内窥镜辅助下微创牙周基础治疗的临床疗效评价

目的 探讨牙周内窥镜辅助下超声龈下刮治及根面平整(subgingival scaling and root planning,SRP)对重度牙周炎治疗的临床疗效.方法 选取2017年6月至2019年1月于南京大学医学院附属口腔医院就诊的Ⅲ-Ⅳ期牙周炎患者19例,随机分为内窥镜组及对照组.内窥镜组在龈上洁治术1周后,牙周...     

牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

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。     

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.     

Adjunctive Non‐Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial

Background: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin‐1β (IL‐1β) in patients receiving regular periodontal maintenance therapy. Methods: This single‐masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥5 mm with bleeding on probing (BOP). Fifty‐six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty‐eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL‐1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Results: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL‐1β levels between SRP + L and SRP alone were not statistically significant. Conclusion: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥5 mm PD.     

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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。     

Clinical Effectiveness of Diode Laser Therapy as an Adjunct to Non‐Surgical Periodontal Treatment: A Randomized Clinical Study

Background: The aim of this randomized clinical study is to evaluate the effect of a 980‐nm diode laser as an adjunct to scaling and root planing (SRP) treatment. Methods: Thirty‐five patients with chronic periodontitis were selected for the split‐mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. Results: The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18‐week (P <0.05) and 6‐ to 18‐ week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). Conclusion: The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980‐nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).     

重度广泛型侵袭性牙周炎患者非手术治疗的临床疗效观察

目的 观察重度广泛型侵袭性牙周炎(generalized aggressive periodontitis,GAgP)患者牙周非手术治疗后临床指标的变化,并评价其治疗效果.方法 19例GAgP患者在洁治后1个月内完成刮治和根面平整,每2个月进行1次牙周维护,纵向观察6个月.在基线和维护期各时间点记录全口探诊深度(probing depth,PD)、探诊出血(bleeding on probing,BOP)、附着丧失(attachment loss,AL)和牙齿松动度,磨牙记录根分叉病变的程度,其中7例患者在基线和治疗后6个月进行白细胞计数、中性粒细胞百分比和甘油三酯的检测.结果 在基线时患者的平均PD为(5.1±2.1)mm,BOP阳性位点占98.0%,AL(3.9±1.9)mm.治疗后6个月平均PD为(3.0±1.1)mm,BOP阳性位点减少至11.9%,AL(3.2±1.2)mm,其中重度位点治疗后PD减少[(4.0±1.6)mm]大于中度位点[(2.2±0.9)mm,P<0.001],切牙治疗后PD减少大于磨牙,中性粒细胞百分比治疗后6个月[(55.4±9.3)%]较治疗前[(65.7±9.9)%]明显减少(P<0.05).结论 GAgP患者经牙周非手术治疗和定期牙周维护能取得良好的治疗效果,磨牙可能需要进一步的刮治和根面平整或手术治疗.     

Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study

BACKGROUND: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. METHODS: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) > or =5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. RESULTS: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. Moreover, the PD was reduced in the SRP + CHX treatment group compared to the SRP treatment group at 3 and 6 months, whereas the RAL was similar for both treatments at 3 months and was reduced in the SRP + CHX treatment group at 6 months. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001). The TBCs decreased significantly with both treatments. A similar, although less evident, pattern was noted when only the pockets with an initial PD > or =7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and 1 month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P <0.01 and P <0.05, respectively). Over time, both treatments generally reduced the percentages of sites positive for the eight putative periodontopathic bacteria, although greater reductions were seen often for the SRP + CHX treatment group. CONCLUSIONS: The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota.     

Short-term clinical and immunologic effects of scaling and root planing with Er:YAG laser in chronic periodontitis

BACKGROUND: Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for the treatment of periodontal pockets affected with chronic periodontitis. METHODS: Twenty-one subjects with pockets from 5 to 9 mm in non-adjacent sites were studied. In a split-mouth design, each site was randomly allocated to a treatment group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL)-1beta levels in crevicular fluid were evaluated at baseline and at 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline and 30 days after treatment. A statistical analysis was conducted (P <0.05). RESULTS: Twelve days postoperatively, the PI decreased for SRPL and SRP groups (P <0.05); the GI increased for L, SRP, and C groups but decreased for the SRPL group (P <0.05); and BOP decreased for SRPL, L, and SRP groups (P <0.01). Thirty days postoperatively, BOP decreased for treated groups and was lower than the C group (P <0.05). PD decreased in treated groups (P <0.001), and differences were found between SRPL and C groups (P <0.05). CAL gain was significant only for the SRP group (P <0.01). GR increased for SRPL and L groups (P <0.05). No difference in IL-1beta was detected among groups and periods. CONCLUSION: Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.     

牙周内镜辅助牙周非手术治疗对牙龈退缩的影响

目的: 探讨牙周内镜辅助超声龈下刮治及根面平整术（scaling and root planing,SRP）对上颌侧切牙唇侧牙龈退缩的影响。方法: 从2020年6月—12月就诊于上海市普陀区眼病牙病防治所牙周病科的患者中收集36例中、重度慢性牙周炎患者作为受试者。采用单盲随机分口自身对照设计方案,先行全口超声龈上洁治术,2周后随机确定一侧上颌侧切牙行牙周内镜辅助下SRP（内镜组）,对侧侧切牙行常规SRP（ SRP组）作为对照,术后菌斑控制,记录基线、3个月和6个月时上颌侧切牙唇侧近中、中和远中3个位点的牙周探诊深度（PD）、附着丧失（AL）、牙龈退缩（GR）。采用SPSS 22.0软件包对2组治疗前后各项指标差异进行统计学分析。结果: 基线时内镜组和SRP组相比,各临床指标无显著差异。3个月时,内镜组的牙龈退缩量（ΔGR）显著小于SRP组（P<0.05）;3个月和6个月时,2组间的其他指标比较均无显著差异。与SRP组相比,内镜组PD的减少程度与AL的增加程度有更大趋势,治疗后3个月最明显。与基线相比,2组3个月和6个月时,PD、AL均有显著差异;实验组PD在3个月和6月个时相比,也有显著差异。3个月和6个月时相比,2组ΔGR均存在显著差异。结论: 牙周内镜辅助SRP清创彻底,创伤小,3个月时上颌侧切牙唇侧牙龈退缩减少量较常规SRP更少,美学效果优势凸显。     

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。     

Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. I. clinical results

OBJECTIVE: The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis. METHODS: Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova. RESULTS: A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm. CONCLUSION: The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.     

生物抗菌多肽辅助治疗Ⅲ期牙周炎的短期疗效观察

目的 探讨生物抗菌多肽在辅助治疗Ⅲ期牙周炎患者中的疗效。方法 将51例患者根据治疗方式随机分为单纯机械刮治组、盐酸米诺环素组和生物抗菌多肽组,3组患者均进行牙周序列治疗,超声龈上洁治后进行刮治、根面平整、抛光、冲洗。盐酸米诺环素组、生物抗菌多肽组分别于治疗后的牙周袋内注入盐酸米诺环素软膏及生物抗菌多肽牙周凝胶,单纯机械刮治组不用药。记录基线及治疗后90 d的牙周检查表,比较3组间牙周探诊深度(probing depth, PD)、牙龈出血指数(bleeding index, BI)、附着水平(attachment level, AL)差异;收集3组基线、治疗后7 d、治疗后90 d的龈沟液,利用酶联免疫吸附法(enzyme-linked immunosorbent assay, ELSIA)检测肿瘤坏死因子-α(tumour necrosis factor-α,TNF-α)、白细胞介素(interleukin, IL)-1β变化。结果 基线时,3组牙周临床检查指标(PD、BI、AL)以及龈沟液中TNF-α、IL-1β含量差异无统计学意义(P>0.05)。治疗后7 d及90 d, ...     

光敏灭菌辅助龈下刮治后不同深度牙周袋的恢复率比较研究

目的评价PERIOWAVETM光敏灭菌法治疗慢性牙周炎后≥4mm牙周袋的恢复效果。方法经伦理委员会同意后,选择45例患者(每位患者口腔内至少有4个以上≥5mm的牙周袋并分布在2个以上口腔区域内),在接受基础检查以及根面平整术(SRP)治疗后,随机分入3组,A组在SRP之后接受1次PERIOWAVETM光敏灭菌治疗,B组在SRP后及6周后各接受1次PERIOWAVETM治疗,而C组仅接受SRP治疗。在基础检查及12周后测量牙周袋深度。结果在基础检查中共有1851个≥5mm牙周袋,经过治疗后,C组有212(36.7%)个牙周袋≤3mm,A组有160(62.5%)个牙周袋≤3mm,而B组有187(84.6%)个牙周袋≤3mm;705个4mm的牙周袋,治疗后PD≤3mm的C组147(66.5%)个,A组160(62.5%)个,B组187(84.6%)个。经两样本二项分布检验,对于基础检查中为测量为4mm及≥5mm牙周袋,B组的恢复均明显好于A组及C组(P<0.0001)。结论在SRP基础上加以2次光敏灭菌治疗牙周炎对于浅(4mm)及深(≥5mm)牙周袋深度的恢复均明显大于单独使用SRP。     

2 multi-center trials assessing the clinical efficacy of 5% sanguinarine in a biodegradable drug delivery system

Abstract A biodegradable drug delivery system containing 5% sanguinarium (Sa) was compared to vehicle control (VC), scaling and root planing (SRP). and supragingival plaque control (SPC) in the treatment of adult periodontitis in 2 well-controlled clinical trials. Studies were 4-quadrant (split mouth) designs at 2 centers each, having 94 (Study A) and 107 (Study B) patients. All patients had at least 3 pockets between 5 and 9 mm that bled on probing, in each quadrant. Probing pocket depth (PD), clinical attachment level (AL), bleeding on probing (BOP), and plaque index were recorded at baseline, 14, 30, 60, and 90 days. All treatments gave statistically significant reductions from baseline for PD and BOP. and significant gains for AL. For PD reduction. SRP was superior to all test groups at all time points in both studies (p < 0.001). Sa was superior to VC in Study A at 14 and 30 days and to SPC at all time points. For AL gain at 90 days, in both studies. SRP gave gains of 0.42 and 0.78 mm respectively with superiority seen over the SPC group at 90 days (p<0.001) in study A only. For BOP reduction, in Study A SRP was superior to Sa. VC. and SPC at 60 and 90 days (p<0.005) and in Study B superiority to Sa and VC was at 90 days and to SPC at 60 days (p<0.05). Sa was superior to VC for pocket depth in deep pockets only. Sa failed to demonstrate superiority over VC on a consistent basis. Analysis of residual Sa indicates that Sa potency was insufficient to show an advantage beyond clinical effects inherent in treatments with VC and SPC.     

Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months

BACKGROUNDS, AIMS: The aim of our study was to evaluate the clinical, radiological and microbiological response to the local delivery of tetracycline (TE) of sites with persistent periodontal lesions. MATERIALS AND METHODS: The study was conducted in a split-mouth design. Nineteen patients with at least four bilateral pockets 4-5 mm and bleeding on probing (BOP) were treated with scaling and root planing (SRP) plus TE fibres (test sites) or with SRP alone (control sites). Clinical and radiological measurements were taken at baseline, 6 months and 12 months post-operatively. Subgingival plaque samples were collected at baseline, at fibres removal, 6 and 12 months following treatment and analysed by polymerase chain reaction. RESULTS: Both treatments yielded a statistically significant (p<0.05) reduction of probing depth (2.05 and 1.21 mm), gain of clinical attachment level (1.71 and 0.53 mm) and reduction of BOP scores (23.68% and 57.89%) for TE and SRP groups, respectively, when comparing 12-month data with baseline. The differences between two groups were significant. The prevalence of Treponema denticola and Bacteroides forsythus decreased after therapy in both groups but only in the test sites Actinobacillus actinomycetemcomitans and Prevotella intermedia were not yield detected. The pathogens could be eliminated from five periodontal pockets by SRP alone, while 21 TE sites were not recolonized at 12 months. CONCLUSIONS: SRP plus TE fibres gave the greatest advantage in the treatment of periodontal persistent lesions at least 12 months following treatment.     

Moxifloxacin as an adjunctive antibiotic in the treatment of severe chronic periodontitis

BACKGROUND: The impact of moxifloxacin (MOX) was analyzed in the treatment of severe chronic periodontitis. METHODS: In a randomized, prospective, clinical multicenter trial, 92 subjects with severe chronic periodontitis were treated with scaling and root planing (SRP) alone (control group; n = 21), SRP plus adjunctive doxycycline (DOX group; n = 36), or SRP plus adjunctive MOX (MOX group; n = 35). Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline and at 3, 6, and 12 months after non-surgical periodontal treatment. The load of periodontopathogens, the level of interleukin-8, and the activities of granulocyte elastase and myeloperoxidase were also measured. RESULTS: All three procedures led to significant reductions in PD, CAL, and BOP. PD reduction was significantly greater (P <0.05) in the MOX group (2.46 +/- 1.17 mm at 6 months and 2.84 +/- 1.53 mm at 12 months) compared to the DOX group (1.85 +/- 1.24 mm and 2.19 +/- 1.13 mm at 6 and 12 months, respectively) and the controls (1.77 +/- 0.57 mm and 1.86 +/- 0.56 mm at 6 and 12 months, respectively). Only in the MOX group was the load of all investigated bacteria and all inflammatory parameters reduced at each appointment compared to baseline. CONCLUSIONS: The adjunctive application of antibiotics improved the treatment outcome in subjects with severe chronic periodontitis. MOX seemed to be more effective than DOX and might be an alternative drug in the treatment of periodontal diseases.     

Local Minocycline Effect on Inflammation and Clinical Attachment During Periodontal Maintenance: Randomized Clinical Trial

Background: Minocycline microspheres (MMs) are being used to treat residual inflamed periodontal pockets during periodontal maintenance therapy (PMT), but evidence for efficacy from randomized clinical trials is lacking. The purpose of this study is to evaluate the effect of MMs plus scaling and root planing (SRP) on these sites. Methods: Sixty patients with chronic periodontitis on 6‐month PMT intervals to be followed for 1 year were randomized (51 completed the study) into two statistically similar groups, SRP + MM (aged 66.8 years) and SRP alone (aged 67 years), to treat a ≥5 mm posterior interproximal pocket during PMT with a history of bleeding on probing (BOP). Group treatments were applied to the site at baseline and 6 months. Clinical attachment levels (CALs; primary outcome), probing depths (PDs), plaque, and BOP also were recorded at baseline and 6 and 12 months. In addition, gingival crevicular fluid was analyzed for an inflammation index ratio of interleukin (IL)‐1β/IL‐1 receptor antagonist (ra) using enzyme‐linked immunosorbent assays. Results: All clinical parameters improved significantly (P <0.005) from baseline in both groups with no differences between groups at any time point. CAL decreased 17% (0.9 ± 0.8 mm) and 13% (0.7 ± 0.9 mm) in SRP + MM and 11% (0.7 ± 1.1 mm) and 21% (1.2 ± 0.9 mm) in SRP at 6 and 12 months, respectively. The odds of having BOP decreased 90% (down to 38% of patients) and 95% (26%) in SRP + MM and 82% (42%) and 82% (41%) in SRP at 6 and 12 months, respectively. IL‐1β/IL‐1ra decreased a significant 61% (P = 0.009) only in SRP + MM at 6 months. Conclusions: SRP of inflamed moderate pockets during 6‐month PMT, with or without MMs, improves CALs, along with PDs and BOP over a 1‐year period. The use of MMs did not result in an additional benefit over SRP alone.     

A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial

Background: We aimed to analyze clinical, microbiologic, and serologic effects of chlorhexidine (CHX) chips used as a subgingival controlled‐release delivery device before and immediately after scaling and root planing (SRP). Methods: Twenty‐four patients presenting with ≥12 teeth with probing depth (PD) ≥5 mm and bleeding on probing were assigned in test or control groups. After prophylaxis, CHX chips (test) or placebo chips (control) were placed in pockets with PD ≥5 mm. Ten days later, SRP was performed in all teeth with PD ≥4 mm in a single appointment. Immediately after SRP, new chips were inserted in all pockets with PD ≥5 mm. Parameters were assessed at baseline; beginning of SRP; and 1, 3, and 6 months after treatment. Subgingival samples were obtained at baseline; beginning of SRP; and at 1 month after treatment. Periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were analyzed. Serum levels of high sensitive C‐reactive and lipopolysaccharide‐binding proteins were measured. The changes of the parameters between and within the groups were tested by Mann‐Whitney U test (P <0.05). Results: All clinical and serologic parameters improved in both groups over time. There was a significant difference in clinical attachment level (CAL) gain from baseline to 6 months between groups (1.17 mm in the test group versus 0.79 mm in the placebo group) (P <0.05). The treatment with CHX chips showed a greater reduction of the microorganisms of the “red complex” after 1 month (P = 0.02). Conclusion: The use of CHX chips before and immediately after SRP improved CAL and reduced the subgingival microorganisms of the red complex in the treatment of chronic periodontitis.