❞ كتاب Antibiotics and Antiseptics in Periodontal Therapy ❝

❞ كتاب Antibiotics and Antiseptics in Periodontal Therapy ❝

Antibiotics and Antiseptics in Periodontal Therapy

by :Dr. Dumitrescu


1. Antibiotics and Antiseptics in Periodontal Therapy
2. Alexandrina L.Dumitrescu Antibiotics and Antiseptics in Periodontal Therapy
3. ISBN 978-3-642-13210-0e-ISBN 978-3-642-13211-7 DOI 10.1007/978-3-642-13211-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010937957 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is ­concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant ­protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli- cation contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Author Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry Department of Periodontology 9037 Tromsø Norway [email protected]
4. v Preface Periodontitis is defined as an inflammatory disease of the periodontium characterized by inflammation of the gingival and adjacent attachment apparatus, illustrated by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone. Periodontitis represents the major cause of tooth loss in adults leading to long-term disability and increased treatment needs. It is well estab- lished that the various periodontal diseases are caused by bacterial infection. Dental plaque was defined as “matrix-enclosed bacterial populations adherent to each other and/or to surfaces or interfaces”. Dental plaque is a microbial biofilm, a diverse microbial community found on the tooth surface embedded in a matrix of polymers of bacterial and salivary origin. This complex biofilm may offer some pro- tection from the host’s immunologic mechanisms as well as chemotherapeutic agents used for treatment. It is therefore logical to do first the mechanical removal and dis- ruption of the dental plaque biofilm itself. Antimicrobial agents are used extensively in both medicine and dentistry to elimi- nate infection. These drugs are also widely used as a prophylaxis to prevent infection in the “at risk” patient. This book is a collection of data from scientific papers and textbooks found to be important for the understanding of the antibiotics and antisep- tics used in the periodontal therapy. This book is addressed to dentists, periodontologists, undergraduate and postgrad- uate dental students, dental hygienists, and other co-associated professionals. Alexandrina L. Dumitrescu
5. vii Contents 1Antimicrobial Resistance of Dental Plaque Biofilm ...............................1 1.1 Characteristics of Dental Plaque as a Bacterial Biofilm........................1 1.1.1Biofilm Formation ....................................................................1 1.1.2Architecture of Dental Plaque Biofilm.....................................2 1.1.3Microbial Composition of Dental Plaque.................................3 1.1.4Importance of Biofilms in Human Diseases............................. 7 1.2Mechanisms of Biofilm Resistance Against Antimicrobials.................8 1.2.1Biofilm Impermeability to Antimicrobial Agents.....................8 1.2.2Altered Growth Rates in Biofilm Organisms............................9 1.2.3The Biofilm Microenvironment Antagonizing Antimicrobial Activity..............................................................9 1.2.4The Role of Horizontal Dissemination in the Biofilm..............9 1.2.5Communications Systems (Quorum Sensing)..........................13 1.2.6Antibiotic Susceptibility of Bacterial Species Residing in Biofilms.................................................................13 1.2.7Role for Drug Delivery Systems for Combating Bacterial Resistance of Biofilm........................14 References......................................................................................................15 2The Prophylactic Use of Antibiotics in Periodontal Therapy.................19 2.1Levels of Bacteremia Associated with Interventional Procedures and Everyday Activities......................................................20 2.1.1Frequency of Bacteremia Associated with Dental Procedures and Oral Activities..............................20 2.1.2Nature of Bacteremia Associated with Dental Procedures and Oral Activities......................................20 2.1.3 Magnitude of Bacteremia Associated with Dental Procedures and Oral Activities..............................20 2.1.4Duration of Bacteremia Associated with Dental Procedures and Oral Activities..............................44 2.1.5Impact of Dental Disease on Bacteremia..................................44 2.1.6Impact of Oral Hygiene on Bacteremia....................................44 2.1.7Impact of Type of Dental Procedure on Bacteremia.................45 2.1.8Impact of Antibiotic/Antiseptic Therapy on Bacteremia..........45 2.1.9Cumulative Risk over Time of Bacteremias from Routine Daily Activities Compared with the Bacteremia from a Dental Procedure..........................45
6. viiiContents 2.2Prophylaxis of Infective Endocarditis....................................................45 2.2.1Pathogenesis of IE.....................................................................46 2.2.2Clinical Features of IE..............................................................46 2.2.3Identification of At-Risk Patients for Occurrence or Mortality from Endocarditis........................46 2.2.4Identification of At-Risk Dental Procedures.............................46 2.2.5Recommended Prophylactic Regimens for Dental Procedures...............................................................50 2.2.6 Discussion.................................................................................59 2.3Antibiotic Prophylaxis before Invasive Dental Procedure in Patients with Joint Replacements.....................................61 2.3.1Existing Guidelines...................................................................62 2.4The Prevention of Infection Following Dental Surgical Procedures......69 2.4.1The Asplenic Patient.................................................................69 2.4.2Transplantation Patients............................................................69 2.4.3Hematological Patients.............................................................70 2.4.4HIV Infection............................................................................71 References......................................................................................................72 3The Systemic Use of Antibiotics in Periodontal Therapy.......................79 3.1Advantages of Systemic Antibiotic Therapy in Periodontics................79 3.2Disadvantages of Systemic Antibiotic Therapy in Periodontics.........................................................................80 3.3Efficacy of Systemic Antibiotic Therapy in Periodontics......................80 3.4Microbiological Analysis.......................................................................81 3.5Drug Interactions....................................................................................82 3.6Antibiotic Regimens in Periodontal Therapy.........................................82 3.6.1Single Antibiotic Regimes........................................................82 3.6.2Combination Antimicrobial Therapy........................................117 3.6.3Sequencing of Antibiotic Therapy............................................128 3.7Adverse Effects......................................................................................129 3.8Discussions of Available Data Regarding Effectiveness of Systemic Antibiotics in Periodontal Therapy..............134 3.8.1 Plaque Index Change................................................................134 3.8.2Gingival Inflammation..............................................................134 3.8.3PD and CAL Change................................................................135 3.8.4Alveolar Bone Loss...................................................................137 3.8.5Gingival Crevicular Fluid Changes...........................................137 3.9Limitations of Available Data................................................................139 3.9.1The Type of the Periodontal Disease........................................139 3.9.2The Number of Subjects...........................................................139 3.9.3Characteristics of the Study Population....................................148 3.9.4The Nature of the Clinical Measurements Performed in the Studies...........................................................149 3.9.5The Prescribed Antibiotics and Their Dosage and Duration of Administration...................149 3.9.6Characteristics of the Interventions..........................................150 3.9.7The Study Design......................................................................151
7. Contentsix 3.10What Dosage to Use?..........................................................................151 3.11Considering Systemic Antibiotics as Monotherapy in the Treatment of Periodontal Disease?............................................151 3.12Implications of Systemic Antibiotics as an Adjunct to Nonsurgical and Surgical Therapy....................................153 3.13Recommendations for Treating Periodontitis with Antibiotics...........154 3.14Final Considerations............................................................................161 References......................................................................................................162 4The Topical Use of Antibiotics in Periodontal Pockets............................171 4.1Advantages and Disadvantages of Local Antimicrobial Agent Pocket Delivery.................................................... 171 4.2Antibiotics for Topical Use in Periodontal Therapy..............................172 4.2.1 Tetracycline-HCl.......................................................................172 4.2.2 Minocycline..............................................................................173 4.2.3 Doxycycline..............................................................................185 4.2.4 ...................230
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Antibiotics and Antiseptics in Periodontal Therapy

Antibiotics and Antiseptics in Periodontal Therapy

by :Dr. Dumitrescu


1. Antibiotics and Antiseptics in Periodontal Therapy
2. Alexandrina L.Dumitrescu Antibiotics and Antiseptics in Periodontal Therapy
3. ISBN 978-3-642-13210-0e-ISBN 978-3-642-13211-7 DOI 10.1007/978-3-642-13211-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010937957 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is ­concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant ­protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli- cation contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Author Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry Department of Periodontology 9037 Tromsø Norway [email protected]
4. v Preface Periodontitis is defined as an inflammatory disease of the periodontium characterized by inflammation of the gingival and adjacent attachment apparatus, illustrated by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone. Periodontitis represents the major cause of tooth loss in adults leading to long-term disability and increased treatment needs. It is well estab- lished that the various periodontal diseases are caused by bacterial infection. Dental plaque was defined as “matrix-enclosed bacterial populations adherent to each other and/or to surfaces or interfaces”. Dental plaque is a microbial biofilm, a diverse microbial community found on the tooth surface embedded in a matrix of polymers of bacterial and salivary origin. This complex biofilm may offer some pro- tection from the host’s immunologic mechanisms as well as chemotherapeutic agents used for treatment. It is therefore logical to do first the mechanical removal and dis- ruption of the dental plaque biofilm itself. Antimicrobial agents are used extensively in both medicine and dentistry to elimi- nate infection. These drugs are also widely used as a prophylaxis to prevent infection in the “at risk” patient. This book is a collection of data from scientific papers and textbooks found to be important for the understanding of the antibiotics and antisep- tics used in the periodontal therapy. This book is addressed to dentists, periodontologists, undergraduate and postgrad- uate dental students, dental hygienists, and other co-associated professionals. Alexandrina L. Dumitrescu
5. vii Contents 1Antimicrobial Resistance of Dental Plaque Biofilm ...............................1 1.1 Characteristics of Dental Plaque as a Bacterial Biofilm........................1 1.1.1Biofilm Formation ....................................................................1 1.1.2Architecture of Dental Plaque Biofilm.....................................2 1.1.3Microbial Composition of Dental Plaque.................................3 1.1.4Importance of Biofilms in Human Diseases............................. 7 1.2Mechanisms of Biofilm Resistance Against Antimicrobials.................8 1.2.1Biofilm Impermeability to Antimicrobial Agents.....................8 1.2.2Altered Growth Rates in Biofilm Organisms............................9 1.2.3The Biofilm Microenvironment Antagonizing Antimicrobial Activity..............................................................9 1.2.4The Role of Horizontal Dissemination in the Biofilm..............9 1.2.5Communications Systems (Quorum Sensing)..........................13 1.2.6Antibiotic Susceptibility of Bacterial Species Residing in Biofilms.................................................................13 1.2.7Role for Drug Delivery Systems for Combating Bacterial Resistance of Biofilm........................14 References......................................................................................................15 2The Prophylactic Use of Antibiotics in Periodontal Therapy.................19 2.1Levels of Bacteremia Associated with Interventional Procedures and Everyday Activities......................................................20 2.1.1Frequency of Bacteremia Associated with Dental Procedures and Oral Activities..............................20 2.1.2Nature of Bacteremia Associated with Dental Procedures and Oral Activities......................................20 2.1.3 Magnitude of Bacteremia Associated with Dental Procedures and Oral Activities..............................20 2.1.4Duration of Bacteremia Associated with Dental Procedures and Oral Activities..............................44 2.1.5Impact of Dental Disease on Bacteremia..................................44 2.1.6Impact of Oral Hygiene on Bacteremia....................................44 2.1.7Impact of Type of Dental Procedure on Bacteremia.................45 2.1.8Impact of Antibiotic/Antiseptic Therapy on Bacteremia..........45 2.1.9Cumulative Risk over Time of Bacteremias from Routine Daily Activities Compared with the Bacteremia from a Dental Procedure..........................45
6. viiiContents 2.2Prophylaxis of Infective Endocarditis....................................................45 2.2.1Pathogenesis of IE.....................................................................46 2.2.2Clinical Features of IE..............................................................46 2.2.3Identification of At-Risk Patients for Occurrence or Mortality from Endocarditis........................46 2.2.4Identification of At-Risk Dental Procedures.............................46 2.2.5Recommended Prophylactic Regimens for Dental Procedures...............................................................50 2.2.6 Discussion.................................................................................59 2.3Antibiotic Prophylaxis before Invasive Dental Procedure in Patients with Joint Replacements.....................................61 2.3.1Existing Guidelines...................................................................62 2.4The Prevention of Infection Following Dental Surgical Procedures......69 2.4.1The Asplenic Patient.................................................................69 2.4.2Transplantation Patients............................................................69 2.4.3Hematological Patients.............................................................70 2.4.4HIV Infection............................................................................71 References......................................................................................................72 3The Systemic Use of Antibiotics in Periodontal Therapy.......................79 3.1Advantages of Systemic Antibiotic Therapy in Periodontics................79 3.2Disadvantages of Systemic Antibiotic Therapy in Periodontics.........................................................................80 3.3Efficacy of Systemic Antibiotic Therapy in Periodontics......................80 3.4Microbiological Analysis.......................................................................81 3.5Drug Interactions....................................................................................82 3.6Antibiotic Regimens in Periodontal Therapy.........................................82 3.6.1Single Antibiotic Regimes........................................................82 3.6.2Combination Antimicrobial Therapy........................................117 3.6.3Sequencing of Antibiotic Therapy............................................128 3.7Adverse Effects......................................................................................129 3.8Discussions of Available Data Regarding Effectiveness of Systemic Antibiotics in Periodontal Therapy..............134 3.8.1 Plaque Index Change................................................................134 3.8.2Gingival Inflammation..............................................................134 3.8.3PD and CAL Change................................................................135 3.8.4Alveolar Bone Loss...................................................................137 3.8.5Gingival Crevicular Fluid Changes...........................................137 3.9Limitations of Available Data................................................................139 3.9.1The Type of the Periodontal Disease........................................139 3.9.2The Number of Subjects...........................................................139 3.9.3Characteristics of the Study Population....................................148 3.9.4The Nature of the Clinical Measurements Performed in the Studies...........................................................149 3.9.5The Prescribed Antibiotics and Their Dosage and Duration of Administration...................149 3.9.6Characteristics of the Interventions..........................................150 3.9.7The Study Design......................................................................151
7. Contentsix 3.10What Dosage to Use?..........................................................................151 3.11Considering Systemic Antibiotics as Monotherapy in the Treatment of Periodontal Disease?............................................151 3.12Implications of Systemic Antibiotics as an Adjunct to Nonsurgical and Surgical Therapy....................................153 3.13Recommendations for Treating Periodontitis with Antibiotics...........154 3.14Final Considerations............................................................................161 References......................................................................................................162 4The Topical Use of Antibiotics in Periodontal Pockets............................171 4.1Advantages and Disadvantages of Local Antimicrobial Agent Pocket Delivery.................................................... 171 4.2Antibiotics for Topical Use in Periodontal Therapy..............................172 4.2.1 Tetracycline-HCl.......................................................................172 4.2.2 Minocycline..............................................................................173 4.2.3 Doxycycline..............................................................................185 4.2.4 ...................230 . المزيد..

تعليقات القرّاء:

التعويضات السنية Prosthodontics وتشمل
الجسور الثابتة Fixed bridges والزرعات Implants
الطقوم الكاملة المتحركة removable complete denture
الطقوم الجزئية المتحركة removable partial denture
معالجة و إصلاح الأسنان Operative Dentistry وتشمل:
تشخيص تسوس الأسنان caries diagnosis
الوقايه والحد من انتشار تسوس الاسنان management of dental caries
تبييض الأسنان Dentalbleaching
تجميل الأسنان cosmetic dentistry
حشوات الأسنان Dental Fillings
معالجة لب الأسنان Endodontics
معالجة الأسنان المجهرية microscopic endodontics
طب الأسنان الوقائي Preventive Dentistry
تقويم الأسنان Orthodontics
جراحة الفم والوجه والفكين Oral and Maxillofacial Surgery
طب أسنان الأطفال Pedodontics
أمراض اللثة
أمراض الأنسجة المحيطة بالأسنان Periodontics
زراعة الأسنان Dental Implantology
أشعة الأسنان Dental Radiology
طب الأسنان الشرعي Forensic Dentistry
طب الفم Oral Medicine
أمراض الفم Oral Pathology
أنسجة الفم والأسنان Oral Histology
المادة السنية Dental material
تشريح الأسنانDental anatomy
مواضيع متعلقة بطب الأسنان
طب الأسنان للرضع
جراحة الأسنان
أسنان
طقم أسنان
طب الاسنان في الاردن
طب الأسنان في جميع أنحاء العالم

Antibiotics and Antiseptics in Periodontal Therapy

by :Dr. Dumitrescu


1. Antibiotics and Antiseptics in Periodontal Therapy
2. Alexandrina L.Dumitrescu Antibiotics and Antiseptics in Periodontal Therapy
3. ISBN 978-3-642-13210-0    e-ISBN 978-3-642-13211-7 DOI 10.1007/978-3-642-13211-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010937957 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is ­concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant ­protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli- cation contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Author Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry Department of Periodontology 9037 Tromsø Norway [email protected]
4. v Preface Periodontitis is defined as an inflammatory disease of the periodontium characterized by inflammation of the gingival and adjacent attachment apparatus, illustrated by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone. Periodontitis represents the major cause of tooth loss in adults leading to long-term disability and increased treatment needs. It is well estab- lished that the various periodontal diseases are caused by bacterial infection. Dental plaque was defined as “matrix-enclosed bacterial populations adherent to each other and/or to surfaces or interfaces”. Dental plaque is a microbial biofilm, a diverse microbial community found on the tooth surface embedded in a matrix of polymers of bacterial and salivary origin. This complex biofilm may offer some pro- tection from the host’s immunologic mechanisms as well as chemotherapeutic agents used for treatment. It is therefore logical to do first the mechanical removal and dis- ruption of the dental plaque biofilm itself. Antimicrobial agents are used extensively in both medicine and dentistry to elimi- nate infection. These drugs are also widely used as a prophylaxis to prevent infection in the “at risk” patient. This book is a collection of data from scientific papers and textbooks found to be important for the understanding of the antibiotics and antisep- tics used in the periodontal therapy. This book is addressed to dentists, periodontologists, undergraduate and postgrad- uate dental students, dental hygienists, and other co-associated professionals. Alexandrina L. Dumitrescu
5. vii Contents 1    Antimicrobial Resistance of Dental Plaque Biofilm ...............................    1 1.1 Characteristics of Dental Plaque as a Bacterial Biofilm........................    1 1.1.1    Biofilm Formation ....................................................................    1 1.1.2    Architecture of Dental Plaque Biofilm.....................................    2 1.1.3    Microbial Composition of Dental Plaque.................................    3 1.1.4    Importance of Biofilms in Human Diseases............................. 7 1.2    Mechanisms of Biofilm Resistance Against Antimicrobials.................    8 1.2.1    Biofilm Impermeability to Antimicrobial Agents.....................    8 1.2.2    Altered Growth Rates in Biofilm Organisms............................    9 1.2.3    The Biofilm Microenvironment Antagonizing Antimicrobial Activity..............................................................    9 1.2.4    The Role of Horizontal Dissemination in the Biofilm..............    9 1.2.5    Communications Systems (Quorum Sensing)..........................    13 1.2.6    Antibiotic Susceptibility of Bacterial Species Residing in Biofilms.................................................................    13 1.2.7    Role for Drug Delivery Systems for Combating Bacterial Resistance of Biofilm........................    14 References......................................................................................................    15 2    The Prophylactic Use of Antibiotics in Periodontal Therapy.................    19 2.1    Levels of Bacteremia Associated with Interventional Procedures and Everyday Activities......................................................    20 2.1.1    Frequency of Bacteremia Associated with Dental Procedures and Oral Activities..............................    20 2.1.2    Nature of Bacteremia Associated with Dental Procedures and Oral Activities......................................    20 2.1.3 Magnitude of Bacteremia Associated with Dental Procedures and Oral Activities..............................    20 2.1.4    Duration of Bacteremia Associated with Dental Procedures and Oral Activities..............................    44 2.1.5    Impact of Dental Disease on Bacteremia..................................    44 2.1.6    Impact of Oral Hygiene on Bacteremia....................................    44 2.1.7    Impact of Type of Dental Procedure on Bacteremia.................    45 2.1.8    Impact of Antibiotic/Antiseptic Therapy on Bacteremia..........    45 2.1.9    Cumulative Risk over Time of Bacteremias from Routine Daily Activities Compared with the Bacteremia from a Dental Procedure..........................    45
6. viii    Contents 2.2    Prophylaxis of Infective Endocarditis....................................................    45 2.2.1    Pathogenesis of IE.....................................................................    46 2.2.2    Clinical Features of IE..............................................................    46 2.2.3    Identification of At-Risk Patients for Occurrence or Mortality from Endocarditis........................    46 2.2.4    Identification of At-Risk Dental Procedures.............................    46 2.2.5    Recommended Prophylactic Regimens for Dental Procedures...............................................................    50 2.2.6 Discussion.................................................................................    59 2.3    Antibiotic Prophylaxis before Invasive Dental Procedure in Patients with Joint Replacements.....................................    61 2.3.1    Existing Guidelines...................................................................    62 2.4    The Prevention of Infection Following Dental Surgical Procedures......    69 2.4.1    The Asplenic Patient.................................................................    69 2.4.2    Transplantation Patients............................................................    69 2.4.3    Hematological Patients.............................................................    70 2.4.4    HIV Infection............................................................................    71 References......................................................................................................    72 3    The Systemic Use of Antibiotics in Periodontal Therapy.......................    79 3.1    Advantages of Systemic Antibiotic Therapy in Periodontics................    79 3.2    Disadvantages of Systemic Antibiotic Therapy in Periodontics.........................................................................    80 3.3    Efficacy of Systemic Antibiotic Therapy in Periodontics......................    80 3.4    Microbiological Analysis.......................................................................    81 3.5    Drug Interactions....................................................................................    82 3.6    Antibiotic Regimens in Periodontal Therapy.........................................    82 3.6.1    Single Antibiotic Regimes........................................................    82 3.6.2    Combination Antimicrobial Therapy........................................    117 3.6.3    Sequencing of Antibiotic Therapy............................................    128 3.7    Adverse Effects......................................................................................    129 3.8    Discussions of Available Data Regarding Effectiveness of Systemic Antibiotics in Periodontal Therapy..............    134 3.8.1 Plaque Index Change................................................................    134 3.8.2    Gingival Inflammation..............................................................    134 3.8.3    PD and CAL Change................................................................    135 3.8.4    Alveolar Bone Loss...................................................................    137 3.8.5    Gingival Crevicular Fluid Changes...........................................    137 3.9    Limitations of Available Data................................................................    139 3.9.1    The Type of the Periodontal Disease........................................    139 3.9.2    The Number of Subjects...........................................................    139 3.9.3    Characteristics of the Study Population....................................    148 3.9.4    The Nature of the Clinical Measurements Performed in the Studies...........................................................    149 3.9.5    The Prescribed Antibiotics and Their Dosage and Duration of Administration...................    149 3.9.6    Characteristics of the Interventions..........................................    150 3.9.7    The Study Design......................................................................    151
7. Contents    ix 3.10    What Dosage to Use?..........................................................................    151 3.11    Considering Systemic Antibiotics as Monotherapy in the Treatment of Periodontal Disease?............................................    151 3.12    Implications of Systemic Antibiotics as an Adjunct to Nonsurgical and Surgical Therapy....................................    153 3.13    Recommendations for Treating Periodontitis with Antibiotics...........    154 3.14    Final Considerations............................................................................    161 References......................................................................................................    162 4    The Topical Use of Antibiotics in Periodontal Pockets............................    171 4.1    Advantages and Disadvantages of Local Antimicrobial Agent Pocket Delivery.................................................... 171 4.2    Antibiotics for Topical Use in Periodontal Therapy..............................    172 4.2.1 Tetracycline-HCl.......................................................................    172 4.2.2 Minocycline..............................................................................    173 4.2.3 Doxycycline..............................................................................    185 4.2.4 ...................    230

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