四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,牙周袋内局部应用四环素辅助用于洁治和根面平整（Scaling and Root Planing,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四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 attachment level,CAL）的增加。结果：最终8个研究纳入本系统评价。Meta分析结果显示牙周局部应用四环素辅助用于SRP与单纯SRP相比,可以使临床附着水平显著增加,而牙周探诊深度在两治疗组间无统计学差异。结论：在慢性牙周炎的治疗过程中,牙周局部应用四环素辅助用于SRP可以使附着水平显著增加。     

氯己定局部缓释系统辅助龈下刮治和根面平整效果的Meta分析

目的:比较并评价在慢性牙周炎治疗过程中,牙周袋内应用氯己定局部释药系统辅助龈下刮治和根面平整(scaling and root planing,SRP)的临床效果是否优于单纯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氯己定释药系统辅助龈下刮治和根面平整的随机对照试验,随访时间至少3个月。观察指标为术后牙周探诊深度(probing depth,PD)的减少和临床附着水平(clinical attachment level,CAL)的增加。结果:最终有7个研究纳入本系统评价。Meta分析结果显示,牙周局部应用氯己定释药系统辅助SRP与单纯SRP相比,可以使PD显著降低,而CAL在2个治疗组间无统计学差异。结论:在慢性牙周炎的治疗过程中,牙周局部应用氯己定释药系统辅助SRP可以使牙周探诊深度显著降低。     

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。     

米诺环素对慢性牙周炎辅助治疗的疗效观察

目的 评价牙周袋局部应用米诺环素软膏联合刮治和根面平整治疗慢性牙周炎的疗效。方法 64名患中到重度慢性牙周炎的男性吸烟者随机分成SRP和SRP+M两组。对SRP组患者施行刮治和根面平整,对SRP+M组患者在刮治和根面平整的基础上,牙周袋局部应用米诺环素软膏。记录两组患者在基线、3个月和6个月时的菌斑指数（PlI）、牙龈指数（GI）、探诊出血（BOP）、探诊深度（PD）及附着丧失（AL）的变化并进行统计学分析。结果 治疗过程中有6例患者被排除,有效病例数为58例,每组29例。牙周治疗3个月和6个月后,两组患者的PlI、GI和BOP均无统计学差异（P>0.05）,但PD和AL有统计学差异（P<0.05）。治疗后3个月SRP组PD下降1.32 mm,AL减轻1.14 mm;而SRP+M组PD下降1.98 mm,AL减轻1.87 mm。对于基线检查PD≥7 mm的深牙周袋,治疗后3个月SRP组PD下降2.21 mm,AL减轻1.23 mm;而SRP+M组PD下降3.48 mm,AL减轻2.62 mm。治疗后6个月PD和AL状况与3个月相比变化不大。与SRP组相比,SRP+M组临床症状改善更明显。结论 龈下局部应用米诺环素软膏辅助治疗慢性牙周炎可取得较好的疗效,特别是对于有深牙周袋、吸烟的牙周炎患者,机械治疗联合局部应用缓释抗菌素较单纯机械治疗的疗效更好。     

吸烟对牙周炎患者龈下刮治和根面平整术疗效影响的研究

[摘要] 目的 比较吸烟与不吸烟牙周炎患者实施龈下刮治和根面平整治疗术(scaling and root planning,SRP)时,对探诊深度(probing depth,PD)和临床附着水平(clinical attachment level,CAL)的影响。方法 选择临床上中到重度的牙周炎患者,其中53例吸烟患者,56例非吸烟患者,局麻下行龈下刮治和根面平整术(SRP)后,局部龈下放置25%的甲硝唑膜。由同一位检查者分别于初诊及6个月复诊时用牙周探针检查记录探诊深度(PD)和临床附着水平(CAL)。结果 治疗后6个月复诊时,吸烟组PD减小量和CAL增加量均小于不吸烟组(P<0.05),螺旋体比例降低量吸烟组亦较小(P<0.05)。结论 吸烟患者对SRP治疗的反应性较差,且对于局部抗生素治疗的敏感性亦较低。     

米诺环素局部用药治疗老年慢性牙周炎的疗效观察

目的：评价盐酸米诺环素软膏局部应用，治疗老年慢性牙周炎的疗效。0方法：选择60例老年慢性牙周炎的患者，共120颗牙。全口洁治和根面平整后，以患者一侧忠牙局部应用盐酸米诺环素软膏为实验组，对侧同名患牙局部应用双氧水、碘甘油作为对照组。于基线、基线后5、9周检测菌斑指数（PLI）、龈沟出血指数（SBI）、探诊深度（PD）。结果：两组临床指标均较基线有明显改善，PLI实验组优于对照组，差异有显著性（P〈0．01）。结论；牙周袋内应用米诺环素软膏配合牙周基础冶疗，能够有效改善牙周炎症状，且效果优于传统的碘氧疗法。     

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。     

比较局部或全身应用抗生素辅助治疗广泛性侵袭性牙周炎的临床疗效

目的：比较局部或全身应用抗生素加龈下刮治及根面平整的机械治疗对广泛性侵袭性牙周炎临床疗效的影响。方法：采用随机分组方法分为局部使用盐酸米诺环素组、口服阿莫西林＋甲硝唑组和单纯龈下刮治及根面平整的治疗组,通过观察各项临床牙周指数在治疗前后的变化,比较三组之间的疗效差异。结果：三组的各项临床牙周指数较治疗前均有显著性差异（P〈0.01）,治疗后局部用药组和全身用药组的龈沟出血指数（SBI）、探诊深度（PD）和附着水平丧失（CAL）均较单纯机械治疗组有显著性差异（P〈0.01）,但局部用药组和全身用药组之间SBI、PD、CAL的无显著性差异（P〉0.05）。结论：局部或全身应用抗生素均可有效提高广泛性侵袭性牙周炎的临床疗效,且两者疗效无显著性差异。     

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。     

Efficacy of Local Antimicrobials in the Non‐Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review

Background: Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). Methods: Only randomized controlled trials with: 1) at least 6 months of follow‐up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random‐effects meta‐analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. Results: Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well‐controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. Conclusion: In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well‐controlled individuals and deep sites.     

Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial.

BACKGROUND: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline. METHODS: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months. RESULTS: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups. CONCLUSIONS: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.     

Locally Delivered 1% Metformin Gel in the Treatment of Smokers with Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Metformin (MF) (1,1‐dimethylbiguanide HCl) is one of the most commonly used oral antihyperglycemic agents for the treatment of type 2 diabetes mellitus. Recently, MF has been shown to have bone‐sparing properties. The present study is designed to investigate the effectiveness of MF 1% in an indigenously prepared, biodegradable, controlled‐release gel, as an adjunct to scaling and root planing (SRP) in treatment of vertical defects in smokers with generalized chronic periodontitis (CP). Methods: Fifty patients were categorized into two treatment groups: SRP plus 1% MF and SRP plus placebo. Clinical parameters were recorded at baseline and at 3 and 6 months; they included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, intrabony defect (IBD) fill was radiologically assessed using computer software. Results: Mean PD reduction and mean CAL gain were found to be greater in the MF group than the placebo group at all visits. Furthermore, a significantly greater mean percentage of bone fill was found in the MF group (26.17% ± 6.66%) than the placebo sites (3.75% ± 8.06%) (P <0.001). Conclusion: There was greater decrease in mSBI and PD and more CAL gain with significant IBD fill at vertical defect sites treated with SRP plus locally delivered MF, versus SRP plus placebo, in smokers with generalized CP.     

Efficacy of 1% Metformin Gel in Patients With Moderate and Severe Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The aim of this study is to investigate efficacy of metformin (MF) 1% gel as an adjunct to scaling and root planing (SRP) in the treatment of moderate and severe chronic periodontitis (CP). Methods: Seventy patients were categorized into two treatment groups: 1) SRP plus 1% MF and 2) SRP plus placebo. Clinical parameters were recorded at baseline and 3, 6, and 9 months. They included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). Radiologic assessment of intrabony defects (IBDs) and percentage defect depth reduction (DDR%) was done at baseline and 6‐ and 9‐month intervals using computer‐aided software. PD, CAL, and DDR% were evaluated in two subgroups in both the placebo and MF group: 1) initial PD of 5 to 7 mm and 2) initial PD of >7 mm. Results: Mean PD reduction and mean CAL gain was found to be greater in the MF group than the placebo group at all visits. Clinical parameters (PD, CAL) in both subgroups, with initial PDs of 5 to 7 and >7 mm, showed significant improvement in the 1% MF group compared with the placebo group. A significantly greater mean DDR% was found in the MF group than the placebo group at 6 and 9 months in both subgroups, 5 to 7 and >7 mm of initial PD. Conclusion: There was a greater decrease in PD and more CAL gain with significant IBD depth reduction at sites treated with SRP plus locally delivered MF in patients with CP in both initial PD = 5 to 7 and >7 mm subgroups compared with placebo.     

Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis

BACKGROUND: Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP. METHODS: After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group). RESULTS: In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG). CONCLUSIONS: These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.     

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.