Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat "refractory" periodontitis
Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat "refractory" periodontitis
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DOI：
10.1111/j.1600-051x.2004.00573.x
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发表时间：
2004-10-01
影响因子：
6.7
通讯作者：
Socransky, SS
中科院分区：
文献类型：
--
作者：
Haffajee, AD;Uzel, NG;Socransky, SS
背景：本研究调查了对常规牙周治疗“难治性”的患者进行联合积极抗微生物治疗后的临床和微生物变化。方法：14名受试者在刮治和牙根计划（SRP）、牙周手术和全身抗生素治疗后，根据全口平均附着缺失和/或附着缺失大于或等于3mm的bbb3位点被确定为“难治性”。基线监测后，受试者接受SRP，在大于或等于4mm的口袋中局部给予四环素，全身给予阿莫西林（500 mg, t.d d 14天）+甲硝唑（250 mg, t.d d 14天），每周专业清除龈上斑块，持续3个月。治疗后每3个月进行一次临床监测，持续2年。在同一时间点从每颗牙齿的中侧面采集龈下菌斑样本，采用棋盘DNA-DNA杂交法测定龈下菌斑的40个分类群的水平。每个物种的平均水平在每次访问时在受试者体内取平均值。临床和微生物参数随时间变化的意义使用Friedman或Wilcoxon符号秩检验进行评估。结果：平均而言，治疗后受试者各项临床指标均有显著改善。24个月时，平均（+/-SEM）全口袋深度减少0.83+/-0.13 mm，平均附着水平“增益”为0.44+/-0.12。在积极治疗的前3个月，临床改善伴随着多种龈下菌种的显著减少，大多数菌种一直保持到最后一次监测访问。3种放线菌、“橙色复合体”种（包括秀氏弯曲杆菌、结状真杆菌、3种核梭杆菌亚种）、微胃链球菌、中间普雷沃氏菌以及“细粒链球菌”群、血管链球菌、星形链球菌和中间链球菌均出现了减少。受试者对治疗的反应不同；六个适度反应的受试者表现出较少的依恋水平增益，其特征是微生物群从基线减少到3个月，但此后许多物种重新生长。结论：14例“难治性”牙周炎患者联合抗菌药物治疗2年，病情进展得到有效控制。
Background: The present investigation examined clinical and microbial changes after a combined aggressive antimicrobial therapy in subjects identified as "refractory" to conventional periodontal therapy.Method: Fourteen subjects were identified as "refractory" based on full-mouth mean attachment loss and/or >3 sites with attachment loss greater than or equal to3 mm following scaling and root planing (SRP), periodontal surgery and systemic antibiotics. After baseline monitoring, subjects received SRP, locally delivered tetracycline at pockets greater than or equal to4 mm, systemically administered amoxicillin (500 mg, t.i.d. for 14 days)+metronidazole (250 mg, t.i.d. for 14 days) and professional removal of supragingival plaque weekly for 3 months. Subjects were monitored clinically every 3 months post-therapy for 2 years. Subgingival plaque samples were taken at the same time points from the mesial aspect of each tooth and the levels of 40 subgingival taxa were determined using checkerboard DNA-DNA hybridization. Mean levels of each species were averaged within a subject at each visit. Significance of changes in clinical and microbiological parameters over time were evaluated using the Friedman or Wilcoxon signed ranks test.Results: On average, subjects showed significant improvements in all clinical parameters after therapy. Mean (+/-SEM) full-mouth pocket depth reduction was 0.83+/-0.13 mm and mean attachment level "gain" was 0.44+/-0.12 at 24 months. Clinical improvement was accompanied by major reductions in multiple subgingival species during the first 3 months of active therapy that were maintained for most species to the last monitoring visit. Reductions occurred for three Actinomyces species, "orange complex" species including Campylobacter showae, Eubacterium nodatum, three Fusobacterium nucleatum subspecies, Peptostreptococcus micros, Prevotella intermedia as well as the "Streptococcus milleri" group, Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedus. Subjects differed in their response to therapy; six modest response subjects exhibited less attachment level gain and were characterized by reductions in the microbiota from baseline to 3 months, but re-growth of many species thereafter.Conclusions: The combined antibacterial therapy was successful in controlling disease progression in 14 "refractory" periodontitis subjects for 2 years.