不同时机口服抗菌药物辅助机械治疗重度慢性牙周炎的临床疗效

Clinical effect of different sequences of debridement-antibiotic therapy in treatment of severe chronic periodontitis

目的：评价重度慢性牙周炎（chronic periodontitis,CP）患者1周内完成全口龈下刮治及根面平整的可行性及治疗过程中不同时机口服阿莫西林和甲硝唑的临床疗效。方法：选取30例重度慢性牙周炎患者,男性14例,女性16例,平均年龄40.5±8.4岁（35－60岁）,按照随机数字表分为A组（刮治同期用药）,B组（刮治后用药）和C组（单纯刮治）,每组10例。所有患者均于1周内分2次完成全口牙周机械治疗（刮治和根面平整）。A组在龈下刮治开始前0.5－1 h服用阿莫西林胶囊（0.5 g,3次/d）＋甲硝唑片（0.2 g,3次/d）,连服7 d;B组在全口龈下刮治完成次日开始服用阿莫西林胶囊（0.5 g,3次/d）＋甲硝唑片（0.2 g,3次/d）,连服7 d;C组服用安慰剂。3组均在牙周治疗前及治疗完成后2个月进行全口牙周临床检查,观察指标包括菌斑指数、探诊深度（probing depth,PD）、出血指数（bleeding index,BI）和牙齿松动度等。计算全口牙位点的平均探诊深度、平均邻面探诊深度（proximal probing depth,p PD）,PD〉5 mm位点的百分比（PD〉5 mm%）、邻面PD〉5 mm位点的百分比（p PD〉5 mm%）、平均BI及探诊出血比率（percentage of sites with bleeding on probing,BOP%）。结果：（1）治疗前后PD、p PD、PD〉5mm%和p PD〉5 mm%有显著降低（P〈0.001）;BOP%也有显著降低（P〈0.05）。（2）A组平均PD减少值[（2.15±0.42）mm]显著优于B组[（1.76±0.29）mm]和C组[（1.57±0.33）mm],P〈0.05。B组[（1.76±0.29）mm]与C组[（1.57±0.33）mm]平均PD减少值差异无统计学意义,P=0.354。A组p PD减少值[（2.45±0.43）mm]显著优于单纯刮治组[（1.90±0.48）mm],P〈0.05。A组、B组与C组组间BI及BOP%的改善程度差异无统计学意义。结论：重度慢性牙周炎患者1周内分两次完成全口龈下刮治是安全可行的,龈下刮治同时口服阿莫西林胶囊＋甲硝唑较龈下刮治后用药和单纯刮治探诊深度减少更显著。

Objective： To evaluate the feasibility of full-mouth debridement（ subgingival scaling and root planning,SRP） by 2 times within 1 week and compare the clinical effects of different sequences of debridement-antibiotic usage in patients with severe chronic periodontitis（ CP）. Methods： A doubleblinded,placebo-controlled,randomized clinical trial was conducted in 30 severe CP patients（ 14 males and 16 females,40. 5 ± 8. 4 years old on average from 35 to 60） receiving 3 different sequences of debridement-antibiotictherapy： Group A,antibiotic usage（ metronidazole,MTZ,0. 2 g,tid,7 d; amoxicillin,AMX 0. 5 g,tid,7 d） was started together with SRP（ completed by 2 times in 7 d）; Group B,antibiotic usage（ MTZ 0. 2 g,tid,7 d; AMX 0. 5 g,tid,7 d） was started 1 d after SRP（ completed by2 times in 7 d）; Group C,SRP alone[probing depth（ PD）,bleeding index（ BI） and tooth mobility]was examined. The average full-mouth probing depth,the average full-mouth proximal probing depth（ p PD）,the percentage of sites with PD 5 mm（ PD 5 mm%）,the percentage of sites with proximal PD 5 mm（ p PD 5 mm%）,the average bleeding index（ BI） and the percentage of sites with bleeding on probing（ BOP%） were calculated. Clinical examinations were performed at baseline and 2 months post therapy. Results：（ 1） Compared with baseline conditions,all the subjects showed clinical improvements in all the parameters evaluated 2 months post therapy,P 0. 05.（ 2） Significant difference were observed in the average PD changes between Group A [（ 2. 15 ± 0. 42） mm],Group B [（ 1. 76 ± 0. 29）mm] and Group C [（ 1. 57 ± 0. 33） mm],P 〉0. 05. No significant difference was observed in the average PD changes between Group B and Group C,P = 0. 354. Significant differences were observed in the average p PD changes between Group A [（ 2. 45 ± 0. 43） mm] and Group C[（ 1. 90 ± 0. 48） mm],P〉 0. 05. No significant difference was observed in BI and BOP% changes between Group A,Group B and Group C. Conclusion： For patients with severe chronic periodontitis,it is safe and feasible to receive full-mouth SRP by 2 times within 1 week. The short-term（ 2 months） advantages in PD changes are observed in patients receiving SRP and antibiotic usage at the same time comparing with patients using antibiotics after SRP or SRP alone.