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Powerpoint-presentatie

Edwin Winkel DDS PhD
Actinobacillus
actinomycetemcomitans,
Bacteroides gingivalis and
Bacteroides intermedius:
predictors of attachment loss?
Wennström JL, Dahlén G, Svensson
Svensson J, Nyman S
Oral Microbiol. Immunol 1987: 2:158-163
It appeared that the absence of
these “indicator” bacteria
is a better predictor of
no further loss of attachment
than the presence of them
for disease progression
Wenström et al 1987
Treatment of Periodontal
Disease based on
Microbiological Diagnosis.
A 5-year follow up on
Individual Patterns
Dahlén G, Wikström M, Renvert S
J Periodontol 1996: 67: 879-887
The results of this study
suggest that presence of the
indicator bacteria in microbial
samples taken after treatment
may identivy patients at risk
for recurrent periodontitis
Dahlén et al 1996
Untreated periodontal disease
in Indonesian adolescents.
Longitudinal clinical data and
prospective clinical and
microbiological risk assessment
Timmerman, M. F., Van der Weijden, G. A.,
Abbas, F., Arief, E. M., Armand, S., Winkel, E. G.,
Van Winkelhoff, A. J. and Van der Velden, U.
J. Clin. Periodontol. 2000: 27, 932-942.
Factors associated with
progression of disease
• Subgingival calculus
• A. actinomycetemcomitans
• P. gingivalis
Three basic steps in periodontology
van Winkelhoff & Winkel, Current Opinion in Periodontology 35-40, 1997 Infection
Infection
Diagnosis
Restoration
Three basic steps in periodontology
van Winkelhoff & Winkel, Current Opinion in Periodontology 35-40, 1997 Infection
Infection
Diagnosis
Restoration
Three basic steps in periodontology
Infection
Infection
Diagnosis
Restoration
Advantages of local delivery of
antimicrobial agents in periodontics
• high concentrations
• less side-and adverse
• possibility to use
broad-spectrum anti-
• less risk for drug-
septic agents
resistant micro -
• professional
organisms at non-
application reduces
oral body sites
problems with
compliance
A locally delivered drug works when:
• it is adequately subgingivally delivered
• there is sufficient contact time between
the agent and the target microorganisms
• it is possible to achieve a sufficiently high
concentration
• target microorganisms are sufficiently
susceptible to the antimicrobial agent
Antimicrobial agents applied in
local delivery devices
• Metronidazole
(Elyzol)
• Tetracyclines
– tetracycline-HCL
(Actisite)
– minocycline
(Minocin, Arestin)
– doxycycline
(Atridox)
Protocol
• In principe geen anesthesie nodig
• EMS met PerioAid 0.12% irrigatie
• Applicatie Atridox
• Gedurende 1 week :
– Vitis Surgical
– PerioAid Tandpasta-gel 0.12%
Clinical effects of simple debridement+doxycycline
versus thorough SRP after 3 months of active treatment
6 =<3mm PD
6 =<4mm PD
7 =<4mm PD
=> 2 mm CAG
Debr+DOX
Treatment Time
SRP – Baseline
Debr + ATRIDOX – Mon 3
P<0.001
Debr + ATRIDOX – Baseline
SRP – Mon 3
Average treatment time in the S/R
and the Debridement groups
Total:191
Total: 120
Debridement
+Atridox
Debridement
+Atridox
Debridement
Conclusions Wennström et al.
“Results suggest that simplified full
mouth ultrasonic debridement,
combined with locally delivered
controlled release doxycycline in deep
pockets was the most favourable of the
treatment approaches tested.”
Indicaties
• Ondersteuning tijdens de initiële
behandeling
• Locaal probleem
• Overgevoeligheid systemische antibiotica
• Geen behoefte aan chirurgie
• Geringe therapietrouw
Conclusions
• There is a place for local application of
antibiotics in the active periodontal treatment
phase
• Sites that may benefit from topical antibiotics
are probably:
– sites with recurrent disease activity
– refractory sites
• The microbiological profile of a site that will
clinically benefit best, needs to be investigated

Source: http://www.rtvstudieclubophetnet.nl/pdf/LocaleAntibiotica-DrEWinkel.pdf