Publication: Periodontal kemik içi defektlerin yönlendirilmiş periodontal doku rejenerasyonu ve kemik greftleri ile tedavisinde antimikrobiyal uygulamaların etkinliğinin incelenmesi
Abstract
Bu çalışmada, kemik içi defektlerin tedavisinde %10 tetrasiklin kaplı abzorbsiyon süresi uzatılmış polilaktik asit/ poliglikolik asit (PLA/ PGA) membran ile otojen kemik grefti kombinasyonu (T/ XT-RM+OKG) ve kaplı olmayan PLA/ PGA membran ile tetrasiklinle muamele edilmiş anorganik sığır kemiği-peptid 15 kombinasyonunun (XT-RM+T/ ASK-P15) klinik, radyografik ve mikrobiyolojik etkinliği incelendi. Çalışmaya, yaş ortalaması 43.36 olan kronik periodontitisli 17 hastadaki 22 defekt dahil edildi. Başlangıç tedavisinden sonra, sondalanabilir cep derinliği (SCD) ý6mm ve radyografik defekt derinliği ý4mm olan defektler 2 grupta tedavi edildi. Hastalara postoperatif 2 hafta sistemik tetrasiklin verildi. Operasyondan önce (0) ve 2, 4, 8, 12, 24 hafta sonra plak ve dişeti oluğu kanama indeksleri ile mikrobiyolojik örnekler alındı; 0 ve 24. haftada diğer klinik parametreler kaydedildi, radyografiler alındı. Gruplarda sırasıyla 3.44, 3.72 mm SCD'de azalma; 1.54, 1.63 mm dişeti çekilmesi; 1.9, 2.09 mm ataşman kazancı; 1.81, 2.18 mm klinik kemik kazancı (KK), 1.9, 2.27 mm radyografik KK saptandı (p<0.01). Gruplar arasında anlamlı fark bulunmadı. Her iki grupta toplam mikroorganizma (m.o.) sayısı 2. ve 4. ha ftalarda azaldı, 8., 12., ve 24. haftalarda arttı, ancak başlangıca dönmedi. Zorunlu anaerop m.o.'lar, T/ XT-RM+OKG grubunda 2. haftada azaldı (p<0.05); 4. ve 8. haftalarda arttı; 12. ve 24. haftalarda başlangıçtan yüksek bulundu; XT-RM+T/ ASK-P15 grubunda 2. ve 4. haftalarda azaldı (p<0.001); 8. ve 12. haftalarda arttı (p<0.05, p>0.05); 24. haftada başlangıçtan yüksek saptandı. Gruplar arasında, 2. ve 4. haftalarda zorunlu anaeroplarda anlamlı fark bulundu (p<0.01, p<0.05). Bu bulgular, her iki uygulamayla klinik ve radyografik olarak anlamlı ve benzer iyileşme sağlandığını, ancak periodontal patojenler üzerindeki etkinin erken iyileşme dönemiyle sınırlı kaldığını göstermektedir. Evaluation of the Efficacy of Antimicrobial Applications in Intrabony Periodontal Defects Treated with Guided Periodontal Tissue Regeneration and Bone Grafts
This study evaluated clinical, radiographical and microbiological efficacies of 10% tetracycline coated extended-time polylactide/ polyglycolide membrane combined with autogenous bone graft (T/ XT-RM+ABG) in comparison to non-coated membrane combined with tetracycline impregnated anorganic bovine bone-peptide 15 (XT-RM+T/ ABM-P15) in intrabony defects. Twenty two defects with probing depth (PD) ý6 mm, defect depth ý4 mm were treated in 17 chronic periodontitis patients with mean age of 43.36. Patients were prescribed systemic tetracycline for 2 weeks. Plaque, sulcus bleeding indices and microbiological samples were taken at baseline (0) and 2, 4, 8, 12, 24 weeks postsurgery, other parameters were recorded at 0, 24 weeks. Groups presented PD reduction of 3.44, 3.72 mm, recession of 1.54, 1.63 mm, attachment gain of 1.9, 2.09 mm, clinical bone gain of 1.81, 2.18 mm and radiographical bone gain of 1.9, 2.27 mm finally (p<0.01). There were no significant differences between groups. Total viable counts decreased at weeks 2 and 4, increased at weeks 8, 12 and 24. Obligate anaerobes decreased at week 2 (p<0.05), increased at weeks 4 and 8, and passed the baseline at weeks 12 and 24 in T/ XT-RM+ABG, whereas they decreased at weeks 2 and 4 (p<0.001), increased at weeks 8 and 12 (p<0.05, p>0.05), and passed the baseline at week 24 in XT-RM+T/ ABM-P15. Significant differences were found at weeks 2 and 4 between groups (p<0.01, p<0.05). These resu lts suggest that clinical and radiographical healing could be obtained to a similar extent with both techniques and periodontal pathogens could be controlled during initial healing phase
This study evaluated clinical, radiographical and microbiological efficacies of 10% tetracycline coated extended-time polylactide/ polyglycolide membrane combined with autogenous bone graft (T/ XT-RM+ABG) in comparison to non-coated membrane combined with tetracycline impregnated anorganic bovine bone-peptide 15 (XT-RM+T/ ABM-P15) in intrabony defects. Twenty two defects with probing depth (PD) ý6 mm, defect depth ý4 mm were treated in 17 chronic periodontitis patients with mean age of 43.36. Patients were prescribed systemic tetracycline for 2 weeks. Plaque, sulcus bleeding indices and microbiological samples were taken at baseline (0) and 2, 4, 8, 12, 24 weeks postsurgery, other parameters were recorded at 0, 24 weeks. Groups presented PD reduction of 3.44, 3.72 mm, recession of 1.54, 1.63 mm, attachment gain of 1.9, 2.09 mm, clinical bone gain of 1.81, 2.18 mm and radiographical bone gain of 1.9, 2.27 mm finally (p<0.01). There were no significant differences between groups. Total viable counts decreased at weeks 2 and 4, increased at weeks 8, 12 and 24. Obligate anaerobes decreased at week 2 (p<0.05), increased at weeks 4 and 8, and passed the baseline at weeks 12 and 24 in T/ XT-RM+ABG, whereas they decreased at weeks 2 and 4 (p<0.001), increased at weeks 8 and 12 (p<0.05, p>0.05), and passed the baseline at week 24 in XT-RM+T/ ABM-P15. Significant differences were found at weeks 2 and 4 between groups (p<0.01, p<0.05). These resu lts suggest that clinical and radiographical healing could be obtained to a similar extent with both techniques and periodontal pathogens could be controlled during initial healing phase