ANTİBİYOTİKLER PERİODONTAL TEDAVİDE NE ZAMAN VE NASIL KULLANILMALI?

Yıl 2014, Cilt: 3 Sayı: 2, 122 - 125, 31.08.2014

Pınar Gümüş Nurcan Buduneli

Öz

Periodontitisin etkeni subgingival alanda yerleşip çoğalan patojen mikroorganizmalardır. Patojen bakteriler, diş yüzeylerine tutunur ve biofilm adı verilen karmaşık yapı içinde kolonize olur. Biyofilm, bakteriler için antimikrobiyal maddelere karşı korunaklı bir ortam sağladığından mekanik olarak diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi işlemleri yapılmaksızın tek başına uygulanan antibiyotikler ile periodontal tedavi sağlanamaz. Periodontal tedavide asıl hedef patojen bakterilerin diş yüzeylerinde yerleşmesini ve çoğalmasını önlemektir. Hastanın periodontal hastalıklar hakkında bilgilendirilmesi, iyi ağız bakımının öğretilmesi, diş yüzeyi temizliği ve kök yüzeyi düzleştirilmesi işlemlerini kapsayan cerrahisiz periodontal tedavi genellikle başarılı tedaviyi sağlar. Ancak, bazı durumlarda tedavinin etkinliğini arttırmak için tüm bu mekanik işlemlere ek olarak antibiyotiklerden de yararlanılır. Derleme türündeki bu makalede, hangi antibiyotikler, ne zaman, ne amaçla, nasıl periodontal tedavide mekanik işlemlere ek olarak kullanılmalı konularında güncel bilgilerin ortaya konulması amaçlanmıştır.

Anahtar Kelimeler

Sistemik antibiyotik, Periodontitis

WHEN AND HOW TO USE ANTIBIOTICS IN PERIODONTAL TREATMENT?

Öz

Microorganisms that colonise in the subgingival area are the main cause of periodontitis. Pathogen bacteria adhere to the tooth surfaces and colonise in the complex structure called biofilm. The biofilm provides a protected area for the bacteria and therefore, without the mechanical debridement procedures, which comprise scaling and root planing the sole antibiotic application cannot provide effective periodontal treatment. The primary purpose of periodontal treatment is to prevent adhesion and colonisation of pathogen bacteria to the tooth surfaces. Non-surgical periodontal treatment comprising patient motivation and instruction on optimal plaque control, scaling and root planing usually results in effective periodontal treatment. However, additional antibiotic usage may be necessary in some instances to increase the efficiency of mechanical treatment procedures. This review article aims to provide a contemporary overview on which antibiotics to use, when and how to use them in periodontal treatment.

Anahtar Kelimeler

Systemic antibiotics, Periodontitis

Kaynakça

• 1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999;4:1-6.
• 2. Otomo-Corgel J, Pucher JJ, Rethman MP, Reynolds MA. State of the science: chronic periodontitis and systemic health. J Evid Based Dent Pract 2012; 12(Suppl):20-8.
• 3. Page RC, Kornman K. The pathogenesis of human periodontitis: an introduction. Periodontol 2000. 1997;14:9-11.
• 4. Kasimanickam RK, Ranjan A, Asokan GV, Kasimanickam VR, Kastelic JP. Prevention and treatment of biofilms by hybrid and nanotechnologies. Int J Nanomedicine 2013;8:2809-19.
• 5. Teles RP, Haffajee A, Socransky S. Microbiological goals of periodontal therapy. Periodontol 2000 2006;42:180-218.
• 6. Lindhe J, Liljenberg B, Adielson B, Borjesson I. Use of metronidazole as a probe in the study of human periodontal disease. J Clin Periodontol. 1983;10:100–12.
• 7. J. López JN, Gamonal JA, Martinez B. Repeated Metronidazole and Amoxicillin Treatment of Periodontitis. A Follow-Up Study. J Periodontol. 2000;71:79-89.
• 8. AAP. Systemic antibiotics in periodontics. J Periodontol 1996;67:831-38.
• 9. Gilbert P, Collier PJ, Brown MR. Influence of growth rate on susceptibility to antimicrobial agents: biofilms, cell cycle, dormancy, and stringent response. Antimicrob Agents Chemother 1990;34:1865-1868.
• 10. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999;284:1318-22.
• 11. Keren I, Kaldalu N, Spoering A, Wang Y, Lewis K. Persister cells and tolerance to antimicrobials. FEMS Microbiol Lett 2004;230:13-18.
• 12. Lewis K. Persister cells and the riddle of biofilm survival. Biochemistry Mosc 2005;70:267-74.
• 13. Werner G, Coque TM, Franz CM, Grohmann E, Hegstad K, Jensen L et al. Antibiotic resistant enterococci-tales of a drug resistance gene trafficker. Int J Med Microbiol. 2013;303:360-79.
• 14. Bridier A, Briandet R, Thomas V, Dubois-Brissonnet F. Resistance of bacterial biofilms to disinfectants: a review. Biofouling. 2011;27:1017-32.
• 15. Mombelli A, Cionca N, Almaghlouth A. Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery? Periodontol 2000 2011;55:205-16.
• 16. Müller HP, Heinecke A, Borneff M, Knopf A, Kiencke C, Pohl S. Microbial ecology of Actinobacillus actinomycetemcomit- ans, Eikenella corrodens and Capnocytophaga spp. in adult periodontitis. J Periodontal Res 1997;32:530-42.
• 17. Müller HP, Lange DE, Müller RF. Actinobacillus actinomyce- temcomitans recovery from extracrevicular locations of the mouth. Oral Microbiol Immunol 1993;8:344-48.
• 18. Naito Y, Gibbons RJ. Attachment of Bacteroides gingivalis to collagenous substrata. J Dent Res 1988;67:1075-80.
• 19. Pertuiset JH, Saglie FR, Lofthus J, Rezende M, Sanz M. Recurrent periodontal disease and bacterial presence in the gingiva. J Periodontol 1987;58:553-58.
• 20. Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 2002;29(Suppl. 3):136-159.
• 21. Rooney J, Wade WG, Sprague SV, Newcombe RG, Addy M. Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study. J Clin Periodontol 2002;29:342-50.
• 22. Guerrero A, Griffiths GS, Nibali L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non- surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 2005;32:1096-107.
• 23. Smith SR, Foyle DM, Daniels J, et al. A double-blind placebo- controlled trial of azithromycin as an adjunct to non-surgical treatment of periodontitis in adults: clinical results. J Clin Periodontol 2002;29:54-61.
• 24. Herrera D, Bettina AB, Leon R, Roldan S, Sanz M. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol 2008;35(Suppl. 8):45-66.
• 25. Gomi K, Yashima A, Nagano T, Kanazashi M, Maeda N, Arai T. Effects of full-mouth scaling and root planing in conjunction with systemically administered azithromycin. J Periodontol 2007;78:422-29.
• 26. Haffajee AD, Torresyap G, Socransky SS. Clinical changes following four different periodontal therapies for the treatment of chronic periodontitis: 1-year results. J Clin Periodontol 2007;34:243-53.
• 27. Mascarenhas P, Gapski R, Al-Shammari K, et al. Clinical response of azithromycin as an adjunct to non-surgical periodontal therapy in smokers. J Periodontol 2005;76:426-36.
• 28. Sigusch B, Beier M, Klinger G, Pfister W, Glockmann E. A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis. J Periodontol 2001;72:275-83.
• 29. Xajigeorgiou C, Sakellari D, Slini T, Baka A, Konstantinidis A. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Periodontol 2006;33:254-64.
• 30. Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontol 2000 2002;28:106-76.
• 31. Rams TE, Degener JE, van Winkelhoff AJ. Antibiotic Resistance in Human Chronic Periodontitis Microbiota. J Periodontol. 2014;85:160-9.
• 32. Hanes PJ, Purvis JP. Local anti-infective therapy: pharmacological agents. A systematic review. Ann Periodontol 2003;8:79-98.
• 33. Etienne D. Locally delivered antimicrobials for the treatment of chronic periodontitis. Oral Dis 2003;9(Suppl):45-50.
• 34. Herrera D, Matesanz P, Bascones-Martínez A, Sanz M. Local And Systemic Antimicrobial Therapy In Periodontics. J Evid Base Dent Pract 2012;12(Suppl):50-60.
• 35. Emingil G. Periodontal hastalıklarda sistemik antibiyotik kullanımı. EÜ Dişhek Fak Derg 2005;26:23-34.
• 36. Atilla G. Periodontal hastalıklarda enfeksiyon kontrolü: Hangi sistemik antibiyotik niçin ve ne zaman. Dişhekimliği Dergisi 2009;89:44-8.