四环素透明质酸凝胶辅助治疗慢性牙周炎的疗效观察

目的：观察四环素透明质酸凝胶辅助治疗牙周炎的临床疗效。方法：采用口内自身对照研究方法，选择68名牙周炎病人共200个牙周袋分为四环素透明质酸凝胶实验组和对照组。实验组患牙行洁治、刮治、根面平整后，龈下辅助给予四环素透明质酸凝胶，对照组仅作洁治、刮治、根面平整，观察两组患牙的临床指标（PLI、SBI、PD、AL、MD）和龈下菌斑螺旋体构成比的动态变化。结果：两组患牙各临床指标在治疗后均显著改善，治疗后4周，对照组PD、AL、MD及龈下菌斑螺旋体的构成比与治疗后1周相比无显著差异。结论：慢性牙周炎在基础治疗上，龈下局部应用四环素透明质酸凝胶辅助治疗牙周炎可取得较好的疗效。     

甲硝唑凝胶在治疗侵袭性牙周炎中的临床观察

目的观察牙周袋内使用甲硝唑凝胶治疗侵袭性牙周炎的临床效果。方法侵袭性牙周炎患者56例（256颗牙）,随机分成2组,均采用龈上洁治、龈下刮治术,治疗组采用甲硝唑凝胶牙周袋内注射治疗（注满约10mg）,每周1次,共4次;对照组口服罗红霉素片（每日2次,每次1片0.15g）和甲硝唑片（每日3次,每次1片0.1g）,每周连续服用3日,共4周。记录并分析治疗前后2周、停药2周、停药4周后的出血指数（BI）、牙体松动度、牙周袋探诊深度（PD）和牙体附着水平（CAL）。结果治疗组和对照组在治疗前牙周水平基线一致,治疗后,治疗组BI、PD、CAL均较对照组明显改善（P〈0.05）。结论牙周袋内局部应用甲硝唑凝胶能提高侵袭性牙周炎的治疗效果,是值得临床广泛应用的局部治疗侵袭性牙周炎的药物。     

派丽奥软膏治疗牙周脓肿的近期疗效观察

目的：探讨派丽奥软膏在牙周脓肿治疗中的临床疗效。方法：将派丽奥（盐酸米诺环素软膏）应用于牙周脓肿病人，与临床常用的甲硝唑棒、碘甘油对照研究。选择牙周脓肿的病人87例，患牙共90个，将患牙随机分成3组：常规洁治后，派丽奥组设为实验组；甲硝唑棒组设为标准组；20g／L碘甘油组设为对照组。分别于第1周、第2周观察各组的牙周袋深度（PD）、龈沟出血指数（SBI）、牙齿松动度（MD）等临床指标以评定综合疗效。结果：3组治疗均能改善症状。派丽奥组与碘甘油组差异有显著意义（P＜0．05），派丽奥组与甲硝唑组差异无显著意义；结论：采用缓释抗菌药物派丽奥局部治疗牙周脓肿是一种安全、有效、简便的牙周炎辅助治疗方法，具有一定的临床推广价值。     

中草药方剂治疗慢性牙周炎的临床观察

目的：观察中草药方剂治疗慢性牙周炎的临床疗效。方法：选择慢性牙周炎病例70例,共200个受检位点。分为两组,每组35例100个受检位点记录牙菌斑指数,牙周袋探诊深度,龈沟出血指数,牙周附着水平,牙齿松动度等临床指标,分别施行基础治疗后实验组口服中草药煎剂。对照组口服甲硝唑片剂。在第4周进行观察比较。结果：实验组与对照组临床指标比较差异均有统计学意义（P〈0.05）。结论：在牙周基础治疗前提下,中草药方剂治疗慢性牙周炎疗效优于甲硝唑组。     

甲硝唑棒辅助治疗牙周病的临床疗效观察

目的评价局部应用甲硝唑棒治疗牙周病的临床效果。方法86例牙周炎患者随机分为甲硝唑棒治疗组(46例)和口服甲硝唑片对照组(40例),对比观察疗效。结果局部应用甲硝唑棒疗效优于口服甲硝唑片。结论甲硝唑棒可作为牙周病局部缓释用药治疗牙周病。     

复方甘菊利多卡因凝胶在慢性牙周炎辅助治疗中的疗效研究

目的:研究复方甘菊利多卡因凝胶在慢性牙周炎辅助治疗中的疗效。方法:选取中、重度牙周炎患者60例,牙周基础治疗后随机分为辅助治疗组和对照组(无辅助治疗),每组30例。用分口设计法将辅助治疗组患者两侧随机分为甘菊组和米诺组,基础治疗后于牙周袋内分别置入复方甘菊利多卡因凝胶和盐酸米诺环素软膏。记录治疗前、治疗后6、12周临床牙周指标、采集龈下菌斑,PCR法检测致病菌Pg和Pi。结果:(1)甘菊组与米诺组中致病菌的检出率及临床牙周指标在治疗后均低于治疗前(P<0.05),组间无差异(P>0.05);(2)甘菊组和米诺组均优于对照组(P<0.05)。结论:复方甘菊利多卡因凝胶可作为慢性牙周炎辅助治疗的局部用药,与盐酸米诺环素软膏有相同的抑菌作用和疗效。     

甲强复合凝胶治疗牙周炎的细菌学研究

目的:评价甲强复合凝胶对牙周炎病原菌的抗菌作用.方法:选择慢性牙周炎患者20例,选择其左右侧对应牙,局部应用甲强复合凝胶和甲硝唑前后采集龈下细菌并分离、培养.测定产黑色素厌杆菌、梭杆菌、优杆菌等牙周袋原菌的检出变化.结果:甲强复合凝胶对牙周炎病原菌的消除率均高于甲硝唑棒;甲强复合凝胶的抗菌效果优于甲硝唑,用药前后龈下优势牙周病原菌的检出量二者有显著性差异(P＜0.01).结论:局部应用甲强复合凝胶对牙周病原菌有明显的抗菌作用.     

米诺环素软膏局部治疗慢性牙周炎的临床疗效

目的评价盐酸米诺环素软膏局部应用治疗慢性牙周炎的疗效。方法选择30例慢性牙周炎患者，共80颗牙，全口洁治和根面平整后，以患者一侧患牙局部应用派丽奥盐酸米诺环素软膏为实验组，对侧同名患牙局部应用牙康(甲硝唑棒)为对照组，于基线、基线后8、16周检测临床指标：菌斑指数(plaque index，PLI)、龈沟出血指数(sulcus bleeding index，SBI)、探诊深度(probing depth，PD)。结果实验组与对照组基线时临床指标无显著性差异；基线后8周、16周，两组临床指标均显著比各自基线时有改善。基线后8周，实验组PLI、PD显著低于对照组，SBI无显著差异；基线后16周，实验组茵斑指数PLI、SBI、PD均显著低于对照组。结论派丽奥局部应用治疗慢性牙周炎短期内可以显著缓解牙周炎症状，且效果优于牙康。     

派丽奥与牙康棒局部缓释药物对轻、重度慢性牙周炎治疗的疗效观察

目的:比较派丽奥和牙康棒对轻、重度慢性牙周炎的临床疗效。方法:选择轻、重度慢性牙周炎病人59人,共284个患牙,其中轻度牙周炎126个,重度牙周炎158个,经常规根面平整术等牙周基础治疗后,随机分为2组,分别用派丽奥和牙康棒进行治疗,每周1次共4次,记录治疗4周、8周后GI(牙龈指数)、BI(出血指数)、PD(牙周袋深度)并进行统计学分析。结果:两组药物治疗轻、重度慢性牙周炎4周和8周后,GI、BI、PD等各项指标均较基线有明显好转,差异有统计学意义(P<0.05)。派丽奥对重度慢性牙周炎的疗效优于牙康棒。结论:派丽奥和牙康棒局部应用均具有效改善牙周炎的临床各项指标,派丽奥对重度慢性牙周炎效果更好。     

布洛芬缓释凝胶治疗慢性牙周炎的临床研究

目的:探讨布洛芬局部用药新剂型的研制及其对慢性牙周炎的临床治疗效果.方法:采用PLGA(聚乳酸-乙醇酸共聚物)作为缓释辅料制备布洛芬缓释凝胶.运用紫外分光光度法检测布洛芬缓释凝胶的体外释放度.临床选择慢性牙周炎患者30例共60颗患牙作为研究对象,每例患者保证口腔内有2颗病情相近的患牙用作自身对照,分别分入实验组和对照组.实验组患牙在进行牙周洁刮治及根面平整后向牙周袋内注入实验药物,每周1次,共2次;而埘照组患牙仅进行牙周洁刮治及根面平整.分别于基线、治疗后第2周及第4周观察患牙局部的临床症状、龈沟出血指数、牙周袋探诊深度及附着丧失.2组间对比并进行统计学处理.结果:实验组与对照组在治疗后各项临床指标差异具有显著性(P＜0.05).结论:布洛芬缓释凝胶能有效改善慢性牙周炎的临床症状,控制牙周炎症,减少组织破坏,具有很好的临床实用意义.     

替硝唑棒局部应用治疗牙周炎的细菌学研究

目的 :探讨局部应用替硝唑棒对牙周炎病原菌的抗菌作用。方法 :选择 41例牙周炎患者 ,局部应用替硝唑棒和甲硝唑棒前后采集龈下细菌并分离、培养 ,测定产黑色素厌氧杆菌、梭杆菌、优杆菌等牙周病原菌的检出变化。结果 :替硝唑棒对产黑色素厌氧杆菌、梭杆菌和普氏菌的清除率均高于甲硝唑棒。替硝唑棒和甲硝唑棒使用前后 ,龈下优势牙周病原菌的检出量均有显著性差异 ,但替硝唑棒的抗菌效果优于甲硝唑棒。结论 :局部应用替硝唑棒对牙周病原菌有明显的抗菌作用。     

3 regimens of topical metronidazole compared with subgingival scaling on periodontal pathology in adults

Abstract. This report presents the findings from an open randomized multicentre clinical trial designed to compare the clinical efficacy of scaling with application of 3 different preparations/dose frequencies of topical metronidazole in the treatment of adult periodontitis. The 4 treatments were: (A) metronidazole 25% dental gel administered 1 × a week for 2 weeks; (B) metronidazole 15% dental gel applied 1 × a week for 2 weeks; (C) metronidazole 15% dental gel applied 2 × a week for 2 weeks; (D) subgingival scaling, performed 1 × only. A split mouth design was used. Patients were included in the study if they had at least 1 tooth in each quadrant with a pocket depth ≥ 5 mm in at least 1 of 4 sites. A total of 61 patients from 4 centres were entered into the study. The efficacy parameters were probing pocket depth and bleeding on probing. Follow-up visits for recording of clinical efficacy were made at 2, 4, 6 and 12 weeks after the end of metronidazole treatment. All 3 antibiotic treatments (A, B, C) reduced the symptoms of periodontal pathology and yielded results comparable to those seen after subgingival scaling (D). When using a topical drug therapy, it seems important to use a preparation that requires as few applications as possible. The best candidate for drug therapy would therefore be treatment (A) metronidazole 25% applied 1 × a week for 2 weeks.     

替硝唑棒对牙周炎和冠周炎病原菌的抗菌作用

目的:评价替硝唑棒对牙周炎和冠周炎病原菌的抗菌作用。方法:(1)采用厌氧菌药物敏感试验的二倍琼脂稀释法测定替硝唑和甲硝唑对200株临床分离株的MIC50和MIC90。(2)采用厌氧菌培养方法测定51例牙周炎和冠周炎患者局部应用替硝唑和甲硝唑前后,牙周炎病原菌和冠周炎病原菌的变化。结果:替硝唑棒剂对牙龈卟啉单胞菌、中间普氏菌、梭杆菌和消化链球菌具有明显抗菌作用,其MIC50和MIC90分别为0.25、0.25、0.25、8 mg/L和0.5、0.5、1、8mg/L;其清除率为94.4％～100％,细菌数量均有明显减少。替硝唑对牙周炎和冠周炎病原菌的抗菌活性明显强于甲硝唑(P<0.05)。结论:局部应用替硝唑棒可明显抑制牙周炎和冠周炎的病原菌。     

Meta-analysis of local metronidazole in the treatment of chronic periodontitis

BACKGROUND: Meta-analysis was used to assess the effectiveness of local delivery of metronidazole alone or as an adjunct to mechanical therapy in patients with chronic periodontitis. METHODS: Studies were identified using MEDLINE and other sources. Meta-analyses were performed on the basis of probing depth (PD) at baseline and experimental and control regimens studied (i.e., metronidazole plus scaling and root planing [SRP] versus SRP and metronidazole versus SRP); the effect of local metronidazole on PD and attachment level (AL) was evaluated for follow-up times of 4, 8, 12, 24, and 36 weeks. The DerSimonian & Laird random effects model was used. RESULTS: Twelve studies that met inclusion criteria were entered into the meta-analysis. A significant mean reduction in PD for the combined metronidazole and SRP was observed in all comparisons with initial PD > or = 4 mm (0.38 mm at 8 weeks to 0.6 mm at 12 weeks); whereas, with initial PD > or = 5 mm a significant mean reduction was observed from 12 weeks (0.29 to 0.48 mm at 24 and 36 weeks, respectively). Meta-analysis could be performed for AL to test the effectiveness of metronidazole as an adjunct to SRP and a significant AL improvement was found in all analyses (0.2 mm at 4 weeks to 0.29 mm at 24 and 36 weeks). Meta-analyses were performed including two to four studies. CONCLUSION: Our results demonstrated the effectiveness of metronidazole as an adjunct to SRP in the treatment of chronic adult periodontitis, but clinical significance and dissemination of antibiotics should be taken into account in the evaluation of metronidazole as an alternative to SRP.     

Comparative clinical and microbiological effects of subgingival metronidazole application in adult periodontitis; 12-months results

The aim of the present study was to evaluate the clinical and microbiological effects of subgingival application of 25% metronidazole dental gel as an adjunct to scaling and root planing (SRP) in the treatment of adult periodontitis. Eighty teeth in 18 patients were evaluated using a split mouth design. The test teeth received SRP and a 25% metronidazole gel applied subgingivally on days 0 and 7. The control teeth received SRP only. Clinical and microbiological examinations were carried out before treatment and on weeks 1, 3, 7, 13, 26, 38 and 52 of the experimental period. Colony forming units of Porphyromonas gingivalis and Prevotella intermedia / Prevotella nigrescens were determined. Both treatments provided significant improvements in all the clinical and microbiological parameters (P<0.05). However, none of the differences between the study groups were statistically significant (P > 0.05). As a conclusion, the present study does not provide evidence in favour of the routine use of adjunctive metronidazole dental gel in the treatment of adult periodontitis.     

派丽奥与牙康治疗牙周炎的疗效比较

目的　比较派丽奥(2%盐酸米诺环素软膏)与牙康(甲硝唑棒)治疗牙周炎的临床疗效及对牙周可疑致病菌的清除作用。方法　选取11例慢性牙周炎患者的26颗牙周炎患牙为研究对象。患牙要求:①牙周袋探诊深度≥4 mm,且探诊后出血;②左右对称。26颗患牙随机分成实验组(派丽奥治疗组)13颗,对照组(牙康治疗组)13 颗。观察用药前及用药后7 d和14 d,患牙的牙周临床指标菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、探诊出血(BOP)的变化和龈下附着菌斑中螺旋体、球菌、杆菌的百分比,以及非附着菌斑中牙龈卟啉单胞菌、中间普氏菌、二氧化碳噬纤维菌等牙周可疑致病菌百分比的变化。结果　实验组和对照组患牙在用药前各项牙周临床指标和微生物学指标均无显著性差异(P>0.05)。用药后,两组患牙绝大部分牙周临床指标和微生物学指标均较用药前明显改善(P<0.05),但两组间无显著性差异(P>0.05)。结论　派丽奥与牙康均是治疗牙周炎有效、安全的局部治疗药物,两者的疗效无显著性差异。     

Metronidazole plus amoxycillin in the treatment of Actinobacillus associated periodontitis

The potential use of an adjunctive therapy of metronidazole plus amoxycillin for the subgingival elimination of Actinobacillus actinomycetemcomitans in periodontitis patients was investigated. 22 patients participated in this study, 11 with localized juvenile periodontitis (LJP) and 11 with rapidly progressive periodontitis (RPP). 14 patients had received periodontal treatment in the past. All patients were subgingivally infected with A. actinomycetemcomitans. After mechanical subgingival debridement in combination with the antibiotic treatment, elimination of A. actinomycetemcomitans was achieved in all patients but one. With this one exception, clinical improvements were observed in all patients, resulting in reduced pocket probing depths as well as in a significant reduction in bleeding on probing. Re-examination of 16 patients after 9-11 months revealed that A. actinomycetemcomitans was still undetectable and further clinical improvement was observed. It was concluded that the combination of metronidazole plus amoxycillin is a valuable adjunct to mechanical therapy in A. actinomycetemcomitans associated periodontal infections.     

Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis

AIM: To evaluate and compare the effects of adjunctive metronidazole plus amoxicillin, doxycycline and metronidazole on clinical and microbiological parameters in patients with generalized aggressive periodontitis. MATERIAL AND METHODS: Forty-three patients participated in this randomized clinical trial divided into four groups. Six weeks after scaling and root planning (SRP), groups 1-3 received adjunctive metronidazole, plus amoxicillin, doxycycline and metronidazole respectively, and group 4 acted as controls. Clinical recordings concerning probing depth, probing attachment level and bleeding on probing were performed at baseline, 6 weeks after SRP and 6 months from baseline. Subgingival samples were analysed using the 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia and Treponema denticola. Results: All treatments resulted in improvement of clinical parameters (ANOVA p > 0.05). Systemic administration of metronidazole plus amoxicillin or metronidazole resulted in statistically significant greater reduction of the proportion of sites > 6 mm than SRP (z-test, p < 0.05). These antimicrobials yielded a significant effect on levels of important periodontal pathogens for 6 months. CONCLUSION: Adjunctive metronidazole plus amoxicillin or metronidazole alone (when A.actinomycetemcomitans is not involved) is effective in deep pockets of aggressive periodontitis patients.     

A Randomized,Double‐Masked Clinical Trial Comparing Four Periodontitis Treatment Strategies: 1‐Year Clinical Results

Background: The benefit of full‐mouth disinfection (FDIS) over traditional scaling and root planing (SRP) remains equivocal, and it is not known whether the use of adjunctive antibiotics may enhance the effect of FDIS. The aim of the present study is to test the hypothesis that there is no difference in the 1‐year clinical outcome of therapy among groups of patients treated with conventional SRP performed over 2 to 3 weeks, or same‐day FDIS, with or without adjunctive metronidazole. Methods: A total of 184 patients with moderate‐to‐severe periodontitis were randomly allocated to one of four treatment groups: 1) FDIS+metronidazole; 2) FDIS+placebo; 3) SRP+metronidazole; or 4) SRP+placebo. Recordings of plaque, bleeding on probing, probing depth (PD), and clinical attachment level (CAL) were carried out in four sites per tooth at baseline and at 3 and 12 months after treatment. Results: No differences were observed in the mean CAL or PD values between the four experimental groups at baseline and 3 or 12 months post‐treatment. All four groups displayed significant improvements in all parameters. However, using absence of pockets ≥5 mm as the criterion for treatment success, the two groups receiving adjunctive metronidazole performed significantly better than the two placebo groups. Conclusion: Metronidazole had a significant, adjunctive effect in patients with a metronidazole‐sensitive subgingival microbiota on the clinical parameters of CAL, PD, and absence of pockets ≥5 mm.     

Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel

BACKGROUND, AIMS: Conventional treatment of chronic periodontitis involves mechanical debridement of periodontal pockets. Recently, subgingival antimicrobials have been used adjunctively following such debridement. This 2-centre study compared the clinical effects of subgingival scaling (SRP) with SRP plus subgingival application of 25% metronidazole gel, Elyzol (SRP+gel), in patients with chronic adult periodontitis. METHOD: Voluntary informed written consent was obtained from 45 subjects at the Eastman (mean age 46, range 34-63) and 43 subjects at RAF Halton (mean age 47, range 34-71) who participated in this blind, randomised split-mouth design study. All had at least 2 sites in each quadrant with probing pocket depth (PPD) > or = 5 mm. PPD, bleeding on probing (BOP), and clinical probing attachment levels (CAL) measured using a stent, were recorded at baseline and at 1, 3, 6 and 9 months post-therapy. After subgingival scaling of all quadrants, 2 quadrants were randomly selected to be treated with metronidazole gel. RESULTS: A paired t-test on baseline values showed no bias between groups. Both treatments effectively reduced the signs of periodontitis. At each follow-up visit, reduction in PPD, CAL and BOP after the combined treatment was greater than for SRP alone. Paired t-tests showed that the improvement in the SRP+gel group was statistically significantly better (p<0.001) than for SRP alone (mean 0.5 +/- 0.6 mm. 95% CI 0.4-0.6 mm.) Similarly, the % of sites which improved to a final pocket depth of < or = 3 mm and the % of sites which improved over the 9 months of the study by as much as > or = 2 mm were greater for SRP+gel than for SRP alone. CONCLUSIONS: At the end of the study, the mean reductions for PPD were 1.0 mm (SRP) compared to 1.5 mm (SRP+gel), and for CAL they were 0.4 mm (SRP) compared to 0.8 mm (SRP+gel), with mean difference for CAL between treatments of 0.4 +/- 0.6 mm (95% confidence intervals of 0.3-0.6 mm). The combination therapy of SRP+gel was superior to the conventional treatment of SRP alone, and these differences were maintained for 9 months.