The Therapy of Periodontal Abscess

8/18/2019 The Therapy of Periodontal Abscess

1/7

Obradović i sar. / tERAPIJA PARODONtALNOg APScESA

775

TERApIJA pARODONTALNOG ApScESA

ThE ThERApy OF pERIODONTAL ABScESS

Obradović R. Radmila, Kojović B. Draginja, Branković R. Vesna

1MEDIcINSKI FAKULtEt, KLINIKA ZA StOMAtOLOgIJU, ODELJENJE ZA ORALNU MEDIcINU I PARODONtOLOgIJU, NIš, SRBIJA

1 MEDIcAL FAcULtY, DENtAL cLINIc, DEPARtMENt OF ORAL MEDIcINE AND PERIODONtOLOgY, NIš, SERBIA

Aa Somaoloia Naissi jun/June 2008, vol. 24, broj/number 57 sr./p 775 - 782

Kratak sadržaj

Parodontalni apsces predstavlja urgentno stanje u stomatologiji, sa

zastupljenošću 7-14% svih urgentnih stanja u stomatologiji. Uzroci

nastanka su mnogobrojni: egzarcerbacija parodontopatije, impakcija

stranih tela, promena morfologije korena itd. Pri postavljanju dijag-noze treba uzeti u obzir analizu celokupnih simptoma i znakova. Mi-

kroorganizmi izolovani iz parodontalnog apscesa nisu specični, ali

dominiraju Gram negativni striktni anaerobi. Zub sa parodontalnim

apscesom ima lošu prognozu i veći je rizik za njegov gubitak.

Terapija parodontalnog apscesa je predstavljala izazov dugi niz go-

dina. U prošlosti, parodontalni apsces kod parodontopatičnog zuba bio

je glavni razlog njegove ekstrakcije. U literaturi se ne nalazi dovoljno

naučnih dokaza koji bi istakli jedinstveni terapijski protokol. Danas se

govori o tri terapijska pristupa u rešavanju ovog problema: drenaža i

kiretaža apscesa, sistemska primena antibiotika i parodontalna hirur-

gija u hroničnoj fazi oboljenja.

Bitni faktori uspešne terapije su lokalizacija akutnog parodontalnog ap-

scesa i mogućnost postizanja drenaže. Antibiotici se propisuju u slučaju

prisutnih opštih simptoma ili ako postoji povećan rizik za nastanak

komplikacija. Lekovi izbora su metronidazol, tetraciklini i klindamicin.

Penicilin je tradicionalno bio lek izbora, pa i njegov značaj ne treba zanemariti.

Nakon smirivanja akutne faze potrebno je uraditi adekvatnu mehaničku

obradu i ispiranje antiseptičnim rastvorom. U slučaju prisutnog

hroničnog parodontalnog apscesa pristupa se parodontalnoj hirurgiji.

Ključne reči : parodontalni apsces, drenaža, antibiotici, parodontalna

hirurgija

Uvod

Parodonalni apses je česa komplikaija

parodonopaije, kada dolazi do brze desruk-ije kiva. Akuni parodonalni apses je jednaod nekoliko reki klinički siuaija u par-

pREGLEDNI RAD

REVIEW ARTICLE

Summary

The periodontal abscess is the third most frequent dental emergency,representing 7–14% of all dental emergencies. Numerous etiologies are possible: exacerbations of the existing disease, post-therapy abscesses,impaction of foreign objects, factors altering root morphology, etc. The

diagnosis should take into account the analysis of signs and symptoms.The microora related with periodontal abscesses doesn’t seem to be specic and is dominated by gram-negative strict anaerobe, rods. Atooth suffering from a periodontal abscess has a worse prognosis andis at a higher risk of being lost.The treatment of the periodontal abscess has been a challenge for many years. In the past, the periodontal abscess in periodontal diseased teethwas the main reason for tooth extraction. There is not enough scienticevidence in the literature to provide a unique treatment regime for peri-odontal abscesses. Today, three therapeutic approaches have been dis-cussed, including: drainage and debridement; systemic antibiotics and periodontal surgery procedures applied in chronic phase of disease.The localization of the acute periodontal abscess and the possibilityof obtaining drainage are essential considerations for successful treat-ment. Antibiotics should be prescribed in case of general symptoms orif complications can be suspected. Metronidazole, tetracyclines andclindamycin are drugs of choice. Penicillin was traditionally the drug

of choice and its importance should not be neglected. Proper mechanical debridment and local antiseptic irrigation shouldbe carried out after resolution of the acute inammatory phase. In thecase of chronic periodontal abscess periodontal surgery procedures should be considered.

Key words: periodontal abscess, drainage, antibiotics, periodontal

surgery

Introduction

te periodonal absess is a frequen peri-odonal ondiion durin periodonal disease

in wi periodonal issues may be rapidlydesroyed. te aue periodonal absess isone of e few linial siuaions in periodon-


2/7

Aa Somaoloia Naissi, jun/June 2008, vol. 24, broj/number 57

776

odonopaiji u kojoj je paijenu neopodnaurenna pomoć somaoloa. Njeov značajnije samo u pronozi parodonopaično zuba,već i u posojanju opasnosi od irenja infek -ije.1 Parodonalni apses se opisuje kao lezija

sa izraženim razaranjem parodonijuma u kra-kom vremenskom periodu sa lako uočljivimkliničkim znaima i simpomima, kao o jelokalizovana akumulaija purulenno sadržajaunuar parodonalno džepa.2-4

cilj ovo preledno rada je da kriički sa-leda raspoloživu lierauru vezanu za erapiju

parodonalno apsesa.

Učestalost

Parodonalni apses je po učesalosi narećem mesu čineći 7-14% urenni sanja usomaoloiji, a javlja se kod 6-7% paijena-a koji dolaze u somaoloku kliniku.4 Premaovome, parodonalni apses je značajan zbosvoje relaivno visoke učesalosi i o ulavnom,kod paijenaa sa parodonopaijom. Kod ovi

paijenaa veća je verovanoća da će se javiiu već posojećem parodonalnom džepu,4 anjeova značajnos leži ne samo u učesalosi

već i u ome kako uiče na pronozu zuba. U prolosi, zubi sa apsesom su obično smarani beznadežnim5 i pojava apsesa bila je jedan odlavni razloa njiove eksrakije u oku era-

pije parodonopaije.6,7

Etiologija

U oku parodonopaije moući uzroi pojave parodonalno apsesa su:

– posojanje duboki i serpiinozni pa-rodonalni džepova,4

– marinalno zavaranje parodonalnodžepa (dovodi do irenja infekije u okolna

parodonalna kiva usled priiska izazvanosupuraijom unuar zavoreno parodonalnodžepa),3,8,9

– promena u sasavu mikroore, virulen-ije bakerija ili odbrambeni sposobnosidomaćina (oežava drenažu džepa i povećavasupuraiju),8

– erapija sisemskim anibioiima bez sub-inivalne kireaže kod paijenaa sa uznapre-dovanom parodonopaijom.10-12

is were paiens may seek immediae are.Is imporane lies no only wi e prono-sis of e periodoniis affeed oo, bu alsowi e possibiliy of infeion spreadin.1 te

periodonal absess as been dened as a le-

sion wi an expressed periodonal breakdown,ourrin durin a limied period of ime, andwi easily deeable linial sympoms andsins su as a loalized aumulaion of pus,loaed wiin e periodonal poke.2-4

te aim of e presen review was o rii-ally evaluae e available lieraure reardine erapy of periodonal absess.

Prevalence

te periodonal absess is e ird mosfrequen denal emereny, represenin 7–14%of all denal emerenies, and affein 6–7‰of all paiens seen in a denal lini.4 conse-quenly, e periodonal absess is imporan,due o is relaively i prevalene, mosly in

paiens wi periodoniis. In ese paiens, a periodonal absess is more likely o our in a preexisin periodonal poke,4 and is impor-ane lies no only on is ourrene, bu alsoow is absess affes e pronosis of e

oo. In e pas, ee wi an absess wereusually onsidered opeless,5 and ereforee ourrene of an absess may be one of emain reasons for oo exraion durin peri-odonal mainenane.6,7

Etiology

Differen eioloies of periodonal absessin periodoniis are possible:

– e exisene of deep and oruous peri-

odonal pokes4 – e marinal losure of a periodonal

poke may lead o an exension of e infeionino e surroundin periodonal issues due oe pressure of e suppuraion inside e losed

poke3,8,9

– anes in e omposiion of e miroora, baerial virulene, or in os defensesould also make e poke lumen inefien odrain e inreased suppuraion8

– reamen wi sysemi anibiois wi-

ou subinival debridemen in paiens wiadvaned periodoniis may also ause absessformaion.10-12


3/7

Obradović e al. / thE thERAPY OF PERIODONtAL ABScESS

777

Parodonalni apses se akođe može javii iu odsusvu parodonopaije i o iz sledeći ra-zloa:

– impakija srani ela8 (kao o su kona začićenje zuba, ljuspie od kokia, deo čačkalie

za zube, riblje kosi, ili nepoznao sranoela,4,13-15

– perforaija korena endodonskim insru-menima,4,16

– infekija laeralni isa8 i – promena morfoloije korena zuba izazva-

na dejsvom lokalni fakora (prisusvo okinu-i parčića emena u predelu vraa zuba).17-19

Mikrobiologija

U lierauri se nalazi podaak da su puru-lenne oralne infekije polimikrobne i izazvaneendoenim bakerijama.20 topoli i saradnii12 i Sims9 su objavili da su oko 60% kulivisani

bakerija srikni anaerobi. Iako nisu speičniza ovo oboljenje, najučesaliji mikrooranizmisu poznai periodonopaoeni Porpyromonasinivalis, Prevoella inermedia i Fusobae-rium nuleaum.

Dijagnoza

Dijanoza parodonalno apsesa se zas-niva na simpomima koje sam paijen okrivai znaima koji se uvrđuju kliničkim preledomi renen snimkom. Kliničkim preledom semože uočii ovalan ook inive pored korenazuba.4 Ipak, ako je apses lokalizovan duboko u

parodonijumu eže je uočljiv. Simpomi varira- ju po inenzieu od blae nelaodnosi do jako bola, osećaja da je zub „razlabavljen“ i „dužiod osali“, oseljivosi zuba na palpaiju.21,22 Čes klinički nalaz je supuraija, bilo sponanaili nakon priiska u predelu apsesa,4 uz prisu-nu brzu desrukiju kiva i formiranje duboko

parodonalno džepa.21 Rendenoloki snimakmože okrii normalan nalaz ili određen sepenubika kosi. U nekim slučajevima javlja se i

poremećaj ope sanja sa povienom eles-nom emperaurom, leukoiozom i reional-nom limfadenopaijom.4,21

Komplikaije i posledie nelečeno ilineadekvano lečeno parodonalno apsesa suubiak zuba i irenje infekije.

Periodonal absesses an also develop ine absene of periodoniis, due o e follow-in auses:

– impaion of forein bodies8 (su as a piee of denal oss, a poporn kernel, a piee

of a oopik, sbone, or an unknown ob- je),4,13-15 – perforaion of e oo wall by an end-

odoni insrumen,4,16

– infeion of laeral yss,8 – loal faors affein e morpoloy of

e roo may predispose o periodonal absessformaion. (te presene of ervial emenalears as been relaed o rapid proression of

periodoniis and e developmen of absess-es).17-19

Microbiology

Review ariles ave poined ou a pu-rulen oral infeions are poly-mirobial, andaused by endoenous baeria.20 topoll e al12 and Newman & Sims9 repored a around60% of ulured baeria were sri anaerobes.I does no seem o be spei, bu known peri-odonal paoens su as Porpyromonas in-ivalis, Prevoella inermedia and Fusobaeri-um nuleaum, are e mos prevalen baerialspeies.4

Diagnosis

Dianosis of a periodonal absess is basedon e sympoms revealed by e paien, ande sins found durin e oral examinaion,and radiorapi examinaion. te urren sinon examinaion is an ovoid elevaion of e in-iva alon e laeral par of e roo.4 how-ever, absesses loaed deep in e periodoni-um may be less eviden. Sympoms rane from

li disomfor o severe pain, oo mobiliyand elevaion, sensiiviy of e oo o pal- paion.4,21,22 Anoer ommon ndin is suppuraion, eier sponaneous or afer pressureon e absess,4 ombined wi rapid issuedesruion and deep poke formaion.21 teradiorapi examinaion may reveal a normalappearane, or some deree of bone loss. Sys-emi involvemen as been repored in somesevere ases, inludin fever, leukoyosis andreional lympadenopay.4,21

compliaions and onsequene of unrea-

ed or inadequae reaed periodonal absess in-lude oo loss and spreadin of infeion ooer body sies.


4/7


778

Terapija

terapija parodonalno apsesa predsav-lja izazov dui niz odina. Ona obično obu-vaa dva sadijuma: saniranje akune lezije i

adekvanu erapiju rezidualno proesa kada jesiuaija savljena pod konrolu.4,23 Ako je zub jako oećen i ako je njeova pronoza loa,najekasnija erapijska proedura je eksrakijazuba.24

Prookol erapije parodonalno apsesa preporučuje drenažu kroz parodonalni džep,uklanjanje kamena i konkremenaa, kireažui kompresiju meko zida parodonalno džepauz ispiranje rasvorom anibioika. Paijen sezakazuje na konrolni preled nakon 24–48sai. U određenim slučajevima, za nedelju dana,

porebno je sprovesi deniivnu erapiju. Uovim slučajevima prisupa se režanj operaijiuz ispiranje anisepičnim sredsvom.4

Jo uvek ne posoji čvrs sav o sisem-skoj primeni anibioika u erapiji parodon-alno apsesa. Njiova primena ima za iljsprečavanje irenja infekije i nasanak oz-

biljni komplikaija.25-27 Konenraija ovakoaplikovani anibioika je mnoo niža u ap-sesu neo u krvi, a zbo slabe snabdevenosiapsesa krvlju posizanje maksimuma konen-

raije anibioika u parodonalnom apsesukasni u odnosu na krvook. Iako se primeneanibioii u erapiji parodonalno apsesa nesme izosai meanička obrada ili meaničkaobrada sa irurkom erapijom.28,29 Neki auori

primenjuju sisemski anibioike samo u slučaju poremećaja ope sanja ili ako infekija nijeoraničena.31 Drui auori ipak, preporučujusisemsku primenu anibioika samo kao počenireman u slučajevima kada se ne može posićiadekvana drenaža. Na primer, u slučaju veliko

apsesa sa difuznim ookom i jako izraženim bolom.30 Dužina aplikaije i vrsa anibioika česo su

predme polemisanja. Neki auori preporučujukraću uporebu anibiooka vrdeći da je ona jed-nako ekasna kao i sandardni režim aplikai-

je.30,31 Drui auori saveuju kombinovanjekonzervaivne-bazične erapije (inizija, drena-ža i kireaža) sa anibioskom erapijom.4,32 Duo se „uspenom“ smarala kombinaija in-izije i ispiranja uz sisemsku aplikaiju peni-

ilina. U Velikoj Brianiji anibioii iz rupe peniilina bili su duo prvi lek izbora u erapiji parodonalno apsesa i korisilo i je 57% so-

Treatment

te reamen of a periodonal absess as been a allene for many years. te reamenof e aue periodonal absess usually in-

ludes wo saes: e manaemen of e auelesion and e appropriae reamen of eoriinal and/or residual lesion, one e auesiuaion as been onrolled.4,23 If e oo isseverely damaed, and is pronosis is bad, oneof e mos effeive reamens ould be ooexraion.24

For e reamen of periodonal absesses,a proool as been reommended: drainaerou e poke, salin of e oo surfae,ompression and debridemen of e sof issuewall and irriaion wi anibioi soluions.Afer erapy, e paien sould be examinedfor e absess resoluion afer 24–48 ours.In some ases one week laer, e deniivereamen sould be arried ou. In ese asesap surery and opial anisepis may be ap-

plied.4 te addiion of sysemi anibiois o e

reamen reime of e periodonal absess isno a well dened issue. Sysemi anibioireamen of denal absess aims a preven-in baerial spreadin and serious omplia-

ions.25-27 te onenraion of anibiois ine absess is onsiderably lower an in e

blood, and beause of poor blood supply eonenraion peaks laer in e absess an ine blood. In addiion o anibiois, a periodon-al absess sould always reeive meanial,or meanial and surial erapy.28,29 Someauors exlude sysemi anibiois, unless alear sysemi involvemen is presen or wene infeion is no well loalized.31 Oer au-ors, owever, reommend e use of sysemi

anibiois as e only iniial reamen, in aseswen iniial adequae drainae an no be esab-lised. For example, in ases of lare absesseswi diffuse swellin, or exreme pain.30

te duraion and e ype of e anibioierapy is also a maer of disussion. Someauors ave reommended sorer anibioireimes, laimin a ey are as effeive asonvenional reimes.30,31 Some auors re-ommend e ombinaion of basi reamens(inision, drainae, debridemen) and anibioi

erapies.4,32

te ombinaion of inision anddrainae wi e sysemi adminisraion of peniillins as been onsidered as „ofen su-


5/7


779

maoloa, nji 21% je korisilo amoksiilin, a14% meronidazol.1 Na žalos, anaerobni mikro-oranizmi pokazuju različiu oseljivos na pe-niilin. Prema Eiku i saradniima33 41% gram

poziivni bakerija je rezisenno na peniilin.

Kod paijenaa alerični na peniilin lek izbo-ra je eriromiin.34 Ipak, sve veći broj značajnianaeroba je rezisenan na eriromiin.35 Danas,meronidazol i drui niroimidazoli (ornidazoli inidazol) i klindamiin su dokazano ekasnikod srikno anaerobni bakerijski vrsa.28

hafsröm i saradnii2 preporučuju konzer-vaivnu erapiju sa iljem posizanja o veće re-eneraije epielno pripoja. Drenaža se posižekroz parodonalni džep uz ispiranje serilnimziolokim rasvorom. Ukloni se suprainival-ni kamena, a eraiklini se prepisuju u rajanjuod dve nedelje (1 ram dnevno). Ovaj erapijski

prookol je klinički i mikrobioloki ispian narupi od dvadese apsesa, rinaes i je praćeno180 dana, a sedam 42 dana. Dobijeni rezulaisu bili zadovoljavajući sa prosečnim smanjen- jem dubine džepa od 4.3 mm. Auori isičusledeće zaključke: prvo, veliki značaj drenaže(prva 4 apsesa su reirana anibioiima, ali

bez drenaže, i dva od nji su se ponovo javilaza oko 40 dana); i druo, sklonos ka reidivi-ranju apsesa se čeće javlja ako se ne uklone

konkremeni i obradi džep.Smi i Davies24 su proučavali ponaanje

apsesa nakon sprovedene erapije. Oni su pra-ili 62 parodonalna apsesa. Kod 22 od nji,u akunoj fazi urađena je inizija i drenaža,uz primenu meronidazola sisemski (200 m,5 dana). Kasnije, urađena je parodonalna era-

pija koja je obuvaala održavanje oralne ii- jene uz pomoć loreksidina, uklanjanja ka-mena i konkremenaa, kireažu parodonalnidžepova, i u indikovanim siuaijama parodon-

alnu iruriju. Od 22 reirana zuba, 14 je eks-rairano iz parodonoloki razloa u oku riodine, dok je preosalo samo 8 zuba.

Fine36 je praio 3 paijena kod koji su se ja-vljala 3 do 6 apsesa odinje. Saveovao je uk-lanjanje kamena i konkremenaa sa kireažom

parodonalni džepova svi zuba uz sisemskuaplikaiju anibioka nakon mikrobioloke ana-lize subinivalne mikroore. Sva ri slučaja suuspeno sanirana.

Palmer 15 je opisao slučaj akuno laeralno

parodonalno apsesa koji je uspeno saniran peroralnom primenom peniilina. Posinua je popuna reeneraija desrukije. U ovom

essful“.4 In e Unied Kindom, peniillinswere e rs dru of oie in e reamenof periodonal absesses, bein used by 57%of deniss, followed by amoxiillin (21%) andmeronidazole (14%).1 Unforunaely, anaer-

obes sow variable susepibiliy o peniillin.Aordin o Eik e al.33 41% of e ram+ baerial isolaes were peniillin resisan.Eryromyin as been used as an alernaivedru for reamen of paiens alleri o peniil-lin.34 however, an inreasin number of impor-an anaerobes are resisan o eryromyin.35 today, meronidazole, oer niroimidazoles(ornidazole and inidazole) and lindamyin are

proven o be effeive aains srily anaerobi baerial srains.28

hafsröm e al.2

proposed a onservaivereamen, aimin o e as mu aamenain as possible. Drainae was esablisedrou e periodonal poke, and irriaionwi serile saline was performed. Only supra-inival salin was done, erayline was

presribed for 2 weeks (1 /day). te prooolwas esed linially and mirobioloially ina roup of 20 absesses, 13 followed for 180days, and 7 for 42 days. te resuls were on-sidered saisfaory, wi a mean reduion of

probin poke dep of 4.3 mm. two onlu-sions were suesed: rsly, e imporane ofe drainae (e rs 4 absesses were reaedwi anibioi bu wiou drainae, and 2 ofem reappeared wiin 40 days); and seondly,e poenial of reeneraion demonsraed bye absesses, wi was supposed o be en-aned by avoidin subinival salin.

Smi & Davies24 also sudied e beav-iour of absesses afer erapy. tey sudied 62

periodonal absesses. In 22 of em, e aue

pase was reaed surially by inision anddrainae, alon wi e adminisraion of sys-emi meronidazole (200 m, id, 5 days). A alaer sae, periodonal erapy was arried ou,inludin oral yiene proedures wi e elpof lorexidine, salin and roo planin, andif neessary, periodonal surery. Ou of e 22reaed ee, 14 were exraed for periodonalreasons wiin e 3 years of follow-up, wileonly 8 ee were sill in plae.

Fine36 repored 3 paiens wo suffered from

3 o 6 absesses per year. te proposed erapywas o rea e paien wi full-mou salinand a sysemi anibioi seleed afer mirobi-


6/7


780

slučaju sumnjalo se da je uzrok nasanka ap-sesa impakija srano ela i da je njeovomeliminaijom uz primenu anibioika dolo do

popune eliminaije proesa. Neki auori sueriu da se uz konzerva-

ivnu erapiju parodonalno apsesa može kao pomoćno sredsvo korisii sof laser za sma-njenje bola i ooka inive.22

U erapiji ronično parodonalno apsesa, preporučuje se irurka erapija (inivekomi- ja ili režanj operaija), ulavnom kod apsesa udubokim infrakoanim džepovima kod koji seeliminaija apsesa i ne može posići na druinačin.4,8 Režanj operaija se preporučuje i uslučajevima kada zbo neprisupačnosi apsesakonzervaivnom erapijom nije mouće ukloniisve konkremene. glavni ilj ovakve erapije je

uklonii preosale konkremene i isovremenousposavii drenažu.37 U lieraurnim podaimaukazuje se na erapiju koja se sasoji od kombi-naije režanj operaije koja omoućava prisup,uklanjanja duboko lokalizovani konkremenaai ispiranja doksiiklinom. Auori su izneli dobrerezulae kod vie od 50 paijenaa.38

Zaključak

Dui niz odina uspena erapija parodon-alno apsesa predsavlja pravi izazov. U

prolosi, pojava parodonalno apsesa kod parodonopaični zuba bila je lavni razlo zaeksrakiju zuba.

Ne posoji dovoljno naučni dokaza u lie-raurnim podaima koji bi obezbedili poso-

janje jedinsvene dokrine u lečenju parodon-alno apsesa. Danas se ovori o ri erapijska

prisupa u reavanju ovo problema: drenažai kireaža apsesa, sisemska primena anibio-ika i parodonalna irurija u roničnoj fazi

oboljenja. Anibioike reba primenii u slučaju pojave opi simpoma ili kod posojanja sum-nje na mouć razviak komplikaija. Lek iz-

bora su meronidazol, eraiklini i klindamiin.U slučaju posojanja ronično parodonalnoapsesa reba razmorii i primenu parodonal-ni irurki proedura. Smara se da su loka-lizaija proesa i moućnos posizanja drenaželavni preduslovi uspene erapije.

oloial analyses of e subinival miroora.Bo 3 ases were reaed suessfully.

Palmer 15 repored a ase of an aue laeral periodonal absess reaed suessfully wi aourse of oral peniillin, wi omplee reen-

eraion of e desruion. In is ase a foreinobje impaaion was suspeed, and is elimi-naion, wi e elp of e anibioi, led o eomplee resoluion.

Some auors suesed a adjun o on-servaive reamen, sof laser erapy ould beused o derease pain and swellin of ini-val.22

In e reamen of roni periodonal ab-sesses, surial erapy (eier iniveomyor ap proedures) as also been advoaed,4 mainly in absesses assoiaed wi deep veri-

al defes, were e resoluion of e absessmay only be aieved by a surial operaion.8 Surial aps ave also been proposed in asesin wi alulus is lef subinivally afer ereamen. te main objeive of e erapy iso eliminae e remainin alulus and obaindrainae a e same ime.37 A erapy, wi aombinaion of an aess ap wi deep salinand irriaion wi doxyyline, as also been

proposed. te auor repored ood resuls wimore an 50 paiens.38

Conclusions

te suessful reamen of e periodonalabsess as been a allene for many years. Ine pas, e periodonal absess in periodonaldiseased ee was e main reason for oo ex-raion.

tere is no enou sieni evidene ine lieraure o provide a unique reamen re-ime for periodonal absesses. today, ree

erapeui approaes ave been disussed,inludin: drainae and debridemen; sysemianibiois and periodonal surery proeduresapplied in roni pase of disease. Anibioissould be presribed in ase of eneral symp-oms or if ompliaions an be suspeed.Meronidazole, eraylines and lindamyinare drus of oie. In e ase of roni peri-odonal absess periodonal surery proeduressould be onsidered. te loalizaion of eaue periodonal absess and e possibiliy of

obainin drainae are essenial onsideraionsfor suessful reamen.


7/7


781

Address of correspondence:Radmila Obradović, DDS, MSD

Medial Fauly, Denal cliniBulevar dr Zorana Đinđića 52, 18000 Ni, Serbia

tel: 064/2359595E-mail: [email protected]

Adresa za korespondenciju:Ass. dr Radmila ObradovićMediinski fakule, Klinika za somaoloijuBulevar dr Zorana Đinđića 52, 18000 Ni, Srbijatel: 064/2359595E-mail: [email protected]

LITERATURA / REFERENCES

1. Lewis MAO, Meean c, MaFarlane tW, LameyPJ, Kay E. Presenaion and animirobial reamen ofaue orofaial infeions in eneral denal praie. Br JOral Maxillofa Sur 1990;28:359–366.

2. hafsröm cA, Wiksröm MB, Renver SN, Dalengg. Effe of reamen on some periodonopaoensand eir anibody levels in periodonal absesses. J Peri-odonol 1994;65:1022–1028.

3. DeWi gV, cobb cM, Killoy WJ. te aue peri-odonal absess: mirobial peneraion of e issue wall.In J Periodonis Resoraive Den 1985;1:39–51.

4. herrera D, Roldan S, Sanz M. te periodonal ab-sess: a review. J clin Periodonol 2000; 27:377–386.

5. Beker W, Ber L, Beker BE. te lon ermevaluaion of periodonal reamen and mainenane in95 paiens. In J Periodonis Resoraive Den 1984;2:55–70.

6. cae R, Low S. Survival araerisis of peri-odonally-involved ee: a 40-year sudy. J Periodonol1993;64:701–705.

7. MLeod DE, Lainson PA, Spivey JD. too lossdue o periodonal absess: a rerospeive sudy. J Peri-odonol 1997;68:963–966.

8. Karea MJ, Rosenber ES, Dehaven h. tera- peui onsideraions in e manaemen of a periodon-al absess wi an inrabony defe. J clin Periodonol1981;8:375–386.

9. Newman Mg, Sims tN. te predominan uliva- ble mirobioa of e periodonal absess. J Periodonol1979;50:350–354.

10. helovuo h, Paunio K. Effes of peniillin anderyromyin on e linial parameers of e periodon-

ium. J Periodonol 1989;60:467–472.11. helovuo h, hakkarainen K, Paunio K. canesin e prevalene of subinival eneri rods, sapylo-oi and yeass afer reamen wi peniillin and ery-romyin. Oral Mirobiol Immunol 1993;8:75–79.

12. topoll hh, Lane DE, Müller RF. Muliple peri-odonal absesses afer sysemi anibioi erapy. J clinPeriodonol 1990;17:268–272.

13. Fuss Z, Bender IB, Rikoff BD. An unusual peri-odonal absess. J Endodon 1986;12:116–118.

14. Emslie R D. Some onsideraions on e roleof emenum in periodonal disease. J clin Periodonol1978;5:1–12.

15. Palmer RM. Aue laeral periodonal absess. BrDen J 1984;157:311–313.

16. Abrams h, cunninam cJ, Lee S B. Periodonalanes followin oronal/ roo perforaion and formo-resol pulpoomy. J Endodon 1992;18:399–402.

17. haney JM, Leknes KN, Lie t, Selvi KA, Wikes- jö UME. cemenal ear relaed o rapid periodonal break-down: a ase repor. J Periodonol 1992;63:220–224.

18. Isikawa I, Oda S, hayasi J, Arakawa S. cervi-al emenal ears in older paiens wi adul periodoni-is. case repors. J Periodonol 1996;67:15–20.

19 cen RJ, Yan JF, cao tc. Invainaed ooassoiaed wi periodonal absess. Oral Sur Oral MedOral Paol 1990;69:659-660.

20. tabaqali S. Anaerobi infeions in e ead andnek reion. Sand J Infe Dis 1988;57:24–34.

21. Ibbo cg, Kova RJ, carlson- Mann LD. Aue periodonal absess assoiaed wi an immediae im- plan sie in e mainenane pase. In J Oral MaxillofaImplans 1993;8:699–702.

22. Kesi Lj, Jovanovi g. te effe of sof laser ap- pliaion in e erapy of periodonal absess. In con-ress Series 2003;1248:437-439.

23. Kaldal WB, Kalwarf KL, Pail KD, Molvar MP,Dyer JK. Lonerm evaluaion of periodonal erapy(I). Response o 4 erapeui modaliies. J Periodonol1996;67:93–102.

24. Smi Rg, Davies RM. Aue laeral periodonalabsesses. Br Den J 1986;161:176–178.

25. Flood tR, Samaranayake LP, MaFarlane tW,MLennan A, MaKenzie D, carmiael F. Baeraemiafollowin inision and drainae of enoalveolar absess-es. Br Den J 1990;169:51–53.

26. geno RJ. Usin animirobials aens o manae periodonal diseases. J Am Den Asso 1991;122:31–38.

27. Robers gJ, Serriff M. Baeraemia followininision and drainae of deno-alveolar absesses. BrDen J 1990;169:149-149.

28. Dalen g. Mirobioloy and reamen of denalabsesses and periodonal-endodoni lesions. Periodon-ol 2000 2002;28:206-239.

29. Sira R. Baerioloy and reamen of denalinfeions.Oral Sur Oral Med Oral Paol Oral RadiolEndod 1980;2:103–109.

30. Lewis MAO, MaFarlane tW. Sor-oursei-dosae amoxyillin in e reamen of aue deno-

alveolar absess. Br Den J 1986;161:299–302.31. Marin MV, Lonman LP, hill JB, hardy P. Auedenoalveolar infeions: an invesiaion of e duraionof anibioi erapy. Br Den J 1997;183:135–137.

32. gill Y, Sully c. te mirobioloy and manae-men of aue denoalveolar absess: views of Briisoral and maxillofaial sureons. Br J Oral MaxillofaSur 1988;26:452–457.

33. Eik S, Pser W, Sraube E. Animirobial sus-epibiliy of anaerobi and apnopili baeria isolaedfrom odonoeni absess and rapidly proressive peri-odoniis. In J Animirob Aens 1999;12:41–46.

34. gill Y, Sully c. Orofaial odonoeni infe-ions: review of mirobioloy and urren reamen.Oral Sur Oral Med Oral Paol Oral Radiol Endod

1990;2:155–158.35. Fineold S. treamen of anaerobi infeions: anoverview. Sand J Infe Dis 1985;46:89–95.

36. Fine Dh. Mirobial ideniaion and anibioisensiiviy esin, an aid for paiens refraory o peri-odonal erapy. J clin Periodonol 1994;21:98–106.

37. Dello Russo MM. te pos-propylaxis peri-odonal absess: eioloy and reamen. In J Periodon-is Resoraive Den 1985;1: 29–37.

38. Queis-taani DS. traamieno efeivo de losabsesos periodonales ronios. Quiness In 1996; 27:697–699.

The Therapy of Periodontal Abscess

Documents

Transcript of The Therapy of Periodontal Abscess