1
|
Atieh MA, Shah M, Hakam A, Alghafri M, Tawse-Smith A, Alsabeeha N. Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis. Aust Dent J 2024; 69:4-17. [PMID: 37875345 DOI: 10.1111/adj.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use of AZT or AMX/MTZ for the treatment of periodontitis from current published literature. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), outcomes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analysed using a statistical software program. RESULTS Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1-3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI -0.20 to 0.22; P = 0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of ≥5 mm at 1-3 months compared to the adjunctive use of AMX/MTZ (MD -3.41; 95% CI -4.73 to -2.10; P < 0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72; P = 0.43). CONCLUSIONS Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1-3 months. AZT seem to be associated with less sites with residual probing pocket depths of ≥5 mm at 1-3 months and fewer adverse events compared with AMX/MTZ. © 2023 Australian Dental Association.
Collapse
Affiliation(s)
- M A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - M Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - M Alghafri
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nhm Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
| |
Collapse
|
2
|
Xiang S, Han N, Xie Y, Du J, Luo Z, Xu J, Liu Y. Antimicrobial peptides in treatment of Stage III Grade B periodontitis: A randomized clinical trial. Oral Dis 2023. [PMID: 37926979 DOI: 10.1111/odi.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/20/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND To evaluate the effects of antimicrobial peptides (AMPs) on Stage III Grade B periodontitis. METHODS This trial abided by the principle of consistency test, approved by ethics committee and registered in clinical trials. All qualified 51 patients with Stage III Grade B periodontitis were randomly divided into three groups: SRP group, SRP with minocycline hydrochloride (Mino group) as Control groups, and SRP with AMPs (AMP group) as the Test group. Clinical examinations and subgingival plaques were monitored at baseline and at 7 and 90 days after treatment in the SRP, SRP with AMP and Mino groups. RESULTS The AMP group (Test group) had a reduced PD (Periodontal probing depth) and an attachment gain significantly higher than SRP and Mino groups (Control groups) at day 90. The abundance of periodontal pathogens was decreased in the AMP group at 7 and 90 days compared with the SRP group and Mino group. Only the AMP group showed an increase the abundance of periodontal probiotics including Capnocytophaga, Gemella, and Lactobacillus at 7 and 90 days. CONCLUSIONS This study shows that AMPs as an adjunct to SRP promote additional clinical and microbiological benefits in the treatment of Stage III Grade B periodontitis.
Collapse
Affiliation(s)
- Shuchang Xiang
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Qinhuangdao Stomatological Hospital, Qinhuangdao, China
| | - Nannan Han
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongmei Xie
- Department of General Medicine, Capital Medical University, Beijing, China
| | - Juan Du
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Luo
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junji Xu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Ghazal M, Ahmed S, Farooqui WA, Khalid F, Riaz S, Akber A, Shabbir S, Khan FR, Sadiq A. A placebo-controlled randomized clinical trial of antibiotics versus probiotics as an adjuvant to nonsurgical periodontal treatment among smokers with Stage III, Grade C generalized periodontitis. Clin Adv Periodontics 2023; 13:197-204. [PMID: 37327229 DOI: 10.1002/cap.10253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Probiotics are viable microorganisms, which if delivered in appropriate dose can provide health benefits. Lactobacillus reuteri (DM17938+ATCC PTA 5289) has been recommended as a safe choice for probiotics. The objective of this study is to compare the improvement in the periodontal parameters amongst smokers with generalized periodontitis with Stage III, Grade C treated with nonsurgical periodontal treatment (NSPT) to which either an antibiotics or probiotics were given as an adjuvant. METHODS Sixty smokers with Stage III, Grade C generalized periodontitis were randomized in two groups after taking informed consent. Periodontal parameters including bleeding on probing (BOP), probing depth (PD), attachment loss (AL), gingival index (GI), and plaque index (PI) were recorded. Group 1 received (after NSPT and oral hygiene instructions) amoxicillin and metronidazole for 7 days and a placebo for probiotics for 30 days. Group 2 was provided (after NSPT and oral hygiene instructions) with one tablet of Lactobacillus reuteri probiotics (2 × 108 CFU) twice daily for 30 days and placebo antibiotics for 7 days. The periodontal parameters were recorded again at 1- and 3-month follow-ups as outcome variables. Mean, standard deviation, and confidence interval were reported using SPSS 20.0. RESULTS A statistically significant clinical improvement in the PD, BOP, PI, and GI were observed in both the groups at 3-month follow-up. However, the AL remained unchanged in both the groups. CONCLUSIONS Administration of probiotics and antibiotics along with NSPT yield statistically significant differences in PD and BOP from baseline to 3-month follow-up. However, between the group differences were not statistically significant for the periodontal parameters (AL, PD, and BOP).
Collapse
Affiliation(s)
- Mehwish Ghazal
- Department of Periodontology, Dow University of Health Sciences, Karachi, Pakistan
| | - Shahbaz Ahmed
- Department of Operative Dentistry, Dr. Ishratul Ebad Khan Institute of Oral Health Sciences, Karachi, Pakistan
| | | | - Fizza Khalid
- Department of Periodontology, Baqai Dental College, Karachi, Pakistan
| | - Sania Riaz
- Department of Periodontology, Baqai Dental College, Karachi, Pakistan
| | - Ather Akber
- Department of Periodontology, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumaiya Shabbir
- Department of Periodontology, Dow University of Health Sciences, Karachi, Pakistan
| | - Farhan Raza Khan
- Department of Surgery, Section Dentistry, Aga Khan University & Hospital, Karachi, Pakistan
| | - Ali Sadiq
- Department of Surgery, Section Dentistry, Aga Khan University & Hospital, Karachi, Pakistan
| |
Collapse
|
4
|
Kherul Anuwar AH, Saub R, Safii SH, Ab-Murat N, Mohd Taib MS, Mamikutty R, Ng CW. Systemic Antibiotics as an Adjunct to Subgingival Debridement: A Network Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11121716. [PMID: 36551373 PMCID: PMC9774554 DOI: 10.3390/antibiotics11121716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis.
Collapse
Affiliation(s)
- Ainol Haniza Kherul Anuwar
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Roslan Saub
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Syarida Hasnur Safii
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Norintan Ab-Murat
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Syukri Mohd Taib
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Chiu Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
5
|
Tamura H, Maekawa T, Domon H, Hiyoshi T, Hirayama S, Isono T, Sasagawa K, Yonezawa D, Takahashi N, Oda M, Maeda T, Tabeta K, Terao Y. Effects of Erythromycin on Osteoclasts and Bone Resorption via DEL-1 Induction in Mice. Antibiotics (Basel) 2021; 10:antibiotics10030312. [PMID: 33803007 PMCID: PMC8002756 DOI: 10.3390/antibiotics10030312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/14/2023] Open
Abstract
Macrolides are used to treat various infectious diseases, including periodontitis. Furthermore, macrolides are known to have immunomodulatory effects; however, the underlying mechanism of their action remains unclear. DEL-1 has emerged as an important factor in homeostatic immunity and osteoclastogenesis. Specifically, DEL-1 is downregulated in periodontitis tissues. Therefore, in the present study, we investigated whether the osteoclastogenesis inhibitory effects of erythromycin (ERM) are mediated through upregulation of DEL-1 expression. We used a ligature-induced periodontitis model in C57BL/6Ncrl wild-type or DEL-1-deficient mice and in vitro cell-based mechanistic studies to investigate how ERM inhibits alveolar bone resorption. As a result of measuring alveolar bone resorption and gene expression in the tooth ligation model, ERM treatment reduced bone loss by increasing DEL-1 expression and decreasing the expression of osteoclast-related factors in wild-type mice. In DEL-1-deficient mice, ERM failed to suppress bone loss and gene expression of osteoclast-related factors. In addition, ERM treatment downregulated osteoclast differentiation and calcium resorption in in vitro experiments with mouse bone marrow-derived macrophages. In conclusion, ERM promotes the induction of DEL-1 in periodontal tissue, which may regulate osteoclastogenesis and decrease inflammatory bone resorption. These findings suggest that ERM may exert immunomodulatory effects in a DEL-1-dependent manner.
Collapse
Affiliation(s)
- Hikaru Tamura
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
- Division of Periodontology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (N.T.); (K.T.)
| | - Tomoki Maekawa
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
- Correspondence: (T.M.); (H.D.); Tel.: +81-25-227-2828 (T.M.); +81-227-2840 (H.D.)
| | - Hisanori Domon
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
- Correspondence: (T.M.); (H.D.); Tel.: +81-25-227-2828 (T.M.); +81-227-2840 (H.D.)
| | - Takumi Hiyoshi
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Division of Periodontology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (N.T.); (K.T.)
| | - Satoru Hirayama
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
| | - Toshihito Isono
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
| | - Karin Sasagawa
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Division of Periodontology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (N.T.); (K.T.)
| | - Daisuke Yonezawa
- Division of Oral Science for Health Promotion, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
| | - Naoki Takahashi
- Division of Periodontology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (N.T.); (K.T.)
| | - Masataka Oda
- Department of Microbiology and Infection Control Sciences, Kyoto Pharmaceutical University, Yamashita 607-8414, Japan;
| | - Takeyasu Maeda
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
| | - Koichi Tabeta
- Division of Periodontology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (N.T.); (K.T.)
| | - Yutaka Terao
- Division of Microbiology and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (H.T.); (T.H.); (S.H.); (T.I.); (K.S.); (Y.T.)
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan;
| |
Collapse
|
6
|
The effect of drug dose and duration of adjuvant Amoxicillin-plus-Metronidazole to full-mouth scaling and root planing in periodontitis: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5671-5685. [PMID: 33751238 DOI: 10.1007/s00784-021-03869-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim is to explore the optimal drug dose and duration of adjunctive Amoxicillin-plus-Metronidazole (AMX/MET) to full-mouth scaling and planing (FMSRP) in periodontitis. METHODS An electronic search in four databases and manual search in four journals were conducted for randomised clinical trials comparing AMX/MET adjunct to FMSRP with FMSRP alone for at least 3 months. RESULTS Eleven studies were eligible and included. The primary outcome was clinical attachment level (CAL) gain, the secondary outcomes were periodontal pocket depth (PPD) reduction and adverse events. Our results showed a beneficial effect of adjunctive AMX/MET with higher drug dose to FMSRP for CAL gain and PPD reduction at 3 months, and the benefit remained stable at 6 months. However, minimal difference among three-seven-and ten-day drug duration was observed. In addition, the risk difference of adverse events was minimal between two groups. CONCLUSION FMSRP adjunct to a high drug dose of 500/500 mg of AMX/MET showed a significant and stable improvement on 6-month follow-up period. No decision for drug duration could be made due to limited evidence. CLINICAL RELEVANCE On 6-month follow-up, higher dose of AMX/MET adjunct to FMSRP could provide a stable clinical effect. No recommendation for drug duration could be made.
Collapse
|
7
|
Čuk K, Povšič K, Milavec S, Seme K, Gašperšič R. Influence of adjunctive azithromycin on microbiological and clinical outcomes in periodontitis patients: 6-month results of randomized controlled clinical trial. BMC Oral Health 2020; 20:241. [PMID: 32873290 PMCID: PMC7465355 DOI: 10.1186/s12903-020-01209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment. METHODS In a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS The number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0-11) and control (Me = 5, IQR = 1-22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p < 0,001). CONCLUSION Despite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP. TRIAL REGISTRATION EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.
Collapse
Affiliation(s)
- Katarina Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - Katja Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | | | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
| |
Collapse
|
8
|
Al-Rabiah M, Al-Hamoudi N, Al-Aali KA, Slapar L, AlHelal A, Al Deeb M, Mokeem SA, Vohra F, Abduljabbar T. Efficacy of Scaling and Root Planing with Photobiomodulation for Treating Periodontitis in Gutka Chewers: A Randomized Controlled Trial. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:545-551. [PMID: 32833578 DOI: 10.1089/photob.2020.4819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To explore the influence of photobiomodulation (PBMT) as an adjuvant to scaling and root planing (SRP) for treating periodontitis among gutka chewers. Materials and methods: Self-reported smokeless-tobacco (gutka) users were enrolled; and underwent SRP with (test group) and without (control group) PBMT. Full-mouth plaque index (P-I), bleeding upon probing (BUP), probing depth (P-D) clinical attachment loss (CAL), marginal bone loss (MBL) (on mesial and distal surfaces of the teeth), and number of missing teeth were recorded before treatment and at 3 and 6 months. Group comparisons were performed and p < 0.05 was referred significant. Results: In the control group, P-I (p < 0.013), BUP (p < 0.001), and P-D (p < 0.012) were high at baseline compared with 3 months follow-up. P-I, BUP, and P-D were higher in the test group, at baseline in comparison with the 3-month (p < 0.001) and 6-month (p < 0.01) follow-up. At 3 and 6 months, scores of P-I, BUP, and P-D were high in the control compared with the test group. No difference in CAL, and mesial and distal MBL was found among patients of both groups at 3 and 6 months. Conclusions: Among gutka chewers, SRP with PBMT is more efficient than SRP alone in the management of periodontitis.
Collapse
Affiliation(s)
- Mohammed Al-Rabiah
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nawwaf Al-Hamoudi
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Khulud Abdulrahman Al-Aali
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lonnie Slapar
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Abdulaziz AlHelal
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Biological Research in Dental Health, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Modhi Al Deeb
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sameer A Mokeem
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fahim Vohra
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Biological Research in Dental Health, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Biological Research in Dental Health, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155601. [PMID: 32756461 PMCID: PMC7432753 DOI: 10.3390/ijerph17155601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
Abstract
In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled trials. Two review authors independently screened, extracted data, and assessed risk of bias. We conducted meta-analysis, assessed heterogeneity, and assessed certainty of evidence using GRADEPro software. We included 19 studies (n = 1350 participants), representing 18 randomized controlled trials and found very little or no impact of antibiotics on inflammatory biomarkers. A meta-analysis of eight studies demonstrated a mean reduction of 0.26 mm in the periodontal pockets at three months (mean difference [MD] −0.26, 95%CI: −0.36 to −0.17, n = 372 participants, moderate certainty of evidence) in favor of the antibiotics. However, results from five studies reporting clinical attachment level (mm) yielded little or no difference at three months (MD −0.16, 95% CI: −0.35 to 0.03, n = 217 participants) between antibiotic and placebo groups. There is little or no evidence that adjunctive systemic antibiotics therapy improves inflammatory systemic biomarkers, compared to mechanical debridement alone, among adults with chronic periodontitis.
Collapse
|
10
|
Liaw A, Miller C, Nimmo A. Response to Letter to the Editor. Aust Dent J 2019; 64:383. [PMID: 31721224 DOI: 10.1111/adj.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A Liaw
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
| | - C Miller
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Smithfield, Queensland, Australia
| | - A Nimmo
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
| |
Collapse
|
11
|
Liaw A, Miller C, Nimmo A. Comparing the periodontal tissue response to non-surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate-to-severe periodontitis: a preliminary randomized controlled trial. Aust Dent J 2019; 64:145-152. [PMID: 30628088 DOI: 10.1111/adj.12674] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The usefulness of administrating adjunctive systemic antibiotics to expedite healing of periodontal tissues is a topic of interest given the lack of clear guidelines. AIM To compare clinical outcomes in patients given adjunctive azithromycin (AZ), adjunctive amoxicillin plus metronidazole (AMX + MTZ), or scaling and root planing (SRP) alone in the treatment of moderate-to-severe chronic periodontitis. METHODS Thirty-eight patients were randomly assigned into: SRP alone; 500 mg AMX plus 400 mg MTZ three times per day for 7 days; or 500 mg AZ for 3 days. Antibiotics were administered after the first SRP session and clinical parameters for full-mouth and baseline probing pocket depth (PPD) categories were reviewed 2-months post-treatment. RESULTS Thirty-four of 38 patients completed the study. All groups experienced significant improvements in full-mouth clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing. AZ exhibited greater reductions in PPD than SRP alone for baseline severe sites, whilst AMX+MTZ showed significant improvements in PPD and CAL than SRP alone for baseline moderate and severe sites. Of the two antibiotic therapies, AMX+MTZ showed greater reductions in PPD compared with AZ in baseline moderate sites only. CONCLUSIONS For patients with moderate-to-severe periodontitis, adjunctive systemic antibiotics might result in greater clinical benefits.
Collapse
Affiliation(s)
- A Liaw
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
| | - C Miller
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Smithfield, Queensland, Australia
| | - A Nimmo
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
| |
Collapse
|
12
|
Kaufmann M, Lenherr P, Walter C, Thurnheer T, Attin T, Wiedemeier DB, Schmidlin PR. Comparing the Antimicrobial In Vitro Efficacy of Amoxicillin/Metronidazole against Azithromycin-A Systematic Review. Dent J (Basel) 2018; 6:E59. [PMID: 30347835 PMCID: PMC6313342 DOI: 10.3390/dj6040059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
On account of its proven clinical efficacy, the combination of systemically administered amoxicillin and metronidazole is frequently adjuncted to non-operative periodontal therapy and well documented. Potential drawbacks of this regimen, e.g., side effects and problems with the compliance, led to an ongoing search for alternatives. Azithromycin, an antibiotic extensively used in general medicine, has recently found its niche in periodontal therapy as well. This systematic review aimed to analyze the in vitro antimicrobial efficacy of amoxicillin plus metronidazole versus azithromycin. For this purpose, a systematic literature search was performed, and studies published up to 29 March 2018 referenced in Medline, Embase, Cochrane, and Biosis were independently screened by two authors. An additional hand search was performed and studies focusing on the evaluation of in vitro antimicrobial efficacy of amoxicillin + metronidazole or azithromycin on bacteria from the subgingival biofilm were included. English and German language research reports were considered. From 71 identified articles, only three articles were eligible for inclusion. These studies showed heterogeneity in terms of analytical methods and strains explored. However, all studies used multispecies biofilm models for analysis of the antimicrobial activity. Unanimously, studies reported on more pronounced antimicrobial effects when applying the combination of amoxicillin + metronidazole, compared to azithromycin. Based on the few studies available, the combination of amoxicillin + metronidazole seemed to display higher antimicrobial efficacy in vitro than azithromycin.
Collapse
Affiliation(s)
- Manuela Kaufmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Patrik Lenherr
- Private Practice, Zahnmedizin Wiesental, CH-9100 Herisau, Switzerland.
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, CH-4056 Basel, Switzerland.
| | - Thomas Thurnheer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Thomas Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| |
Collapse
|
13
|
Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, Souza SLS, Taba M, Novaes AB, Furlaneto FAC, Messora MR. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol 2018; 45:1198-1210. [PMID: 30076613 PMCID: PMC6221043 DOI: 10.1111/jcpe.12995] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/14/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
Abstract
AIM This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis. MATERIALS AND METHODS Forty-one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed. RESULTS The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days. CONCLUSION The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).
Collapse
Affiliation(s)
- Marcos M Invernici
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Sérgio L Salvador
- Department of Clinical Analyses, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Pedro H F Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Mariana S M Soares
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Renato Casarin
- Department of Prosthodontics and Periodontics, School of Dentistry, Campinas State University - UNICAMP, Piracicaba, SP, Brazil
| | - Daniela B Palioto
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Sérgio L S Souza
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Mario Taba
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Arthur B Novaes
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Flávia A C Furlaneto
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| | - Michel R Messora
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo - USP, Ribeirao Preto, SP, Brazil
| |
Collapse
|
14
|
Comparison of repeated applications of aPDT with amoxicillin and metronidazole in the treatment of chronic periodontitis: A short-term study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 174:364-369. [DOI: 10.1016/j.jphotobiol.2017.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 01/11/2023]
|