TREATMENT OF PERIODONTAL INFECTIONS

该项目旨在评估最有希望根除由牙周病病原体引起的感染的方法。考虑到除垢和牙根规划（SRP）可能是清除牙菌斑生物膜和感染牙石的必要条件，四种辅助策略似乎可能在传播、病原体库消毒和消除支持牙周病原体生长的环境方面发挥重要作用。根据我们以前的研究和文献中描述的微生物反应的回顾，确定了最有可能消除或抑制牙周病原体的策略。通过向所有受试者提供动力牙刷和三氯生/共聚物牙膏来减少龈上菌斑。在治疗结束后的两周内，将使用氯己定（CHX）漱口水控制病原体传播。病原库的消毒将通过四环素（TC）纤维在所有口袋中应用30mm。通过牙周手术消除支持牙周病原体生长的环境。该提案描述了一个独特的2/3因子设计，其中局部抗生素，全身抗生素和牙周手术将作为SRP后使用电动牙刷和三氯生共聚物牙膏的受试者的辅助治疗进行比较。实验设计通过对8个实验组中的4个进行联合分析来评估主效应，从而提供了高统计灵敏度的潜力。此外，该模型还提供了一种评估被测治疗之间重要相互作用的方法。虽然这项研究解决了与临床实践相关的重要问题，但它也提供了各种治疗形式的生物学效应的信息，并确定了未来研究中最重要的方向。

This project seeks to evaluate the most promising means to eradicate infections caused by 0eriodontal disease pathogens. Considering that scaling and root planing (SRP) is likely to be essential to rid sites of plaque biofilms and infected calculus, four adjunctive strategies appear likely to substantially contribute to the transmission, disinfection of pathogen reservoirs and elimination of environments that support growth of periodontal pathogens. Based on a review of microbiologic responses described in our previous studies and in the literature, the strategies most likely to eliminate or suppress the periodontal pathogens were identified. Reduction of supragingival plaque will be achieved by providing powered toothbrushes and triclosan/co-polymer dentifrice to all subjects. Control of pathogen transmission will be by chlorhexidine (CHX) mouth-rinses for two weeks following completion of therapy. Disinfection of pathogen reservoirs will be by application of tetracycline (TC) fibers in all pockets > 3mm. Elimination of environments that support growth of periodontal pathogens will be by periodontal surgery. The proposal describes a unique 2/3 factorial design in which local antibiotics, systemic antibiotics and periodontal surgery will be compared as adjunctive treatments following SRP in subjects receiving electric toothbrushes and triclosan-co-polymer dentifrice. The experimental design provides the potential for high statistical sensitivity by evaluating main effects through combined analysis of 4 of the 8 experimental groups. In addition, the model provides a means to evaluate important interactions between each of the treatments being tested. Although this study addresses important questions related to clinical practice, it also provides information on biological effects of various forms of therapy and identifies the most important directions to be taken in future investigations.