Periodontal therapeutics--a viable option?

Therapeutic Efficacy of Subgingivally Delivered Doxycycline Hyclate as an Adjunct to Non-surgical Treatment of Chronic Periodontitis

OBJECTIVES

Locally used doxycycline has been shown to concentrate in crevicular fluid and demonstrates a wide spectrum of activity against the periodontal pathogens. The aim of the present clinical study was to evaluate the efficacy of doxycyline hyclate 10% as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

MATERIAL AND METHODS

60 systemically healthy, chronic periodontitis patients were included in the study. Randomized clinical trial was performed over the 6 month period. Test group was treated by scaling and root planing followed by local delivery of doxycycline hyclate 10%, while the control group was treated by scaling and root planing along with placebo.

RESULTS

Significantly greater (P < 0.001) reduction in the mean probing pocket depth was demonstrated in the test group (3.03 ± 0.92 mm) when compared with the control group (2.3 ± 0.65 mm). When the differences in clinical attachment level gain for the test group (2.0 ± 0.64 mm) versus control group (1.13 ± 1.07 mm) were analyzed by Student's unpaired t-test, test group showed statistically greater clinical attachment level gain (0.87 ± 0.22 mm, P < 0.001).

CONCLUSIONS

From the analysis of the results it can be concluded that the use of doxycyline hyclate 10% as an adjunct to scaling and root planing provides more favourable and statistically significant (P < 0.001) reductions in probing pocket depth and gains in clinical attachment level compared to scaling and root planing alone.

Preterm low birth weight and periodontal disease among African Americans

African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites. LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems. Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance. Pregnant women's poor periodontal healtlh is emerging as one such factor. Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries. This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis.

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative multi-centre trial of 2 treatment approaches

AIM

In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated.

MATERIAL AND METHODS

105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months.

RESULTS

At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001).

CONCLUSION

The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.