Topical chemotherapy in human periodontitis using a new controlled-release insert containing ofloxacin. I. Microbiological observation

The recognition that destructive periodontal diseases may be caused by specific microorganisms in periodontal pockets has led to an increased interest in and usage of antimicrobial agents in periodontal therapy. Recently, a new controlled-release insert containing ofloxacin, a synthetic antibiotic, has been developed. In this study, the controlled-release insert (PT-01) was microbiologically evaluated in combination with or without subgingival mechanical debridement. PT-01 was applied in the periodontal pockets of 27 patients with chronic periodontitis. Three sites with a deep probing pocket depth (greater than or equal to 5 mm) were randomly selected in different quadrants of each patient, and were assigned into three groups, i.e., PT-01 applied (T), placebo applied (P) and control sites (C). Periodontal treatments consisted of supragingival scaling with oral hygiene instruction for the first 2 weeks followed by root planing and subgingival scaling PT-01 was applied weekly on day 0 to 35, and the subgingival plaque samples from each site were collected on d 0, 14, 21 and 42. The dynamics of the subgingival microflora was investigated by dark field microscopy and by anaerobic and aerobic cultivation. In the supragingival scaling period, significant reduction in percentages of spirochetes and motile rods and significant increase of the percentage of coccoid cells were observed only at T sites. In addition, the total viable counts of bacteria, black-pigmented Bacteroides and Fusobacterium species were significantly reduced at T sites. After mechanical subgingival debridement, significant shifts in the proportion and reduction of the viable counts in the subgingival microflora were found at all sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of local delivery of ofloxacin using controlled-release strips (PT-01) in periodontal patients. Part 2. Successive delivery system and combination with scaling

Four different sites were randomly selected in each periodontal patient and divided into four group: PT-01-treated site (A), PT-01 treatment combined with scaling (S + A), placebo-treated site (P) and placebo treatment combined with scaling (S + P). PT-01 and the placebo were applied to the periodontal pocket weekly on days 0 to 28, and clinical and microbiological evaluations were made. The results obtained were as follows: 1. Weekly changes in plaque index, plus discharge and mobility of the tooth were not observed in any group. 2. In gingival index, bleeding on probing, pocket depth and gingival crevicular fluid, significant improvement was found in A in comparison with P and in S + A in comparison with S + P. 3. In total number of subgingival bacteria and in the ratio of motile rods and spirochetes to the total number of bacteria, significant reduction was found in A in comparison with P and in S + A in comparison with S + P.     

Intrapocket chemotherapy in adult periodontitis using a new controlled-release insert containing ofloxacin (PT-01).

PT-01 is a newly developed water-soluble controlled-release insert containing ofloxacin (OFLX) as an antibacterial agent. The effect of PT-01 was evaluated by split-mouth application after oral hygiene instruction. No mechanical debridement was carried out during the experiment. PT-01 was applied once a week for 4 weeks in the periodontal pockets of 46 patients with adult periodontitis. The control insert without any antibacterial agent was applied in a selected pocket in a different quadrant for each patient. Clinical findings plaque index, PI; gingival index, GI; bleeding on probing, BOP; pus discharge, pus; and probing depth, PD at both PT-01 and control sites were measured at every visit for 4 weeks. Clinical findings were improved at both PT-01 and control sites, but the improvements were much more significant at PT-01 sites, in particular BOP and PD, than at control sites. PI was also significantly reduced at PT-01 sites. These results suggest that weekly application of PT-01 in the periodontal pocket has a significant effect on the resolution of periodontal inflammation and has an inhibitory effect on supragingival plaque deposition.     

Effectiveness of local delivery of ofloxacin using controlled-release strips (PT-01) in periodontal patients. Part 1. PT-01 application among treatment plans for periodontal disease

Three different sites which have more than 5 mm pocket were randomly selected in each periodontal patient and were divided into three groups: PT-01 treated site, placebo treated site and control site. After application of either PT-01 or placebo twice for two weeks, subgingval scaling and root planing were performed. Then PT-01 and the placebo were applied weekly to the periodontal pocket for four weeks and clinical and microbiological evaluations were made. The results obtained were as follows: 1. On clinical evaluation, significant improvement was found in the PT-01 treated site in comparison with the placebo treated and/or control site. 2. On microbiological evaluation, slight improvement was found in the PT-01 treated site, whereas there was no significant difference among the three sites.     

Topical chemotherapy of chronic periodontitis using controlled-release insert containing ofloxacin (PT-01) without root planing

Topical chemotherapy of periodontal disease using several drug delivery systems (DDS) is currently being attempted. PT-01 is a DDS which consists of fast- and sustained- release parts containing ofloxacin as an antibacterial agent. Since PT-01 was found to sustain the antibacterial effect for 7 days in a periodontal pocket, it was used tor periodontal patients without root planing or scaling in this study. PT-01 and a placebo were applied to two separate and opposite pockets of 46 patients, once a week from the first visit (week 0) to week 3. The clinical parameters (plaque index, gingival index, tooth mobility, bleeding on probing, pus discharge, and probing depth) were evaluated from weeks 0 to 4. At the end of the test (week 4), global improvement at the two sites was assessed. The clinical parameters and the global improvement of the PT-01 and placebo-treated sites were compared statistically. All parameters at the PT-01 sites except for tooth mobility showed much greater improvement than at the placebo sites. The global improvement of PT-01 sites was also significantly greater than that of the placebo sites. No side effects could be seen in patients treated with PT-01. These results indicate that topical chemotherapy using PT-01 could be effective and safe for periodontal therapy.     

Povidone-iodine as a periodontal pocket disinfectant

OBJECTIVES AND BACKGROUND: Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus. METHODS: Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests. RESULTS: At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups. CONCLUSIONS: The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.     

Subgingival irrigation in the maintenance phase of periodontal therapy

The purpose of this study was to evaluate the effect of subgingival scaling versus subgingival pocket irrigation with 0.1% chlorhexidine or saline controls on the repopulation of subgingival periodontal sites with disease-associated micro-organisms following a single procedure of scaling and root planing. Additionally, pertinent clinical parameters (attachment level, plaque index, bleeding on probing) were also recorded. 375 sites in 30 individuals with previously untreated periodontal disease were thoroughly scaled and subsequently either rescaled, irrigated, or not treated at all for the following 6 months at 1-month intervals. The results show that the initial scaling and root planing procedure led to significant clinical and microbiological improvements in all experimental groups. These improvements were maintained in all but the untreated sites. Based on the observed clinical and microbiological changes, subgingival irrigation of periodontal pockets at 1-month intervals was equally effective as scaling and root planing performed at the same pace. 0.1% chlorhexidine however, being used as test irrigant, was not more effective than saline controls.     

Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients

Abstract. The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel + SCRP; (c) Tetracycline paste + SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.     

Short-term effects of triclosan on healing following subgingival scaling

Abstract The present clinical trial was performed to evaluate short-term effects of a triclosan-containing dentifrice/gel combination on soft tissue healing, when applied supra-/sub-gingivally at periodontal sites treated with scaling and root planing. 16 subjects with moderate penodontitis participated in a 2×2-week, split-mouth designed clinical trial. 2 combinations of gel/dentifrice (the test combination containing triclosan) were used. 2 pairs of contralateral sites with probing pocket depth (PPD) ≥ 5 mm, and which bled on probing (BoP +) were selected in each patient as experimental units. A baseline examination included assessments of PPD, BoP, gingival index scores, plaque index scores, and the composition of the subgingival microbiota (dark-field microscopy). The assigned quadrant was anaesthetized and the teeth exposed to meticulous scaling and root planing. Immediately after the completion of mechanical therapy, either the test or control gel was applied sub-gingivally at the experimental sites. The volunteer was instructed to brush his/her teeth with an assigned dentifrice and to apply the gel (via a custom-made stent) supragingivally 2× daily for the following 2 weeks. He/she was recalled on day 7 for a second professional subgingival gel application. Re-examinations were carried out on days 2, 7 and 14 after treatment. 1-week wash-out periods separated the 2 experimental periods. The mean PPD reductions (between days 0 and 14) were 1.8 mm and 1.9 mm for the test and control gel/dentifrice sites. The reduction in BoP and gingival index scores was significantly greater during the test than during the control regimen. No significant differences were observed between the 2 regimens regarding plaque scores and composition of the subgingival microbiota. The findings from the present investigation demonstrated that triclosan, applied both sub- and supra-gingivally reduced soft tissue inflammation following scaling and root planing.     

Clinical alterations in relation to the morphological composition of the subgingival microflora following scaling and root planning

The aim of the present study was to relate shifts in the composition of subgingival plaque in periodontal pockets to alterations of the clinical periodontal conditions following a single course of subgingival scaling and root planing during a period of professional supragingival plaque control. For this purpose, 36 pairs of contralateral periodontal pockets in 10 subjects with moderately advanced periodontitis were assessed for the degree of gingival inflammation, probing pocket depths, bleeding on probing, attachment levels and the amount of supragingival plaque. In addition, samples of subgingival plaque were analyzed morphologically by dark-field microscopy. All patients received detailed information about proper oral hygiene and every 1-2 weeks, professional removal of supragingivally located deposits. When the oral hygiene standard had been sufficiently improved, 1 course of subgingival scaling on 1 side of each jaw only (test side) was carried out. Clinical and microbiological examinations were repeated after the scaling as well as after 2 and 6 months, while patients were recalled for supragingival prophylaxis every 2nd to 4th week. Our data showed that a single course of subgingival scaling and root planing resulted in reduced probing depths, a gain in clinical attachment and a shift in the composition of the subgingival microflora to a composition found in relatively healthy periodontal conditions. In relatively shallow pockets, however, a possible influence of repeated sampling on the subgingival microflora could not be ruled out. Bleeding on gentle probing was a reliable parameter for predicting a subgingival microflora where motile bacteria hold an increased portion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Periodic subgingival antimicrobial irrigation of periodontal pockets

The present investigation was undertaken to study the clinical effect of professionally performed periodic subgingival irrigation per se and as an adjunct to scaling and root planing. 10 patients suffering from moderate-severe periodontal disease participated in the study. Following an initial 3-month period of supervised supragingival plaque control, a total of 102 periodontal sites with probing pocket depth greater than or equal to 6 mm and "bleeding on probing" were selected and subjected to a Baseline examination comprising assessments of oral hygiene and gingival conditions, probing depths and probing attachment levels. The pockets in the various jaw quadrants were randomly assigned to one of the following treatment groups: (1) periodic subgingival irrigation with hydrogen peroxide, (2) periodic subgingival irrigation with chlorhexidine, (3) periodic subgingival irrigation with saline and (4) no subgingival treatment. During the first part of the study (baseline-32 weeks), no mechanical debridement of the subgingival area was performed. The irrigation treatment was carried out by the operator 3 times per week during weeks 1 + 2 and 5 + 6 of the trial. In the 2nd part of the trial (32-52 weeks), the sites were subjected to scaling and root planing combined with professional irrigation during weeks 32-38. The previously non-irrigated control sites were not subjected to adjunctive irrigation when mechanically debrided. During the entire study, the patients were recalled for professional tooth cleaning once every 4 weeks. Re-examinations were carried out at 4, 6, 32, 40 and 52 weeks. The results revealed that repeated professional irrigation of unscaled periodontal pockets with chlorhexidine or hydrogen peroxide resulted in a temporarily reduced frequency of bleeding sites, but not in any clinically significant changes in probing assessments. A similar improvement of bleeding scores was observed in the saline-irrigated control group. Scaling and root planing, in combination with an optimal supragingival plaque control, resulted in a marked resolution of the clinical symptoms of periodontal disease. Adjunctive irrigation with chlorhexidine or hydrogen peroxide did not improve the healing result above and beyond that obtained after mechanical debridement alone or in combination with saline irrigation. Hence, the study failed to demonstrate that professionally performed periodic subgingival irrigation with chlorhexidine or hydrogen peroxide, used alone or in combination with thorough mechanical debridement, has a significant therapeutic effect.     

Efficacy of locally-delivered doxycycline microspheres in chronic localized periodontitis and on Porphyromonas gingivalis

Aim: This study aimed to assess the efficacy and effect of locally‐delivered doxycycline microspheres with scaling and root planing in periodontal pocket therapy and on Porphyromonas gingivalis, respectively. Methods: Twenty sites with a probing pocket depth of 4–6 mm were divided into two groups: a control group consisting of scaling and root planing, with one application of doxycycline microspheres only at baseline, and a test group consisting of scaling and root planing, with an application of doxycycline microspheres at baseline and 1 and 3 months. Clinical readings included the plaque index, gingival index, probing pocket depth, and relative attachment level. Rapid polymerase chain reaction method was used for the detection of P. gingivalis. Results: A statistically‐significant reduction in probing pocket depth and attachment gain was found in both groups; the test group showed a significant reduction in probing pocket depth and attachment gain compared with the control at 3 and 6 months. P. gingivalis cell count in the test group was significantly reduced at all the time periods, except from 1 to 3 months. Conclusion: Local drug delivery of doxycycline microspheres significantly improved the treatment outcomes in periodontal pocket therapy and reduced P. gingivalis in the periodontal pocket.     

Improved periodontal conditions following therapy

The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths. The material consisted of 16 patients, 35-65 years of age. Following a Baseline examination including assessments of oral hygiene status, gingival conditions, probing pocket depths and probing attachment levels, the patients were subjected to periodontal treatment. A "split-mouth" design approach of therapy was used and the jaw quadrants were randomly selected for the following different treatment procedures: (1) scaling and root planning, (2) scaling and root planing in conjunction with a gingivectomy procedure, (3) scaling and root planing in conjunction with an apically repositioned flap procedure without bone recontouring, (4) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring, (5) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and (6) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks during a 6-month period of healing, after which a final examination was performed. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in a low frequency of gingival sites which bled on probing, a high frequency of sites with shallow pockets (less than 4 mm) and the disappearance of pockets with a probing depth of greater than 6 mm. Between the Baseline examination and the 6-month re-examination, the probing attachment level for initially shallow pockets remained basically unaltered, but with a tendency of a minor apical shift. This occurred in all 6 treatment groups. For sites with initial probing depths of 4-6 mm and greater than 6 mm, there was in all groups some gain of probing attachment. This gain was most pronounced in the initially deeper (greater than 6 mm) pockets. With the use of regression analysis, the "critical probing depth" (CPD) value (i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level resulted) was calculated for each of the 6 methods of treatment used. A comparison of the CPD-values between the 6 treatment groups did not reveal any major differences.     

Efficacy of subgingivally applied minocycline in the treatment of chronic periodontitis

BACKGROUND: The use of adjunctive minocycline with mechanical debridement in treating periodontitis has been widely studied using different methods. However, the results from these studies are equivocal. OBJECTIVE: The purpose of this study was to clarify the efficacy of the adjunctive use of subgingival minocycline application plus scaling/root planing as compared with the results of one episode of scaling/root planing in the treatment of chronic periodontitis. METHODS: Fifteen patients were enrolled in this split-mouth clinical trial. Probing depth, clinical attachment loss, gingival index, and bleeding on probing were evaluated at the baseline before scaling/root planing and 6, 10, 14, and 18 weeks later according to a single-blind protocol. The amount of interleukin-1beta (interleukin-1beta pg/site) at each lesion was also simultaneously measured in gingival crevicular fluid in a parallel comparison design. After full-mouth baseline measurements and scaling/root planing, 78 lesions with a residual mean probing depth of 5 mm at anterior teeth were selected and equally distributed in either right or left sites based on a split-mouth symmetrical design and randomly assigned to one of two treatment groups (with or without minocycline administration, n = 39 for each group). RESULTS: Probing depth significantly decreased from the baseline (week 0) to week 6 after scaling/root planing (p < 0.05) in both groups, but there was no statistically significant difference between the two groups (p > 0.05). However, at weeks 10, 14, and 18, the experimental group showed significantly greater improvement in pocket reduction than the control group (p < 0.05). Similarly, both groups also showed significant decreases in gingival index scores from weeks 0-6 (p < 0.05), but gingival index reductions at weeks 10, 14, and 18 were statistically significant in favor of the experimental group (p < 0.05). The experimental group had more attachment gain than the control group at weeks 14 and 18 (p < 0.05). Values of interleukin-1beta (pg/site) at the experimental sites were significantly reduced at weeks 10, 14, and 18, as compared to values at control sites (p < 0.01). Finally, the incidence of bleeding on probing showed no differences between the two groups for any time interval (p > 0.05). CONCLUSIONS: In this 18-week clinical trial, the results suggested that scaling/root planing with adjunctive subgingival administration of minocycline ointment has a significantly better and prolonged effect compared to scaling/root planing alone on the reduction of probing depth, clinical attachment loss, gingival index, and interleukin-1beta content, but not on bleeding on probing.     

Microbiological and clinical effects of surgical treatment of localized juvenile periodontitis

Since Actinobacillus actinomycetemcomitans appears to be a key etiologic agent in localized juvenile periodontitis, this study determined the effectiveness of different treatment modalities in suppressing A. actinomycetemcomitans in localized juvenile periodontitis lesions. A total of 25 deep periodontal lesions from 7 patients with localized juvenile periodontitis were included in the study. The test periodontal lesions either received scaling and root planing alone, scaling and root planing together with soft tissue curettage, or modified Widman flap surgery. Subgingival A. actinomycetemcomitans were enumerated using selective culturing. Clinical measurements included changes in probing periodontal attachment level, probing periodontal pocket depth, gingival index, plaque index, and digital subtraction of standardized serial radiographs. The microbiological and clinical effects of treatment were monitored over a period of 16 weeks. All periodontal lesions studied demonstrated high numbers of A. actinomycetemcomitans prior to treatment. Scaling and root planing alone did not markedly change the subgingival A. actinomycetemcomitans counts, nor any of the clinical parameters studied. In contrast, soft tissue curettage as well as modified Widman flap surgery suppressed A. actinomycetemcomitans to undetectable levels immediately after therapy in more than 80% of the lesions studied. A total of 5 periodontal lesions exhibited gain of probing periodontal attachment after subgingival curettage or Widman flap treatment; 3 of these sites revealed no detectable A. actinomycetemcomitans, and the remaining 2 sites harbored only low levels of A. actinomycetemcomitans. 5 periodontal lesions which lost probing attachment after treatment all demonstrated high numbers of subgingival A. actinomycetemcomitans. Changes in alveolar bone, assessed by digital subtraction of serial radiographs, correlated with changes in probing periodontal attachment level, confirming the clinical results. The present study revealed a close relationship between post-treatment A. actinomycetemcomitans levels and the clinical response to treatment, which supports the concept that A. actinomycetemcomitans is an important organism in the etiology of localized juvenile periodontitis. This study also showed that a substantial suppression of subgingival A. actinomycetemcomitans cannot be achieved by periodontal scaling and root planing alone, but can be accomplished by surgical removal of periodontal tissues.(ABSTRACT TRUNCATED AT 400 WORDS)     

Scaling and granulation tissue removal in periodontal therapy

The present clinical trial was performed to study whether subgingival scaling is a method of therapy which is equally effective as "access" flaps in reducing gingivitis and probing depths and in improving probing attachment levels. The study was also designed to assess whether granulation tissue removal is a determining factor for proper healing in the treatment of periodontal disease. 15 patients with advanced periodontal disease were included in the study. Each patient had at least 4 sites in each quadrant of the jaws with probing depths exceeding 6 mm. A baseline examination was performed to assess the following parameters: the oral hygiene status, the gingival conditions, the probing pocket depths and the probing attachment levels. In addition, in each quadrant, 3 approximal sites were selected for analysis of the subgingival microbiota. All of these sites showed signs of gingivitis. One site had a probing depth of less than 4 mm, another a probing depth between 4 and 6 mm and the third site had a probing depth exceeding 6 mm. The subgingival bacterial samples were studied by dark-field microscopy and the % of spirochetes and motile rods was assessed. By random selection the 4 jaw quadrants in each patient were treated for periodontal disease by the use of (1) the modified Widman flap procedure, (2) the modified Kirkland flap procedure or by (3) nonsurgical scaling and root planing. In all, 20 quadrants were treated with each of the 3 procedures. After the termination of active periodontal treatment, all patients were recalled for professional tooth cleaning once every 2 weeks during a 12-week period. Subsequently, they were recalled for prophylaxis every 3 months. The patients were examined 6 and 12 months after treatment using the same parameters as used at baseline. The data from the examinations demonstrated that subgingival scaling is an effective measure in the treatment of periodontal disease. Both in terms of average gingivitis resolution and average probing depth reduction, non-surgical therapy appeared to be equally effective as a surgical approach to treatment. It was also observed, however, that following non-surgical treatment, a larger number of sites with pockets exceeding 6 mm remained than following surgical therapy. Most of these deep pockets in non-surgically treated quadrants bled on probing to the base of the pocket. In addition, the subgingival microbiota of such sites were found to harbor more than 20% spirochetes and motile rods.(ABSTRACT TRUNCATED AT 400 WORDS)     

单独龈下超声刮治与结合人工刮治两种方法的临床效果比较

目的 比较单独应用龈下超声刮治与结合人工刮治两种治疗方式的临床效果.方法 选取36例慢性牙周病患者,采用半口对照的方法将患牙分为对照组(左半口)和实验组(右半口),先对所有患牙进行龈上洁治术,一周后对照组实行龈下超声刮治术,实验组实行龈下超声刮治结合人工刮治术.治疗前后1个月、3个月分别检查受试牙,并记录各项临床指标( BOP、PD、CAL).结果 在治疗结束后1个月和3个月,两组各项牙周临床指标均有明显改善(P＜0.05),实验组的改善优于对照组,且有显著性差异(P＜0.05).结论 龈下超声刮治后使用人工刮治,可以获得一个更加平整的根面,取得良好的临床效果.     

Local ofloxacin delivery using a controlled-release insert (PT-01) in the human periodontal pocket

PT-01, a controlled-release insert, was developed for topical chemotherapy in periodontal disease. It is a soluble insert that consists of fast-release and sustained-release parts containing ofloxacin (OFLX) as an antibacterial agent. In this study, the release profile of OFLX from PT-01 was investigated in vitro. Twelve adult volunteers were administered OFLX as PT-01 or as an aqueous solution into their periodontal pockets, OFLX concentrations in gingival crevicular fluid (GCF) were evaluated from the viewpoint of pharmacokinetics. The in vitro release profile of OFLX from PT-01 showed a biphasic pattern. The release rate of OFLX was relatively rapid in the early phase and slow thereafter. When OFLX aqueous solution was administered into periodontal pockets, the OFLX level in GCF rapidly decreased to be about 1/100 after 30 minutes. When PT-01 was inserted into the pockets, the OFLX level in GCF immediately reached a peak (about 12 mg/ml), and gradually decreased until the 3rd day, and maintained a constant level above 2 micrograms/ml, the effective minimum antibacterial concentration for periodontopathic microorganisms, from the 3rd to 7th day after insertion. No side-effects were observed in the volunteers who received the PT-01 insert. The above results suggest that PT-01 is a suitable pharmaceutical preparation for periodontal chemotherapy.     

The effect of subgingival debridement on periodontal disease parameters and the subgingival microbiota

Abstract The aim of the present investigation was to analyse the effect of subgingival scaling and root planing in subjects who prior to treatment exercised meticulous supragingival plaque control. 300 subjects were examined at baseline and after 1 and 2 years without treatment. After the year 2 examination, 62 subjects were randomly selected for therapy. They were given detailed instruction in proper self-performed toothcleaning measures and were carefully monitored during the subsequent 2 years. Following the year-4 examination, 2 quadrants, 1 maxillary and 1 mandibular in each subject, were randomly selected for additional therapy. The teeth in the selected quadrants were exposed to subgingival scaling and root planing. The subgingival therapy was repeated until a site no longer bled on gentle probing. This basic therapy was completed within a 2-month period. All subjects were re-examined after another 12-month interval. The examinations at year 4 and 5 included assessment of plaque, gingivitis, probing pocket depth and analysis of samples obtained from the subgingival microbiota at 134 selected sites. The findings from the present study demonstrated: (i) that subgingival scaling and root planing were effective in eliminating subgingival plaque and gingivitis; (ii) that professional therapy resulted in a pronounced reduction of probing depth at sites which at year 4 had a probing depth >3 mm; (iii) that in non-scaled quadrants, the extension of self-performed plaque control resulted in a continued improvement of the periodontal conditions at sites which at year 4 were < 5 mm deep.