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。     

米诺环素对慢性牙周炎的辅助治疗作用

目的 :探讨米诺环素对慢性牙周炎的辅助治疗作用。方法 :将 2 0个病例中患中度及重度慢性牙周炎的患牙 80个随机分成 4组 :①米诺环素 +刮治组 (SRP +M ) ;②单纯刮治组 (SRP) ;③单纯用米诺环素组 (M ) ;④未处理组 (U)。分别在基线、1周 ,4周时检测菌斑指数 (PI)、牙龈指数 (GI)、探诊出血指数 (BOP)、探诊深度 (PD)、附着丧失 (AL)等牙周病临床指标。结果 :SRP +M组在 1周和 4周时探诊深度和探诊出血率显著低于其它 3组 (P <0 .0 5 )。结论 :龈下局部应用米诺环素联合刮治术和根面平整术在降低探诊深度和探诊出血方面比单纯实施刮治术和根面平整术组效果明显。     

盐酸米诺环素对牙周袋内硫化物水平的影响

目的评价口臭的牙周炎患者局部应用盐酸米诺环素软膏对牙周袋内硫化物水平的影响。方法对15例以口臭为主诉的慢性牙周炎患者采用分口（split-mouth）设计,同一患者的一侧半口随机采用刮治和根面平整术（scaling and root planing,SRP）,另一侧采用SRP辅助用盐酸米诺环素软膏治疗。基线、治疗后6周、3个月时检查牙周袋内硫化物（sulfide in periodontal pockets,pS）水平、探诊深度（probing depth,PD）、临床附着水平（clinical attachment level,CAL）、出血指数（bleeding index,BI）、菌斑指数（plaque index,PLI）,在基线、治疗后6周刚果红涂片进行龈下微生物计数。结果在治疗后6周、3个月,SRP＋米诺环素组与单纯SRP组的各项临床指标均较治疗前明显改善（P〈0.05）;比较两组间pS值、PD、CAL、PLI、BI、龈下螺旋体比例,差异均无统计学意义。结论对于口臭的牙周炎的患者,盐酸米诺环素辅助SRP较单纯的SRP并未显示很大的优势;牙周治疗可持续3个月降低袋内硫化物水平。     

派丽奥软膏辅助治疗慢性牙周炎的疗效观察

目的:评价派丽奥软膏辅助治疗慢性牙周炎的疗效。方法:将48例患中重度慢性牙周炎的病人采用左右牙列自身对照的方法分别设立实验组和对照组,在严格仔细的刮治及根面平整后,实验组牙周袋内应用派丽奥软膏,对照组牙周袋内应用碘甘油液。分别记录病人在基线、3个月、6个月时牙周指数的变化并进行统计学分析。结果:牙周治疗3个月、6个月后,两组患牙的PLI、GI、BOP均无统计学差异(P>0.05),但PD和AL有统计学差异(P<0.05)。结论:牙周袋内应用派丽奥软膏辅助治疗慢性牙周炎能取得较好的疗效。     

光动力疗法辅助治疗Ⅲ期、Ⅳ期牙周炎的临床效果评价

目的: 探讨光动力疗法（photodynamic therapy,PDT）辅助龈下刮治术（subgingival scaling and root planning,SRP）在Ⅲ、Ⅳ期牙周炎治疗中的临床效果。方法: 根据2018年牙周病新分类,选择Ⅲ期和Ⅳ期牙周炎患者,经龈上洁治1周后,记录牙周探诊深度（probing depth, PD）、牙龈指数（gingival index, GI）和探诊出血（bleeding on probing,BOP）为基线。将患者分为3组,SRP组进行SRP治疗;PDT1组在SRP后即刻对口内所有PD≥5 mm的位点进行PDT;PDT2组在SRP+PDT后6周,对原位点再进行1次PDT。基线治疗后3、6个月复查,比较PD、GI和BOP阳性率的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果: 共纳入30例患者、1 289个位点。SRP组、PDT1组和PDT2组各10例患者,位点数分别为476个（36.9%）、384个（29.8%）和429个（33.3%）。3组治疗后3个月、6个月复查时,PD、GI、BOP阳性率较基线均显著降低（P<0.05）; 6个月与3个月的复查结果无显著差异。PD≥5 mm的位点,PDT1组和PDT2组可以显著降低患牙的GI和BOP阳性率（P<0.05）;PD≥7 mm时,PDT2组PD显著降低（P<0.05）。结论: 对于Ⅲ、Ⅳ期牙周炎,PDT辅助SRP治疗可以获得比单纯SRP更好的临床效果。     

缓释氯己定凝胶在慢性牙周炎治疗中的应用

目的:观察龈上洁治术、龈下刮治术和根面平整术(scaling and root planing,SRP)结合缓释氯己定凝胶(chlorhexidine,CHX)对慢性牙周炎的治疗作用。方法:选择35～65岁的慢性牙周炎患者36例,将后牙区牙周袋数目较多的单颌设定为实验组,对颌为对照组。实验组采取SRP+CHX治疗,对照组采取SRP治疗。分别于牙周治疗前、中、后3个阶段,记录每个受试牙近颊、颊侧、远颊、近舌、舌侧和远舌位点的牙龈指数(GI)、探诊出血(BOP)、探诊深度(PD)、临床附着水平(CAL)、探诊出血指数(SBI)。结果:BOP、SBI、PD、GI四项指标在治疗后1个月,实验组与对照组之间有显著差异(P<0.05),4个月后则无显著性差异(P>0.05)。CAL在治疗后1个月,两组间无显著(P>0.05),而4个月后差异显著性差异(P<0.05)。无论是实验组还是对照组,治疗前后各项牙周指标后牙区位点对治疗的反应明显不如前牙区,但无显著性差异(P>0.05)。PD>7 mm的深牙周袋,SRP+CHX组与SRP组之间4个月后仍有显著性差异。结论:在慢性牙周炎治疗过程中,SRP+CHX治疗能够改善牙周临床指标,尤其对PD>7 mm的深牙周袋有更好的治疗作用。     

盐酸米诺环素糊剂治疗重度牙周炎的临床研究

目的　评价 2 %盐酸米诺环素糊剂局部应用辅助治疗重度牙周炎的临床效果。方法　用随机、单盲、自身对照的方法研究 2 %盐酸米诺环素糊剂于牙周袋内置药辅助牙周基础治疗的效果 ,以单纯基础治疗为对照 ,观察基线、第 2周及第 5周菌斑指数 (PlI)、牙龈指数 (GI)、牙周探诊深度 (PD)、牙周附着水平 (AL)、龈沟出血指数 (SBI)及用药后反应。结果　第 2周和第5周PlI、GI、PD、AL、SBI较基线时均有改善 (P <0 .0 1) ;实验组第 5周较第 2周除PlI略有反弹外 ,其余指标皆进一步改善 ;在两个观察时段实验组较对照组在GI、PD、AL及SBI方面 ,差异有显著性 (P <0 .0 1) ,但PlI两组间差异无显著性 (P >0 .0 5 ) ;未发现用药后不良反应。结论　 2 %盐酸米诺环素缓释糊剂局部应用辅助治疗重度牙周炎有较好的临床效果     

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。     

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目的    评价脉冲Nd：YAG激光治疗慢性牙周炎患者牙周袋深度（PD）和附着丧失（AL）的效果。方法    选择2008年1—6月在福建医科大学附属协和医院就诊的45例慢性牙周炎患者,每例患者至少有4个以上≥6 mm的牙周袋并且分布在2个以上口腔区域内,在接受基础检查和龈上洁治术后,随机分成3组。A组（15例）：单纯接受龈下刮治和根面平整（SRP）治疗;B组（15例）：SRP+1次激光照射治疗（Nd： YAG激光,输出功率2 W,照射时间40 s）;C组（15例）：SRP+2次激光照射治疗（Nd： YAG激光,第1次照射输出功率2 W,照射时间40 s;第2次照射输出功率1 W,照射时间20s）。每组各选择40个位点。统计在基础检查,治疗2、4和12周时各组的PD和AL。结果    从第2周时,3组的PD均明显减小。而AL的改善在第4周时可以明显观察到,且C组的效果最为明显,并一直延续到12周。结论    SRP基础上辅助2次不同能量的激光治疗对慢性牙周炎PD和AL的改善效果均明显优于单独SRP使用。     

一次性全口龈下刮治和根面平整术治疗慢性牙周炎的近期疗效评价

目的：探讨一次性全口龈下刮治和根面平整术（full-mouth scaling and root planning,FM-SRP）治疗慢性牙周炎的效果,并与常规的分象限刮治（quadrant scaling and root planning,Q-SRP）效果进行比较。方法：将60例慢性牙周炎患者随机分为2组：FM-SRP组在1天内完成全口所有象限的刮治和根面平整。而Q-SRP组每周进行1个象限的刮治,连续4周完成全口治疗。分别在基线、3个月和6个月时,检测菌斑指数（plaque index,PI）、牙龈指数（gingival index,GI）、探诊出血（bleeding on probing,BOP）、探诊深度（probing depth。PD）及附着丧失（attachment loss,AL）的变化及患者的术后反应。所得结果分别进行秩和检验（PI、GI）、t检验（PD、AL）和X^2检验（BOP）。结果：与基线时相比,2种治疗方式在3个月和6个月时的所有临床牙周指数均有显著改善（P〈0．01）,但2组之间无显著性差异（P〉0．05）。在首次治疗24h,FM-SRP组的术后反应发生率显著高于Q-SRP组（P〈0.05）,但患者能够耐受。结论：FM-SRP和Q-SRP两种方法均可达到相同的临床效果,临床医生可根据实际需要,选择合适的治疗方式。     

米诺环素局部应用对洁治和根面平整影响的Meta分析

目的：比较并评价在牙周炎治疗过程中,牙周袋内局部应用米诺环素辅助用于洁治和根面平整（scalingand root paning,SRP）的临床效果是否优于单纯的SRP。方法：主要检索6个数据库,一些全文通过手工检索获得。收集至2009年5月公开发表的中英文牙周局部应用米诺环素辅助用于洁治和根面平整的随机对照试验,随访时间至少1个月。测量结果包括术后牙周探诊深度（probing depth,PD）的减少、临床附着水平（clinical attachmentlevel,CAL）的增加。结果：最终13个研究纳入本系统评价。Meta分析结果显示牙周局部应用米诺环素辅助用于SRP与单纯SRP相比,可以使PD指标显著降低,CAL指标显著增加。结论：在慢性牙周炎的治疗过程中,牙周局部应用米诺环素辅助用于SRP可以使牙周探诊深度显著降低,附着水平显著增加。     

Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a clinical study

BACKGROUND: The aim of this clinical study was to evaluate the association of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers. METHODS: Forty-three patients with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, relative attachment level (RAL), and probing depth (PD) were recorded at baseline, 45 days, and 3 and 6 months. Differences between baseline and each period were considered for analysis. RESULTS: At 6 months, no difference was found between groups regarding plaque, bleeding reduction, gingival recession or PD (P > 0.05). However, RAL gain was greater for SRP-D (1.63 +/- 0.93 mm) than for SRP (1.04 +/- 0.71 mm) (P = 0.025). In addition, deep pockets (> or = 7 mm) showed a significant reduction (3.78 +/- 1.41 versus 2.60 +/- 1.28 mm, P = 0.039) and RAL gain (2.54 +/- 1.27 mm versus 1.29 +/- 0.95 mm, P = 0.01) when doxycycline was applied. The proportion of sites showing RAL gain of 1 to 2 mm was 36.8% versus 21.7% for SRP-D and SRP, respectively (P = 0.01). CONCLUSION: The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers.     

盐酸二甲胺四环素辅助治疗慢性牙周炎的短期临床疗效观察

目的 观察盐酸二甲胺四环素(MINO)辅助治疗慢性牙周炎的临床效果.方法 将78例患者200颗患牙采用自身对照随机分为MINO试验组和对照组,观察用药结束后1周、 4周MINO组与对照组牙周袋深度(PD)、附着水平(AL)、探诊出血(BOP)的变化.结果 用药结束后1周、4周,两组PD、AL和BOP阳性率较基线时都有显著下降; 1周时试验组PD、AL和BOP阳性率虽然都低于对照组,但两组比较差异均无统计学意义(P＞0.05);而4周时两组PD、AL和BOP阳性率比较则差异有统计学意义(P＜0.05).结论 盐酸二甲胺四环素对慢性牙周炎有明显的辅助治疗效果,是临床上一种值得推广的局部治疗药物.     

Locally delivered minocycline microspheres for the treatment of periodontitis in smokers

AIM: The aim of the present analysis of a larger phase 3 clinical trial was to evaluate the efficacy of 1 mg minocycline hydrochloride microencapsulated in 3 mg of resorbable polymer, subgingivally administered as an adjunct to scaling and root planing (SRP) in smokers with chronic periodontitis. MATERIAL AND METHODS: Two hundred and seventy-one patients who smoked were randomized to one of three treatment groups: (1) SRP alone, (2) SRP plus vehicle (polymer without minocycline) or (3) SRP plus minocycline microspheres. Full mouth SRP was performed for all groups at baseline, and vehicle or minocycline microspheres were administered to the appropriate patients at all periodontal pockets > or =5 mm at baseline, 3 and 6 months. Efficacy was evaluated over 9 months. RESULTS: Significantly greater pocket depth reductions with SRP plus adjunctive minocycline microsphere treatment were observed at 1, 6 and 9 months (p<0.05) versus control treatments. At 9 months, smokers treated with SRP plus minocycline microspheres exhibited a pocket depth reduction of 1.19 mm from baseline, as compared to 0.90 mm for smokers treated with SRP alone. The efficacy of adjunctive minocycline microspheres was consistent among all tested smoking subcohorts, including those based on gender, age and smoking exposures. CONCLUSION: These data indicate that treatment with SRP plus locally delivered minocycline microspheres is more effective than SRP alone in reducing pocket depths in smokers with periodontitis.     

Enhancing the value of scaling and root-planing: Arestin clinical trial results

Locally delivered antibiotics are used to treat periodontitis and these agents are found to be effective in improving the treatment result. Microencapsulated minocycline hydrochloride (Arestin) has been tested and reported to provide significantly greater probing depth reduction in conjunction with scaling and root-planing than scaling and root-planing alone. Thus, it was suggested that the use of locally delivered antimicrobial agents should be incorporated as part of an optimal non-surgical therapeutic regimen. This paper evaluates the efficacy of the minocycline microspheres in patients with moderate to severe periodontitis in a model, which is a randomised, evaluator-blinded study with an open-label; four arm parallel design. The patients were selected based upon 'active' disease, as determined by at least two teeth having one site each with pocket depth (PD) > or = 6 mm and with prostaglandin E2 (PGE2) levels > 66.2 ng/ml in gingival crevicular fluid. The trial was of 6 months duration and used a formulation of minocycline microspheres containing 1 mg minocycline. Responses of groups receiving SRP followed by one dose per pocket of the minocycline microspheres (SRP + MPTS) were compared to SRP alone, MPTS alone or no treatment. There were substantially greater reductions in PD and gains in clinical attachment level (CAL) at each post-treatment time point in the SRP + MPTS group compared to the other treatment groups. PD reduction and gain in CAL at month 3 in the SRP + MPTS group vs. SRP alone was statistically significant. These data further support the adjunctive use of minocycline in a slow release vehicle for the treatment of periodontitis with SRP.     

Combining host modulation and topical antimicrobial therapy in the management of moderate to severe periodontitis: a randomized multicenter trial

BACKGROUND: Previous studies showed that host modulation therapy (HMT) or topical antimicrobial therapy (TAT) provided significant adjunctive benefits to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The purpose of this study was to evaluate a combination therapy involving SRP, HMT, and TAT in the treatment of moderate to severe CP. METHODS: A 6-month, randomized, multicenter, placebo-controlled, examiner-masked study was undertaken to evaluate the clinical usefulness of a combination treatment of systemically delivered doxycycline hyclate (HMT; 20 mg, twice a day) plus locally delivered doxycycline hyclate gel (TAT; 10%, in pockets > or =5 mm) in combination with SRP versus SRP plus placebo. Clinical outcomes included mean changes in probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI) at baseline and at 3 and 6 months. RESULTS: In 171 subjects, combination therapy provided significantly greater clinical benefits than control therapy for all clinical measures at 3 and 6 months. In moderate CP (PD of 4 to 6 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P <0.01), CAL (3 months: P <0.01; 6 months: P <0.03), BOP (3 months: P <0.02; 6 months: P <0.05), and GI (3 months: P <0.01; 6 months: P <0.03). In severe CP (PD > or =7 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P <0.01), CAL (3 months: P <0.01; 6 months: P <0.02), BOP (3 months: P <0.01; 6 months: P >0.05), and GI (3 months: P <0.01; 6 months: P <0.01). CONCLUSION: Combination therapy, including SRP, HMT, and TAT, provided significantly greater clinical benefits than SRP alone in the treatment of moderate to severe CP.     

Effect of locally delivered minocycline microspheres on markers of bone resorption

BACKGROUND: Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), a bone-specific degradation product, and interleukin 1-beta (IL-1), a potent bone-resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL-1. METHODS: Forty-eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD < or = 3 mm) and 4 deep (PD > or = 5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL-1 were determined using radioimmunoassay and enzyme-linked immunosorbent assay techniques, respectively. RESULTS: Significant differences (P<0.001) in GCF levels of ICTP and IL-1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL-1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL-1 levels (P <0.02) at 1 month compared to the SRP + V group. CONCLUSIONS: Results of this study indicate that GCF levels of ICTP and IL-1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short-term reduction in GCF IL-1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long-term reductions in GCF ICTP and IL-1 levels.     

Mechanical therapy with adjunctive minocycline microspheres reduces red-complex bacteria in smokers

BACKGROUND: Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis. METHODS: A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis. RESULTS: MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05). CONCLUSIONS: SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.     

Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients

OBJECTIVES: To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients. MATERIALS AND METHODS: Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola. RESULTS: Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p<0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p<0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028). CONCLUSION: SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP.     

Longitudinal clinical evaluation of adjunct minocycline in the treatment of chronic periodontitis

BACKGROUND: The clinical benefits of minocycline in combination with thorough scaling and root planing (SRP) have been examined in multicenter studies. The aim of this longitudinal investigation was to evaluate the clinical response to scaling and root planing combined with the use of locally delivered minocycline microspheres for 720 days in individuals with advanced chronic periodontitis. METHODS: A total of 26 individuals aged 26 to 69 years (mean: 46.8+/-12.1 years) were included in this double-blind randomized clinical trial. After randomization, 13 individuals were selected for the test group (TG) and treated with SRP plus subgingival minocycline at baseline and 90, 180, and 270 days, and 13 individuals were selected for the control group (CG) and received SRP plus vehicle at the same timepoints. Two homologous sites with probing depth (PD)>or=6 mm were chosen in each subject. To evaluate the clinical response after treatment, PD, plaque index (PI), and gingival index (GI) were assessed at baseline and 90, 180, 270, 360, and 720 days. RESULTS: No statistical differences were found between test and control groups in relation to PD at the different timepoints. The mean values of PD demonstrated a higher reduction in the test group at 270 and 360 days. No statistical differences were observed at 90, 180, and 720 days between TG and CG (P<0.05; Wilcoxon test). There were no statistically significant differences between TG and CG concerning PI and GI (P<0.05; analysis of variance and t test) at all evaluated timepoints. CONCLUSION: Our findings demonstrated that both therapies reduced mean PD from 90 to 360 days; however, SRP combined with the use of subgingival minocycline showed a higher reduction at 270 and 360 days following therapy.