Azithromycin and Full-Mouth Scaling For the Treatment of Generalized Stage III and IV Periodontitis: A 6-Month Randomized Comparative Clinical Trial

Abstract The effectiveness of azithromycin combined with full-mouth scaling procedures was compared to quadrant-wise scaling combined with the same dosage of azithromycin when treating periodontitis patients over a 6-month period. In this randomized clinical trial study, thirty-four individuals diagnosed with generalized stage III and IV periodontitis underwent baseline, 3-month, and 6-month post-treatment examinations. The study population was randomly assigned to either full-mouth scaling (FMS) or quadrant-wise scaling and root planning (QSRP) in addition to their taking of systemic azithromycin (500 mg/day) for three consecutive days. Periodontal probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were monitored along with the quantification of total bacterial load and red complex bacterial species (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) in subgingival samples by real time polymerase chain reaction. The volume of gingival crevicular fluid (GCF) was also monitored over time. The primary outcomes included improvements of PD and CAL. Data was statistically analyzed through a repeated-measures analysis of variance (ANOVA) test, multiple least significant difference (LSD) comparisons, Kruskal-Wallis, Friedman, and paired Student t-tests (p<0.05). FMS and QSRP provided similar PD, CAL, GI, PI, and GCF improvements. After treatment, the FMS group displayed lower mean values of total bacterial load and red complex bacterial species in comparison to the QSRP group. FMS and QSRP in conjunction with systemic azithromycin appeared to be an effective and reliable short-term therapeutic approach for the treatment of generalized stage III and IV periodontitis. However, FMD demonstrated superiority in regard to the 6-month antibacterial effects when compared to QSRP.

摘要：本研究在为期6个月的随访周期中，对比了阿奇霉素联合全口刮治（full-mouth scaling, FMS）与象限式刮治联合同等剂量阿奇霉素治疗牙周炎患者的临床疗效。本随机临床试验共纳入34名确诊为广泛型III、IV期牙周炎的受试者，分别于基线、治疗后3个月及6个月开展随访检查。所有受试者均连续3天口服全身性阿奇霉素（500 mg/天），并被随机分配至全口刮治组（FMS组）或象限式刮治及根面平整（quadrant-wise scaling and root planning, QSRP）组。研究监测了牙周探诊深度（PD）、临床附着水平（CAL）、牙龈指数（GI）、菌斑指数（PI），并通过实时聚合酶链反应定量检测龈下样本中的总细菌负荷及红色复合体菌种（牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体），同时动态监测龈沟液（GCF）的体积变化。本研究的主要结局指标为PD与CAL的改善情况。数据采用重复测量方差分析（ANOVA）、最小显著差异多重比较（LSD）、克鲁斯卡尔-沃利斯检验、弗里德曼检验及配对t检验进行统计学分析（P<0.05）。结果显示，FMS组与QSRP组在PD、CAL、GI、PI及GCF的改善效果上无显著差异。治疗后，FMS组的总细菌负荷及红色复合体菌种平均水平均低于QSRP组。综上，联合全身性阿奇霉素的FMS与QSRP均为治疗广泛型III、IV期牙周炎的有效且可靠的短期治疗方案；但相较于QSRP，FMS在6个月的抗菌效果上更具优势。