Abstract OBJECTIVES: The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS: In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS: A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE: Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

O objetivo do estudo foi avaliar, o efeito do laser de Diodo 808nm como coadjuvante ao tratamento periodontal na redução de periodontopatógenos Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia pela técnica da Reação em Cadeia da Polimerase em Tempo Real. Foram selecionados vinte e quatro pacientes portadores de periodontite crônica neste estudo de boca dividida, duplo cego e randomizado. Dois sítios uniradiculares de cada paciente foram utilizados e divididos em dois grupos experimentais: TESTE - raspagem alisamento polimento corono radicular (RAPCR) associado à duas aplicações de laser de Diodo de alta potência (comprimento de onda de 808nm, 1,5 Watts, 597,1 W/cm2, durante 20 segundos no modo contínuo). A primeira aplicação foi realizada 24 horas após RAPCR e a segunda após sete dias; CONTROLE foi realizado o mesmo procedimento porém sem a aplicação do laser. O biofilme subgengival foi coletado antes do tratamento e seis semanas após a segunda aplicação do laser. A avaliação microbiológica foi feita através da Reação em Cadeia da Polimerase em tempo real para a quantificação de Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia. A comparação entre os grupos não demonstram diferenças estatisticamente significantes (p<0,05). Concluiu-se que, dentro dos limites deste estudo, a aplicação do laser de Diodo de 808nm como coadjuvante ao tratamento periodontal não reduziu de forma significativa os periodontopatógenos: Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia quando comparado à RAPCR. / The aim of this study was to evaluate, by real-time polymerase chain reaction, the effect of Diode laser 808nm as an adjuvant in the reduction of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia in to periodontal treatment. Twenty-four patients with chronic periodontitis the study designs was split-mouth, double blind and ramdomized controlled trial. Two sites from uniradicular teeth of each patient were used and divided in two experimental groups: TEST scalling and root planing (SRP) associated with two high power Diode laser application (wavelength of 808nm, 1,5W at the display (597,1 W/cm2) for 20 seconds in the continuous-wave mode) the first laser application was 24 hours after SRP and the second seven days later; CONTROL a similar procedure without laser application. The subgingival biofilm was colleted before treatment and six weeks after the second laser application. The microbiologic evaluation was done by real-time polymerase chain reaction for the quantification of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia. The comparison between the groups did not show significant differences (p<0,05). Within the limits of this study, it can be concluded that Diode laser 808nm application as an adjuvant in the periodontal treatment did not reduce the periodontal pathogens Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia when compared by scaling root planning.

Ziel dieser Studie war es, Auswirkungen von subgingival applizierter Hyaluronsäure (Gengigel®) nach scaling and root planing (SRP) auf mikrobiologische Variablen bei Parodontitispatienten nachzuweisen. Dabei wurden die möglichen Zusammenhänge zwischen Ergebnissen der Bakterienspezies und zuvor ermittelten Ergebnissen klinischer Variablen untersucht. An der Untersuchung nahmen 20 Männer und 29 Frauen teil. Es erfolgte eine Randomisierung in zwei Gruppen, bestehend aus einer Testgruppe mit 23 und einer Kontrollgruppe mit 26 Probanden. Bei den Versuchteilnehmern wurde in zwei Sitzungen in einem 24-stündigen Abstand ein SRP mittels Hand- und Ultraschallinstrumenten durchgeführt. Am Ende des SRP wurde in der Testgruppe Gengigel prof® (mit 0,8% Hyaluronsäure) in die parodontalen Taschen eingebracht. Zusätzlich trugen die Probanden der Testgruppe während der folgenden 14 Tage zweimal täglich morgens und abends Gengigel® (0,2%) auf den Gingivarand auf. In der Kontrollgruppe erfolgte das übliche SRP ohne Verwendung von Gengigel®. Alle Probanden wurden zu Beginn der Untersuchung, nach drei und sechs Monaten aus parodontologischer Sicht untersucht. Des Weiteren wurden Proben der Sulkusflüssigkeit für eine spätere Analyse von zehn parodontopathogenen Keimen sowie der Peroxidase- und Granulozytenaktivität gewonnen. Im Gegensatz zur kontinuierlichen Zunahme in der Kontrollgruppe (p=0,035) konnte beim Verlauf der Gesamtbakterienzahl für die Testgruppe keine Veränderung der Keimzahlen (p=0,737) beobachtet werden. In der Testgruppe wurde nach sechs Monaten für Campylobacter rectus, Treponema denticola und Aggregatibacter actinomycetemcomitans eine Reduktion der Keimbelastung festgestellt (p=0,05; p=0,043; p=0,066). Am Ende der Untersuchung waren in der Testgruppe keine Unterschiede in der bakteriellen Besiedlung unterschiedlich tiefer Taschen mehr nachweisbar (p=1). In der Testgruppe bestand eine stark signifikante Korrelation der Granulozytenaktivität mit der Zeit (r=0,443; p<0,0001) und mit der Gesamtbakterienzahl (r=0,336; p=0,009). Die Ergebnisse der Studie weisen auf einen wachstumshemmenden Effekt der Hyaluronsäure auf parodontopathogene Bakterien hin, welcher womöglich auf einer indirekten Interaktion mit dem Immunsystem basiert.

O objetivo do estudo foi avaliar, o efeito do laser de Diodo 808nm como coadjuvante ao tratamento periodontal na redução de periodontopatógenos Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia pela técnica da Reação em Cadeia da Polimerase em Tempo Real. Foram selecionados vinte e quatro pacientes portadores de periodontite crônica neste estudo de boca dividida, duplo cego e randomizado. Dois sítios uniradiculares de cada paciente foram utilizados e divididos em dois grupos experimentais: TESTE - raspagem alisamento polimento corono radicular (RAPCR) associado à duas aplicações de laser de Diodo de alta potência (comprimento de onda de 808nm, 1,5 Watts, 597,1 W/cm2, durante 20 segundos no modo contínuo). A primeira aplicação foi realizada 24 horas após RAPCR e a segunda após sete dias; CONTROLE foi realizado o mesmo procedimento porém sem a aplicação do laser. O biofilme subgengival foi coletado antes do tratamento e seis semanas após a segunda aplicação do laser. A avaliação microbiológica foi feita através da Reação em Cadeia da Polimerase em tempo real para a quantificação de Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia. A comparação entre os grupos não demonstram diferenças estatisticamente significantes (p<0,05). Concluiu-se que, dentro dos limites deste estudo, a aplicação do laser de Diodo de 808nm como coadjuvante ao tratamento periodontal não reduziu de forma significativa os periodontopatógenos: Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia quando comparado à RAPCR. / The aim of this study was to evaluate, by real-time polymerase chain reaction, the effect of Diode laser 808nm as an adjuvant in the reduction of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia in to periodontal treatment. Twenty-four patients with chronic periodontitis the study designs was split-mouth, double blind and ramdomized controlled trial. Two sites from uniradicular teeth of each patient were used and divided in two experimental groups: TEST scalling and root planing (SRP) associated with two high power Diode laser application (wavelength of 808nm, 1,5W at the display (597,1 W/cm2) for 20 seconds in the continuous-wave mode) the first laser application was 24 hours after SRP and the second seven days later; CONTROL a similar procedure without laser application. The subgingival biofilm was colleted before treatment and six weeks after the second laser application. The microbiologic evaluation was done by real-time polymerase chain reaction for the quantification of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia. The comparison between the groups did not show significant differences (p<0,05). Within the limits of this study, it can be concluded that Diode laser 808nm application as an adjuvant in the periodontal treatment did not reduce the periodontal pathogens Porphyromonas gingivalis, Treponema denticola e Tannerella forsythia when compared by scaling root planning.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-10T18:03:44Z No. of bitstreams: 1 cristinadepaulanovaes.pdf: 2904372 bytes, checksum: 00165445711c1a78d289bd32e6a3e37a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-13T19:22:11Z (GMT) No. of bitstreams: 1 cristinadepaulanovaes.pdf: 2904372 bytes, checksum: 00165445711c1a78d289bd32e6a3e37a (MD5) / Made available in DSpace on 2017-03-13T19:22:11Z (GMT). No. of bitstreams: 1 cristinadepaulanovaes.pdf: 2904372 bytes, checksum: 00165445711c1a78d289bd32e6a3e37a (MD5) Previous issue date: 2016-11-09 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: A doença periodontal (DP) e mucosite oral (MO) são condições imunoinflamatórias que podem ser caracterizadas pela presença constante de inflamação sistêmica e bacteremia. Objetivo: Avaliar o impacto da terapia periodontal na MO e investigar a ocorrência de patógenos periodontais em pacientes submetidos à quimioterapia para tumores sólidos e prévia ao transplante de medula óssea (TMO) Métodos: Avaliação dos dados sócio demográficos, dados da quimioterapia e comorbidades, além de avaliação sistemática orofacial. Estas ocorreram previamente e entre 7 a 14 dias após início da quimioterapia no grupo saúde periodontal (GSP). No grupo doença periodontal (GDP) somente após início da quimioterapia, 7 a 14 dias. A mucosa oral foi examinada para avaliar a presença e grau da MO induzida por quimioterapia. Ainda, testes clínicos para diagnóstico de disfagia, avaliação de xerostomia e qualidade de vida relacionada à saúde bucal (OHIP-14); e classe socioeconômica dos pacientes. Foram coletadas em ambos grupos, amostras subgengivais através da inserção de cones de papel estéreis, nos períodos descritos acima. Análise e quantificação da densidade bacteriana para cada espécie e número total de patógenos periodontais do “complexo vermelho” determinadas através do ensaio biomolecular de FISH (hibridação in situ fluorescente). Resultados: 51 pacientes com idade média de 51.1, sendo 38(74.5%) do sexo feminino e classe socioeconómico C 22(43.1%) predominante. Mama foi o local do tumor primário mais acometido 21(41.1%) e a doxorrubicina agente quimioterápico 22(43.1%) prevalente. A morbidade mais associada a hipertensão 20(39.2%). GSP incluiu 33 pacientes e GDP 18 pacientes. Análises estatísticas revelaram que as distribuições dos pacientes em relação à incidência de MO não diferiu entre estes grupos. Grau 1 de MO foi o mais incidente. Dezesseis(31%) pacientes desenvolveram MO, 9(56.2%) submetidos ao regime de condicionamento quimioterápico prévio ao transplante, 7(43.7%) em quimioterapia comum para tumores sólidos. Na qualidade de vida relacionada à saúde bucal, pacientes com complicações bucais mostraram média OHIP-14 de 1.36, enquanto aqueles sem complicações bucais média de 0.56, após quimioterapia para tumores sólidos. Conclusão: A saúde periodontal, pode afetar a incidência e grau da MO induzida por quimioterapia. Observando-se apenas pacientes com saúde periodontal submetidos ao regime de condicionamento quimioterápico e quimioterapia convencional, encontrou-se menor incidência de MO, comparado a evidências científicas. A necessidade de inclusão de pacientes com periodontite grave para avaliar essa relação dificultou tal julgamento. / Background: Periodontal disease (PD) and oral mucositis (OM) are immunoinflammatory conditions that can be characterized by the constant presence of systemic inflammation and bacteremia. Objective: Evaluate the impact of periodontal therapy in oral mucositis and investigate the occurrence of putative periodontal pathogens in patients undergoing chemotherapy for solid tumors and scheduled for hematopoietic stem cell transplantation (HSCT). Methods: This study included an evaluation of demographic data, data chemotherapy and comorbidities, and global systematic dental assessment. These were obtained prior and between 7- 14 days after initiated chemotherapy in periodontal health group (PH group). The Periodontal disease Group (PD Group) was evaluated during 7 to 14 days after of chemotherapy. The oral mucosa also was examined for scoring of chemotherapyinduced oral mucositis. Furthermore clinical tests for dysphagia diagnosis and evaluation of xerostomia and quality of life related to oral health; socio-economic class of patients was determined. Subgengival samples were collected by inserting sterile paper points for both groups, for same periods described above. Total number of bacterial cells and cells from each species determined by FISH (fluorescence in situ hybridization). Results: Fifty-one patients with solid tumors and scheduled for HSCT were assessed to evaluate the impact of periodontitis in OM. Mean age was 51.12, 38(74.5%) were female and socio-economic Class C 22(43.1%) was prevalent. The primary tumor site was most commonly breast cancer 21(41.1%) and prevalent chemotherapeutic agent was doxorubicin 22(43.1%). The prevalent morbidity associated was hypertension 20(39.2%). PH Group included 33 patients and PD Group enrolled 18 patients. Statistical analyses revealed that the distributions of patients with incidence of OM did not differ between both groups. The majority incidence of grade 1 chemotherapy-induced OM was observed. Sixteen(31%) patients developed oral mucositis, 9(56.2%) in patients undergoing conditioning regimen prior HSCT, and 7(43.7%) in patients undergoing common chemotherapy for solid tumors. Patients with oral complications showed a mean OHIP-14 index of 1.36, while those who did not develop oral complications had a mean OHIP-14 of 0.56, after chemotherapy for solid tumors. Conclusion: This study demonstrated that oral health, could affect experience and incidence of chemoinduced OM. When only patients periodontally healthy undergoing conditioning regimen of therapy and conventional chemotherapy were observed, was noted a lower incidence of oral mucositis, when compared with scientific evidences. The need of inclusion of patients with severe periodontitis to evaluate this relationship hampers such trial.

Recentemente, estudos têm associado a presença de vírus da família herpesviridae à doença periodontal, os quais poderiam estar envolvidos na ocorrência e progressão de diferentes formas da doença periodontal, através da supressão do sistema imune do periodonto, liberação de citotoxinas, mediadores pró-inflamatórios, o que poderia favorecer o crescimento subgengival de microrganismos. Neste estudo, testamos a hipótese de que a prevalência do herpes vírus na placa subgengival de pacientes com gengivite é igual a de pacientes portadores de periodontite crônica. Desse modo, o presente estudo teve como objetivo determinar a presença dos vírus Herpes simples vírus tipo 1 (HSV-1), Citomegalovírus (HCMV) e Epstein-Barr vírus tipo 1 (EBV-1), relacionando-os com a presença de bactérias periodontopatogênicas como: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) e Dialister pneumosintes (Dp) em amostras de placa subgengival, coletadas de 30 pacientes portadores de periodontite crônica (grupo PC), 30 pacientes com gengivite (grupo G) e 30 indivíduos periodontalmente saudáveis (grupo C). Foram coletadas quatro amostras de placa subgengival do sítio mais profundo de cada quadrante nos pacientes do grupo PC e nos pacientes do grupo G e C, um sítio aleatório de cada quadrante foi examinado. A detecção de espécies bacterianas e de herpes vírus na placa subgengival dos grupos foi realizada por PCR e Nested PCR, respectivamente. A análise estatística mostrou que o HCMV foi detectado com freqüência similar nos três grupos estudados e que houve uma maior prevalência do HSV-1, EBV-1 e P. intermedia nos pacientes com periodonite crônica e gengivite em relação ao grupo controle. Houve associação da periodontite crônica com o EBV-1 e as cinco bactérias estudadas, além da associação entre os vírus (EBV-1+ HCMV; EBV-1 + HSV-1; HSV-1 + HCMV) e entre vírus e bactérias (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans; HSV-1 + T. forsythia; HSV-1 + P. gingivalis). / Recently, studies have linked the presence of the virus family herpesviridae and periodontal disease, which may be involved in the occurrence and progression of different forms of periodontal disease through the suppression of the immune system of the periodontium, release of cytotoxins, pro-inflammatory mediators and immunopathological events, may promote growth of subgingival microorganisms. In this study, we tested the hypothesis that the prevalence of herpes virus in sub-gingival plaque of patients with gingivitis is equal to patients with chronic periodontitis. Thus, this study aimed to determine the presence of the virus Herpes simplex virus type 1 (HSV-1), Cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1), relating to the presence of bacteria as periodontopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Dialister pneumosintes (Dp) in subgingival plaque samples collected from 30 patients with chronic periodontitis (CP group), 30 patients with gingivitis (group G) and 30 periodontally healthy subjects (group C). We collected four samples of subgingival plaque from the deepest site in each quadrant and in the PC group and patients in group C and G, a random site in each quadrant was examined. The detection of bacterial species and herpes virus in subgingival plaque of the groups were identified by PCR and nested PCR respectively. Statistical analysis showed that HCMV was detected with a similar frequency among the three groups and significant difference in prevalence of HSV-1, EBV-1 and P. intermedia in patients with gingivitis in the control group. The chronic periodontitis was associated with EBV-1 and the five bacteria studied, and the association of the virus (EBV-1 + HCMV, EBV-1 + HSV-1, HSV-1 + HCMV) and between viruses and bacteria (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans, HSV-1 + T. forsythia; HSV-1 + P. gingivalis).

Recentemente, estudos têm associado a presença de vírus da família herpesviridae à doença periodontal, os quais poderiam estar envolvidos na ocorrência e progressão de diferentes formas da doença periodontal, através da supressão do sistema imune do periodonto, liberação de citotoxinas, mediadores pró-inflamatórios, o que poderia favorecer o crescimento subgengival de microrganismos. Neste estudo, testamos a hipótese de que a prevalência do herpes vírus na placa subgengival de pacientes com gengivite é igual a de pacientes portadores de periodontite crônica. Desse modo, o presente estudo teve como objetivo determinar a presença dos vírus Herpes simples vírus tipo 1 (HSV-1), Citomegalovírus (HCMV) e Epstein-Barr vírus tipo 1 (EBV-1), relacionando-os com a presença de bactérias periodontopatogênicas como: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) e Dialister pneumosintes (Dp) em amostras de placa subgengival, coletadas de 30 pacientes portadores de periodontite crônica (grupo PC), 30 pacientes com gengivite (grupo G) e 30 indivíduos periodontalmente saudáveis (grupo C). Foram coletadas quatro amostras de placa subgengival do sítio mais profundo de cada quadrante nos pacientes do grupo PC e nos pacientes do grupo G e C, um sítio aleatório de cada quadrante foi examinado. A detecção de espécies bacterianas e de herpes vírus na placa subgengival dos grupos foi realizada por PCR e Nested PCR, respectivamente. A análise estatística mostrou que o HCMV foi detectado com freqüência similar nos três grupos estudados e que houve uma maior prevalência do HSV-1, EBV-1 e P. intermedia nos pacientes com periodonite crônica e gengivite em relação ao grupo controle. Houve associação da periodontite crônica com o EBV-1 e as cinco bactérias estudadas, além da associação entre os vírus (EBV-1+ HCMV; EBV-1 + HSV-1; HSV-1 + HCMV) e entre vírus e bactérias (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans; HSV-1 + T. forsythia; HSV-1 + P. gingivalis). / Recently, studies have linked the presence of the virus family herpesviridae and periodontal disease, which may be involved in the occurrence and progression of different forms of periodontal disease through the suppression of the immune system of the periodontium, release of cytotoxins, pro-inflammatory mediators and immunopathological events, may promote growth of subgingival microorganisms. In this study, we tested the hypothesis that the prevalence of herpes virus in sub-gingival plaque of patients with gingivitis is equal to patients with chronic periodontitis. Thus, this study aimed to determine the presence of the virus Herpes simplex virus type 1 (HSV-1), Cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1), relating to the presence of bacteria as periodontopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Dialister pneumosintes (Dp) in subgingival plaque samples collected from 30 patients with chronic periodontitis (CP group), 30 patients with gingivitis (group G) and 30 periodontally healthy subjects (group C). We collected four samples of subgingival plaque from the deepest site in each quadrant and in the PC group and patients in group C and G, a random site in each quadrant was examined. The detection of bacterial species and herpes virus in subgingival plaque of the groups were identified by PCR and nested PCR respectively. Statistical analysis showed that HCMV was detected with a similar frequency among the three groups and significant difference in prevalence of HSV-1, EBV-1 and P. intermedia in patients with gingivitis in the control group. The chronic periodontitis was associated with EBV-1 and the five bacteria studied, and the association of the virus (EBV-1 + HCMV, EBV-1 + HSV-1, HSV-1 + HCMV) and between viruses and bacteria (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans, HSV-1 + T. forsythia; HSV-1 + P. gingivalis).

Ziel dieser Studie war es, Auswirkungen von subgingival applizierter Hyaluronsäure (Gengigel®) nach scaling and root planing (SRP) auf mikrobiologische Variablen bei Parodontitispatienten nachzuweisen. Dabei wurden die möglichen Zusammenhänge zwischen Ergebnissen der Bakterienspezies und zuvor ermittelten Ergebnissen klinischer Variablen untersucht. An der Untersuchung nahmen 20 Männer und 29 Frauen teil. Es erfolgte eine Randomisierung in zwei Gruppen, bestehend aus einer Testgruppe mit 23 und einer Kontrollgruppe mit 26 Probanden. Bei den Versuchteilnehmern wurde in zwei Sitzungen in einem 24-stündigen Abstand ein SRP mittels Hand- und Ultraschallinstrumenten durchgeführt. Am Ende des SRP wurde in der Testgruppe Gengigel prof® (mit 0,8% Hyaluronsäure) in die parodontalen Taschen eingebracht. Zusätzlich trugen die Probanden der Testgruppe während der folgenden 14 Tage zweimal täglich morgens und abends Gengigel® (0,2%) auf den Gingivarand auf. In der Kontrollgruppe erfolgte das übliche SRP ohne Verwendung von Gengigel®. Alle Probanden wurden zu Beginn der Untersuchung, nach drei und sechs Monaten aus parodontologischer Sicht untersucht. Des Weiteren wurden Proben der Sulkusflüssigkeit für eine spätere Analyse von zehn parodontopathogenen Keimen sowie der Peroxidase- und Granulozytenaktivität gewonnen. Im Gegensatz zur kontinuierlichen Zunahme in der Kontrollgruppe (p=0,035) konnte beim Verlauf der Gesamtbakterienzahl für die Testgruppe keine Veränderung der Keimzahlen (p=0,737) beobachtet werden. In der Testgruppe wurde nach sechs Monaten für Campylobacter rectus, Treponema denticola und Aggregatibacter actinomycetemcomitans eine Reduktion der Keimbelastung festgestellt (p=0,05; p=0,043; p=0,066). Am Ende der Untersuchung waren in der Testgruppe keine Unterschiede in der bakteriellen Besiedlung unterschiedlich tiefer Taschen mehr nachweisbar (p=1). In der Testgruppe bestand eine stark signifikante Korrelation der Granulozytenaktivität mit der Zeit (r=0,443; p<0,0001) und mit der Gesamtbakterienzahl (r=0,336; p=0,009). Die Ergebnisse der Studie weisen auf einen wachstumshemmenden Effekt der Hyaluronsäure auf parodontopathogene Bakterien hin, welcher womöglich auf einer indirekten Interaktion mit dem Immunsystem basiert.

Background: Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis. Methods: Forty-six patients (aged 40–65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n = 23) or placebo (n = 23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis. Results: AL, PD, BOP and SBI were significantly improved in both groups after three (p < 0.001) and 6 months (p ≤ 0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p = 0.1). BOP improved better in the test group after 3 months (p = 0.065). Numbers of Treponema denticola (p = 0.044) and Fusobacterium nucleatum (p = 0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p = 0.039). Prevotella micra (p < 0.001,p = 0.035) and Campylobacter rectus (p = 0.002,p = 0.012) decreased significantly in both groups after 3 months. Conclusions: The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm.

Abstract OBJECTIVES: The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS: In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS: A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE: Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.:Inhaltsverzeichnis 1 Einleitung 7 1.1 Klassifikation der Parodontitiden 7 1.2 Prävalenz der Parodontitis 8 1.3 Parodontales Erregerspektrum 9 2 Aufgabenstellung 12 3 Material und Methode 13 3.1 Erhobene Variablen 15 3.2 Therapie und Nachbehandlung 20 3.3 Biochemische und mikrobiologische Analyse 21 3.3.1 Probenentnahme 21 3.3.2 Analyse 22 3.4 Statistische Auswertung 23 4 Ergebnisse 25 5 Diskussion 33 6 Zusammenfassung 40 7 Literaturverzeichnis 44 8 Anhang 61 9 Publikation 65 10 Lebenslauf 66 11 Danksagung 67 12 Erklärung über die eigenständige Abfassung der Arbeit 68