| The treatment of severe chronic periodontitis remains to be an important issue for periodontal practitioners. According to the current research results, the basic treatment is the foundation of the treatment of severe chronic periodontitis, but adjuvant medication is still an indispensable means. If the medicine not only can kill the pathogens but also can inhibit the immune response of periodontitis, then better clinical results can be achieved. Clarithromycin is a new macrolide medicine, studies have shown that in recent years, it not only has good antibacterial activity, but also can play a role in inhibiting the inflammatory response. However, the application of clarithromycin in dentistry is still very limited. This study systematically observed via experiments the effects of clarithromycin in the treatment of severe chronic periodontitis, to determine the possibility of its application in severe chronic periodontitis treatment. This study is divided into three parts.1.Determination of medicine concentration of clarithromycin and metronidazole in the gingival crevicular fluidObjective:To observe the medicine concentrations of clarithromycin and metronidazole in the gingival crevicular fluid in patients with severe chronic periodontitis. Methods:Forty patients with severe chronic periodontitis were randomly divided into2groups:clarithromycin group and metronidazole group, each group20cases. The two groups were treated with clarithromycin and metronidazole respectively for1week. After3days,7days and10days of medication, gingival crevicular fluid samples were collected and the concentration of the two medicine in the gingival crevicular fluid were detected by HPLC methods. The average of the concentration of these two medicines were calculated and compared with the minimum inhibitory concentration of these two medicines on common bacteria, in order to evalutate whether metronidazole and clarithromycin in the gingival crevicular fluid can achieve the minimum inhibitory concentration (MIC)on common bacteria. Results:(1) After3days and7days, the two medicines in the gingival crevicular fluid both showed higher distribution and the concentration both exceeded the plasma concentration of the two medicines. After10days, clarithromycin still could be detected, but metronidazole was undetectable.(2) After3days and7days, both medicines can reach minimum inhibitory concentration on Porphyromonas gingivalis, Aeromonas intermediate Prevotella, viscous actinomycetes microorganisms etc. After10days, the concentration of clarithromycin in the gingival crevicular fluid can still reach the MIC range on commonly found bacterium in periodontal tissues.(3) The concentration of clarithromycin in gingival crevicular fluid after7days was higher than the the concentration after3days (P<0.05), the metronidazole group showed no significant differences on medicine concentrations in the gingival crevicular fluid after3days and7days (P<0.05). Conclusion:During medication, clarithromycin and metronidazole in the gingival crevicular fluid have better distribution, can reach high inhibitory concentration on bacteria. The clarithromycin accumulates in the gingival crevicular fluid and maintains a high medicine concentration in the gingival crevicular fluid after medication for a long period of time.2. Effects of clarithromycin and metronidazole on IL-1and TNF-α levels in the gingival crevicular fluidObjective:To observe the impact of clarithromycin and metronidazole on IL-1and TNF-α levels in the gingival crevicular fluid in patients with severe chronic periodontitis. Methods:90cases of severe chronic periodontitis were randomly divided into three groups:clarithromycin group, metronidazole group and blank control group, each group30cases. Gingival crevicular fluid samples were collected at baseline and1week of patients in each group. IL-1and TNF-α levels in the gingival crevicular fluid of three groups of patients were detected by ELISA kit in order to observe the IL-1and TNF-α changes in gingival crevicular fluid of three groups of patients. Results:(1) at baseline, there were no significant differences of IL-1and TNF-α levels among three groups (P>0.05).(2) After1week, IL-1and TNF-α levels of clarithromycin group were lower than the metronidazole group and blank control group (P<0.05). There was no statistically significant difference between metronidazole group and blank control group after1week (P>0.05).Conclusion:Clarithromycin can effectively reduce IL-1and TNF-α levels in gingival crevicular fluid with severe chronic periodontitis. 3.Evaluation of the clinical effects of Clarithromycin on the treatment of severe chronic periodontitisObjective:To investigate the clinical effect of Clarithromycin for the treatment of severe chronic periodontitis. Methods:90patients with severe chronic periodontitis were randomly divided into3groups:1group with clarithromycin treatment,1with metronidazole treatment and1blank control group, each group contains30cases. After1month and3months, each group was evaluated with gingival sulcus bleeding index (SBI), probing depth (PD) and attachment loss (AL) compared with the baseline. Results:(1) at the baseline levels, there was no significant difference statistically (P>0.05) about all of the three indexes (PD, SBI, AL);(2) after1month, PD, SBI of Clarithromycin group were lower than metronidazole group (P<0.05). There was no significant difference of AL between Clarithromycin group and metronidazole group (P>0.05);(3) after3months, PD, AL of clarithromycin group metronidazole group were lower than metronidazole group (P<0.05), whereas there was no significant difference of SBI between these two groups (P>0.05);(4) after1and3-month, SBI, PD, AL of both clarithromycin group and metronidazole group were lower than the control group (P<0.05). Conclusion:Clarithromycin can be used in the treatment of severe chronic periodontitis with significant clinical effects. |
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