Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial

Objective: The aim of this study was to assess the effect of adjunctive antimicrobial photodynamic therapy (aPDT) in chronic periodontitis. Material and Methods: Twenty patients with untreated chronic periodontitis were included. All teeth received periodontal treatment comprising scaling and root planing. Using a split‐mouth design, two quadrants (test group) were additionally treated with aPDT. Sulcus fluid flow rate (SFFR) and bleeding on probing (BOP) were assessed at baseline, 1 week and 3 months after treatment. Relative attachment level (RAL), probing depths (PDs) and gingival recession (GR) were evaluated at baseline and 3 months after treatment. Results: Baseline median values for PD, GR and RAL were not different in the test group and control group. Values for RAL, PD, SFFR and BOP decreased significantly 3 months after treatment in the control group (median delta RAL: ?0.35 mm, inter‐quartile range: 0.21 mm), with a higher impact on the sites treated with adjunctive aPDT (median delta RAL: ?0.67 mm, inter‐quartile range: 0.36 mm, p<0.05). GR increased 3 months after treatment with and without adjunctive aPDT (p<0.05), with no difference between the groups (p>0.05). Conclusions: In patients with chronic periodontitis, clinical outcomes of conventional subgingival debridement can be improved by adjunctive aPDT.     

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。     

光动力疗法对慢性牙周炎龈下牙周致病菌的影响

目的：应用PeriowaveTM光动力杀菌系统对慢性牙周炎患者进行治疗,通过龈下菌斑中牙周致病菌比例的变化,评价光动力疗法（photodynamic therapy,PDT）治疗慢性牙周炎的临床效果。方法：选取60名慢性牙周炎患者,分别给予SRP＋1次PDT（A组）、SRP＋2次PDT（B组）或单纯SRP（C组）治疗。利用real-time PCR技术检测A、B、C三组在治疗前、治疗后6周、治疗后12周龈下菌斑中牙周致病菌P.g、A.a、T.f所占比例的变化。结果：治疗后6周,A、B两组牙周致病菌P.g在总菌中的比例都有非常显著降低（p〈0.01）,C组有显著降低（p〈0.05）;治疗后12周,A、B组仍有非常显著的降低（p〈0.01）,与C组相比有非常显著差异（p〈0.01）,但A、B两组之间没有差异（p〉0.05）;而仅在治疗后12周,B组的A.a相对于总菌的比例与基线相比有显著降低（p〈0.05）,且这一变化显著大于A、C两组（p〈0.05）;在治疗后6周,A、B组T.f相对于总菌含量的下降与基线相比,明显大于C组（p〈0.05）,治疗后12周,A、B两组T.f相对于总菌的含量仍有非常显著的下降（p〈0.01）,但A组和B组之间都没有差异。结论：PDT对P.g、A.a和T.f3种牙周致病菌都有杀灭作用,但P.g、T.f对PDT更为敏感,PDT可以作为治疗慢性牙周炎的辅助方法。     

5种牙周龈下可疑致病微生物与慢性牙周炎局部不同牙周状态间的关系

目的 观察5种龈下微生物检出水平与慢性牙周炎局部牙周状态的关系。方法 选择20例慢性牙周炎患者的80个位点及10例牙周健康者的20个位点为观察位点,采集龈下微生物样本,记录牙周探诊深度（PD）,根据所测位点的PD进行分组。PD≤4 mm为A组,4 mm＜PD≤6 mm为B组,PD>6 mm为C组,健康对照组为H组。通过聚合酶链反应（PCR）和DNA探针反杂交技术半定量检测各组伴放线菌嗜血菌、牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌的检出率和检出水平。结果 B、C组牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌的检出率和检出水平均高于H组,A组牙龈卟啉单胞菌的检出率和检出水平也高于H组,C组福赛斯坦纳菌和齿垢密螺旋体检出水平高于B组,以上差异均有统计学意义（P<0.05）;伴放线菌嗜血菌在各组间的检出率及检出水平都无明显差异。结论 随着牙周袋的加深,牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌体的阳性检出率和检出水平都有随之增加的趋势;牙龈卟啉单胞菌与慢性牙周炎的早期炎症关系较为密切,而福赛斯坦纳菌和齿垢密螺旋体与中重度慢性牙周炎炎症位点的严重程度有关。     

慢性牙周炎龈下菌斑中五种牙周可疑致病微生物的分布

目的研究五种牙周可疑致病微生物在慢性牙周炎患者龈下菌斑的分布。方法选择27例慢性牙周炎患者,每位患者选取牙周袋最深的两个位点作为观察位点,采集龈下微生物样本,采用多重聚合酶链反应和反杂交的方法对伴放线菌嗜血菌、牙龈卟啉单胞菌、福赛斯坦纳菌、中间普雷沃菌和齿垢密螺旋体五种微生物进行半定量检测。结果在所检测的54个位点中,牙龈卟啉单胞菌、中间普雷沃菌、福赛斯坦纳菌和齿垢密螺旋体均有较高的检出率,分别为98.15%、92.59%、100%和98.15%;伴放线菌嗜血菌检出率较低,为20.37%。牙龈卟啉单胞菌和福赛斯坦纳菌的检出量明显高于其他三种微生物,其差异有统计学意义（P<0.05）。结论慢性牙周炎患者多存在牙龈卟啉单胞菌、福赛斯坦纳菌、中间普雷沃菌和齿垢密螺旋体的同时感染,且牙龈卟啉单胞菌和福赛斯坦纳菌的感染量较高。     

One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial

Background: Single photodynamic therapy (PDT) has been effective in initial periodontal therapy, but only improved bleeding on probing (BoP) in maintenance patients after a single use. Repeated PDT has not been addressed.
Objectives: To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance.
Material and Methods: Ten maintenance patients with 70 residual pockets [probing pocket depth (PPD)5 mm] were randomly assigned for treatment five times in 2 weeks (Days 0, 1, 2, 7, 14) with PDT (test) or non-activated laser (control) following debridement. The primary outcome variable was PPD, and the secondary variables were clinical attachment level (CAL) and BoP. These were assessed at 3, 6 and 12 months following the interventions.
Results: Greater PPD reductions were observed in the test (−0.67 ± 0.34; p =0.01) compared with the control patients (−0.04 ± 0.33; NS) after 6 months. Significant CAL gain (+0.52 ± 0.31; p =0.01) was noted for the test, but not in the control (−0.27 ± 0.52; NS) patients after 6 months. BoP percentages dcreased significantly in test (97–64%, 67%, 77%), but not control patients after 3, 6 and 12 months.
Conclusions: Repeated (five times) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients. The effects were best documented after 6 months.     

Lack of short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis: an open label-randomized clinical trial

Aim: To determine if the adjunctive use of intra-muscular neridronate (NE) during non-surgical periodontal treatment (PT) provides, in patients with generalized chronic periodontitis (GCP), adjunctive benefits as compared with PT alone 3 months after the completion of a 3-month NE therapy.
Material and Methods: Sixty GCP healthy patients were randomly assigned to control (CG) or test group (TG). CG patients received PT only. Thirty subjects in TG also received adjunctive NE (12.5 mg in an i.m. injection/week for 3 months). Clinical parameters were evaluated at baseline, at the end of NE treatment (3 months after PT) and 3 months after the completion of NE treatment (6 months after the beginning of PT).
Results: Groups were balanced at baseline and all clinical parameters showed improvement between baseline and follow-ups. At 6 months improvements from baseline at sites with deep pocket depth (7 mm) were 3.2 mm [95% confidence interval (CI): 2.7–3.9] in CG and 3.0 mm (95% CI: 2.3–3.8) in TG with a non-significant difference of 0.2 mm (95% CI: −1.0–0.5; ancova ; p =0.549) between groups. Secondary outcomes did not show significant differences between groups. No major adverse events were reported.
Conclusions: The adjunctive use of NE during PT did not result in additional short-term improvements in periodontal conditions of GCP patients when compared with PT.