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。

Clinical Effect of Minocycline as Adjunctive Therapy to Scaling and Root Planning on Treatment of Chronic Periodontitis

Objective To evaluate the efficacy of minocycline as an adjunct to scaling and root planning (SRP) in treating chronic periodontitis. Methods 64 male smokers with moderate to advanced periodontitis were randomly di- vided into two groups: SRP alone( SRP) and SRP plus minocycline( SRP M). All clinical parameters including plaque index( PlI), gingival index( GI), bleeding on probing( BOP), probing depth( PD)and attachment gain were recorded at baseline, 3 and 6 months after treatment. Results According to PlI, GI and BOP, there was no signifi- cant difference between the two groups at 3 and 6 months after periodontal therapy( P>0.05). However, PD reduction and attachment gain were significantly greater for SRP M than that for SRP( P<0.05). For SRP M and SRP groups, PD reduction were 1.98 mm and 1.32 mm, and attachment gain were 1.87 mm and 1.14 mm respectively. Deep pock- ets in SRP M group showed more obvious PD reduction( 3.48 mm versus 2.21 mm, P<0.01)and attachment ga(in 2.62 mm versus 1.23 zmm, P<0.01) than that in SRP group. Conclusion Treatment with SRP plus locally delivered minocycline is more effective than SRP alone in male smokers with chronic periodontitis. Mechanical debridement plus locally delivered antibiotics are recommended especially for smokers with deep pocket periodontitis.