing or probing attachment level values at any of the time intervals. At the end of the study, the greatest decrease in pocket depth was noted in group 2 (1.24+/-0.10 mm) which was thought to be the result of gingival recession (0.73+/-0.07 mm). Group 1 was the only group that showed reduction in tooth mobility at 3 months compared to baseline (1.67+/-0.55 PTV units). Group 3 displayed the least reduction in tooth mobility during the entire study period (0.26+/-0.44 PTV units). In conclusion, splinting of mobile teeth before SRP, and thereby elimination of potential SRP-induced trauma to the mobile teeth, did not show any adjunctive effect on healing when compared to splinting after SRP. Thorough debridement of root surfaces, even performed in the presence of increased mobility, resulted in improvements in clinical parameters, i.e. mechanical manipulation of mobile teeth during periodontal treatment did not affect clinical outcome negatively.     

激光法治疗种植体周围炎的短期临床效果评估

目的 探讨Er:YAG激光法治疗种植体周围炎临床效果,以期对今后种植体周围炎的临床治疗有所帮助。方法 20名种植体周围炎患者,满足纳入标准和排除标准后随机分为两组,试验组采用Er:YAG激光法治疗,对照组采用碳纤维刮治器和0.2% 洗必泰抗菌治疗。分别记录治疗前（基线水平）、治疗后3个月和6个月时相关的牙周临床指标,包括菌斑指数、探诊后出血指数、龈沟出血指数、探诊深度、临床附着水平。所有的检查均使用牙周探诊器(PCP12)。结果 基线时试验组和对照组间各项临床牙周指标的差异无统计学意义(P＞0.05)。治疗后3个月,与基线水平相比,各项临床牙周指标均有所降低,激光治疗比刮治治疗的降低幅度大,并且这种降低是具有统计学意义的(P＜0.05)。治疗后6个月时,总体来说牙周各项临床指标仍是低于基线水平的,但与3个月时相比,除了出血指数仍然降低以外,其他牙周指数都有略微反弹的趋势。结论 手工刮治和激光治疗都可以改善种植体周围炎患者的各项临床牙周指标,激光治疗可能疗效更为显著,但稳定性稍显不足。这种改善可能只是短期的,长期的疗效还需要依赖大样本长时间的观察随访。     

Efficacy of subgingivally applied minocycline in the treatment of chronic periodontitis

BACKGROUND: The use of adjunctive minocycline with mechanical debridement in treating periodontitis has been widely studied using different methods. However, the results from these studies are equivocal. OBJECTIVE: The purpose of this study was to clarify the efficacy of the adjunctive use of subgingival minocycline application plus scaling/root planing as compared with the results of one episode of scaling/root planing in the treatment of chronic periodontitis. METHODS: Fifteen patients were enrolled in this split-mouth clinical trial. Probing depth, clinical attachment loss, gingival index, and bleeding on probing were evaluated at the baseline before scaling/root planing and 6, 10, 14, and 18 weeks later according to a single-blind protocol. The amount of interleukin-1beta (interleukin-1beta pg/site) at each lesion was also simultaneously measured in gingival crevicular fluid in a parallel comparison design. After full-mouth baseline measurements and scaling/root planing, 78 lesions with a residual mean probing depth of 5 mm at anterior teeth were selected and equally distributed in either right or left sites based on a split-mouth symmetrical design and randomly assigned to one of two treatment groups (with or without minocycline administration, n = 39 for each group). RESULTS: Probing depth significantly decreased from the baseline (week 0) to week 6 after scaling/root planing (p < 0.05) in both groups, but there was no statistically significant difference between the two groups (p > 0.05). However, at weeks 10, 14, and 18, the experimental group showed significantly greater improvement in pocket reduction than the control group (p < 0.05). Similarly, both groups also showed significant decreases in gingival index scores from weeks 0-6 (p < 0.05), but gingival index reductions at weeks 10, 14, and 18 were statistically significant in favor of the experimental group (p < 0.05). The experimental group had more attachment gain than the control group at weeks 14 and 18 (p < 0.05). Values of interleukin-1beta (pg/site) at the experimental sites were significantly reduced at weeks 10, 14, and 18, as compared to values at control sites (p < 0.01). Finally, the incidence of bleeding on probing showed no differences between the two groups for any time interval (p > 0.05). CONCLUSIONS: In this 18-week clinical trial, the results suggested that scaling/root planing with adjunctive subgingival administration of minocycline ointment has a significantly better and prolonged effect compared to scaling/root planing alone on the reduction of probing depth, clinical attachment loss, gingival index, and interleukin-1beta content, but not on bleeding on probing.     

Systemic use of metronidazole in the treatment of chronic periodontitis: a pilot study using clinical, microbiological, and enzymatic evaluation

The aim of the present parallel, double-blind investigation was to evaluate the effect of using systemic metronidazole alone or associated to scaling and root planing on adult chronic periodontal disease, monitored at baseline, 30, 60 and 90 days. Twelve subjects were divided into three groups: the first group (Group I - 22 sites) was submitted to scaling and root planing (SRP) alone; the second group (Group II - 30 sites) received SRP and 250 mg of metronidazole (3 times a day for 10 days), and the third group (Group III - 31 sites) was treated with metronidazole alone. The clinical parameters evaluated were probing depth (PD), clinical attachment level (CAL), plaque index (PlI), gingival index (GI) and bleeding upon probing (BP). Microbiological (BANA test) and enzymatic (Pocket Watch) tests were also performed. All three proposed treatments produced significant improvements in clinical conditions of subjects, from baseline, 30, 60 and 90-day period, except for clinical attachment level. The results obtained by microbiological and enzymatic tests did not show statistical differences among the groups for the 90-day period (r = 0.7924 and r = 0.7757, respectively). In relation to clinical parameters, statistical differences among groups were observed only for the gingival index (p = 0.0261) between Groups I and II, and probing depth (p = 0.0124) between Group I and the others. We conclude that the use of systemic metronidazole did not produce additional effects on the microbiological conditions of these patients with chronic periodontal disease.     

25例种植体周围黏膜炎治疗的临床研究

目的：观察口腔卫生指导配合碳纤维工作头洁治治疗种植体周围黏膜炎的临床疗效。方法：25例种植体周围黏膜炎患者，用碳纤维工作头对种植体周围进行洁治，同时对患者进行口腔卫生指导以控制菌斑。记录前后种植体周围改良菌斑指数（mPLI）、改良龈沟出血指数（mSBI）、探诊深度（PD）等相关指标。结果：用碳纤维工作头洁治种植体周围和口腔卫生指导可使mPLI、mSBI、PD等指标明显改善。结论：口腔卫生指导和碳纤维工作头洁治术对种植体周围黏膜炎的临床治疗是有效的。     

A six-month comparison of three periodontal local antimicrobial therapies in persistent periodontal pockets

BACKGROUND: Currently, several local antimicrobial delivery systems are available to periodontists. The aim of this 6-month follow-up parallel study was to evaluate the efficacy of three commercially available local delivery systems as adjuncts to scaling and root planing in the treatment of sites with persistent periodontal lesions. METHODS: Seventy-nine patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized into 4 treatment groups which included: scaling and root planing alone (S) (20 patients), or in conjunction with the application of 25% tetracycline fibers (S+Tet) (19 patients), or 2% minocycline gel (S+Min) (21 patients), or 25% metronidazole gel (S+Met) (19 patients). Clinical measurements were taken at baseline, 6 weeks, 3 months, and 6 months after antimicrobial application. Treatments were applied using the distributors' recommended protocols. RESULTS: All 4 therapies resulted in significant improvements from baseline in probing depth, attachment level, bleeding on probing, and the Modified Gingival Index (MGI) scores. The improvements in clinical parameters were greater in all 3 adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions at 6 months were: scaling + tetracycline = 1.38 mm; scaling + metronidazole = 0.93 mm; scaling + minocycline = 1.10 mm; and scaling alone = 0.71 mm. The probing depth reduction at all time points was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P<0.01). There was also a significant improvement for scaling plus tetracycline fiber application over scaling and metronidazole at both 6 weeks and 3 months, although this did not remain significant at the 6-month visit. While the frequency of sites with suppuration was markedly reduced following all antimicrobial treatments, the most effective reductions were seen in the scaling plus tetracycline fiber group, followed by the minocycline group. CONCLUSIONS: Although all 3 locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber placement gave the greatest reduction in probing depth over the 6 months after treatment.     

Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients

Abstract. The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel + SCRP; (c) Tetracycline paste + SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.