| Abstract | Glavna karakteristika parodontne bolesti je upala potpornog aparata zuba. Dolazi do destrukcije parodontnog ligamenta, alveolarne kosti, a moguć je i gubitak zuba. Cilj terapije parodontitisa je zaustaviti daljnju progresiju bolesti, povećanje kliničkog pričvrstka, smanjenje sondiranja dubine džepa, krvarenja na sondiranje i gnojenja. Također je bitno motivirati pacijente da održavaju oralnu higijenu. Kao ključni faktor se navodi prisutnost biofilma te u većine pacijenata učinkovita kontrola biofilma dovodi do značajnog poboljšanja. U slučajevima parodontnog apscesa, nekrotizirajuće parodontne bolesti, agresivnog parodontitisa i kroničnog, koji slabo odgovara na terapiju, indicirana je primjena antibiotika kao dodatak mehaničkoj terapiji. Zbog svoje organizacije, biofilm je otporan na djelovanje antibiotika, stoga, antibiotska monoterapija u liječenju parodontitisa je neučinkovita. Antibiotici koji su ispitivani za sustavnu terapiju parodontitisa su tetraciklin, metronidazol, β-laktamski antibiotici, fluorokinoloni, makrolidi i klindamicin. Kako bi dobili sinergično djelovanje antibiotika, proširili spektar djelovanja antibiotika i smanjili mogućnost razvoja bakterijske rezistencije, antibiotici se mogu kombinirati., pa se tako kombiniraju metronidazol i amoksiciklin te metronidazol i ciprofloksacin. U slučajevima koji ne odgovaraju na terapiju, moguća je serijska primjena antibiotika, bakteriostatika i baktericida (doksaciklin i metronidazol te tetraciklin i amoksiciklin). Za lokalnu primjenu antibiotika koriste se različita sredstva pomoću kojih se osigurava sporo otpuštanje aktivne tvari i duže djelovanje u parodontnom džepu. Dolaze u obliku subgingivnih irigansa, gelova i masti, filmova, vlakna, implantati, mikrokapsula i nanočestica, a mogu sadržavati tetracikline (najčešće doksiciklin i minociklin) i metronidazol. Najveći nedostatak takve primjene antibiotika je brzo odstranjivanje antibiotika iz parodontnog džepa te kratko vrijeme djelovanja. |
| Abstract (english) | The main characteristic of periodontal disease is the occurrence of inflammation in the tooth-supportive tissues. Periodontal disease can lead to destruction of the periodontal ligament, alveolar bone and possibly tooth loss. Aims of periodontal therapy are to stop further disease progression, to minimize symptoms and, if it is possible, to regain lost tissue. It is also important to motivate the patients to maintain their periodontium healthy because its health greatly depends on patient’s oral hygiene. Presence of the biofilm is the key factor for the occurrence of the periodontal disease. Once the effective biofilm control has been established, it results in significant improvement in most patients affected by periodontal disease. In cases of periodontal abscess, necrotising periodontal disease, aggressive periodontitis and chronic periodontitis which respond poorly to conventional therapy, antibiotic therapy is indicated as adjunctive to mechanical treatment. Organized biofilm is resistent to antibiotic activity and antibiotic monotherapy is ineffective in periodontal therapy. Antibiotics used for systemic therapy of periodontitis are tetracyclines, metronidazol, β-lactam antibiotics, fluoroquinolones, macrolides and clindamycin. In order to obtain synergistic antibiotic activity, to expand spectrum of antibiotic activity and to reduce the possibility of developing bacterial resistance, antibiotics can be combined: metronidazole plus amoxicillin and metronidazol plus ciprofloxacin. Cases which do not respond to therapy, can be treated with serial use of antibiotics where bacteriostatics and bactericids are combined (doxacyclin and metronidazol, tetracyclin and amoxicillin). Topically applied antibiotics can be present in various forms that enable release of their active substance and provide longer activity in periodontal pocket. They are available in the form of subgingive irrigations, gels and ointments, films, fibers, in situ forming implants, microspheres and nanoparticles, and may contain tetracyclines (most often doxycicline and minocycline) and metronidazole. The major disadvantage of such antibiotics is their rapid removal from the periodontal pocket and a short time of action |
