Locally delivered antimicrobials for the treatment of chronic periodontitis
Locally delivered antimicrobials for the treatment of chronic periodontitis
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DOI：
10.1034/j.1601-0825.9.s1.8.x
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发表时间：
2003-06-01
期刊：
影响因子：
3.8
通讯作者：
Etienne, D
中科院分区：
文献类型：
--
作者：
Etienne, D
慢性牙周炎的基本治疗是通过刮治和牙根刨平（S/RP）对牙周袋进行机械清创，并结合有效的菌斑控制。局部给药抗菌剂（LDA）已经被推荐给从业者，虽然在临床实践中仍然使用牙龈下冲洗抗菌剂，但在我们的治疗中引入的缓释和牙龈下给药四环素已经改变了从机械治疗到全口/部位消毒联合治疗的基本原理。各种抗生素，防腐剂和可吸收的载体现在提出了类似的目标，以阻止疾病的进展。在慢性牙周炎中，LDA不能常规地与S/RP联合使用，因为临床效益有限，即使深部部位的百分比增加可能显示出改善。考虑疾病进展危险因素的前瞻性多中心研究必须设计以确定可能从LDA获益最多的患者。对于无反应的部位或复发的口袋，争议是有限的，因为联合S/RP和LDA可以避免手术的需要。然而，需要估计患者的成本/收益比以及特定抗生素的不良反应。
The basic treatment of chronic periodontitis is a mechanical debridement of periodontal pockets by scaling and root planing (S/RP) in combination with efficient plaque control. Locally delivered antiseptics (LDA) have been proposed to practitioners and, while subgingival irrigation of antiseptics is still used in clinical practice, the introduction in our therapy of a slow release and subgingival delivery of tetracycline has changed the rationale from a mechanical treatment towards a combined therapy for full mouth/sites disinfection. Various antibiotics, antiseptics and resorbable carriers are now proposed with similar targets to arrest disease progression. In chronic periodontitis, LDA cannot be used routinely in combination with S/RP, because of the limited clinical benefit, even if an increased percentage of deep sites may show an improvement. Prospective multicenter studies considering risk factors for disease progression have to be designed to identify patients who may benefit the most from LDA. For non-responding sites or recurrent pockets, the controversies are limited, because a combined S/RP and LDA may avoid the need for surgery. However, the patient cost/benefit ratio needs to be estimated as well as adverse effects in particular antibiotics.