Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

Response to adjunctive antibiotic therapy along with nonsurgical periodontal therapy in the treatment of peri-implantitis and chronic periodontitis patients: An exploratory review

Objectives

This review was conducted to assess and compare whether there is a difference in response to adjunctive systemic and locally delivered antibiotics along with nonsurgical periodontal therapy (NSPT) in the treatment of peri-implantitis (PI) and chronic periodontitis (CP).

Materials and Methods

A systematic search of literature on the predefined criteria was conducted using PubMed, Embase, and Scopus. Probing pocket depth, bleeding on probing, clinical attachment level, and microbial load reduction were selected as primary outcomes, whereas plaque index and gingival index were evaluated as secondary outcomes. Standard Cochrane risk-of-bias tools were used for the quality assessment of the included studies, and a qualitative data synthesis was conducted owing to the observed heterogeneity of the extracted data.

Results

Adjunctive systemic and local antibiotics with NSPT resulted in additional beneficial effects in cases of both CP and PI, with greater improvement observed in cases of CP as compared to PI. Even for treatment of PI, among local antibiotics, minocycline was the only antibiotic with some significant adjunctive benefits, when used with NSPT as documented.

Conclusion

Within the limitations of the review, it is concluded that the adjunctive use of antibiotics with NSPT offers a beneficial effect in the management of both CP and PI; however, there is insufficient direct evidence regarding the comparative efficacy of the adjunctive antibiotic therapy along with NSPT for the treatment of PI and CP.

Clinical and microbiological effects of adjunctive local delivery of minocycline (Periocline®) in patients receiving supportive periodontal therapy: a pilot study

Purpose

This study aimed to evaluate the clinical and microbiological efficacy of adjunctive local delivery of minocycline (Periocline^®) in patients receiving supportive periodontal therapy (SPT) after initial treatment.

Methods

The participants were 16 men and 8 women (age, 20–65 years) who had at least 15 natural teeth, underwent SPT for more than 1 year due to chronic periodontitis, had 4 or more periodontal pocket sites deeper than 5 mm, and showed >25% gingival bleeding on probing (BoP). They were randomly assigned to the test and control groups. In the test group, mechanical debridement and local antibiotic delivery were performed for all periodontal sulci/pockets; in the control group, mechanical debridement and saline irrigation were performed. In patients who underwent SPT for more than 1 year, clinical and microbiological examinations were performed at baseline and 1 and 3 months after SPT. The clinical examination included an assessment of the periodontal pocket depth, clinical attachment level, plaque index, and BoP. Microbial tests were performed using real-time polymerase chain reaction; the relative ratios of Porphyromonas gingivalis and Fusobacterium nucleatum were determined.

Results

Both groups showed significant improvements in clinical parameters at 1 and 3 months from baseline; there were no significant changes between months 1 and 3. Intergroup differences were insignificant. The microbiological analysis revealed no significant differences in P. gingivalis and F. nucleatum ratios across time points. While intergroup differences were insignificant, there was a tendency for the P. gingivalis and F. nucleatum ratios to decrease in the test group.

Conclusions

Mechanical debridement in patients receiving maintenance therapy resulted in clinically significant improvement; the effectiveness of additional local delivery of antibiotics was not significant. The ratios of P. gingivalis and F. nucleatum showed a tendency to decrease in the test group, although it was not significant.

Assessing the risk of bias in randomized controlled trials in the field of dentistry indexed in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database

CONTEXT AND OBJECTIVE

Well-conducted randomized controlled trials (RCTs) represent the highest level of evidence when the research question relates to the effect of therapeutic or preventive interventions. However, the degree of control over bias between RCTs presents great variability between studies. For this reason, with the increasing interest in and production of systematic reviews and meta-analyses, it has been necessary to develop methodology supported by empirical evidence, so as to encourage and enhance the production of valid RCTs with low risk of bias. The aim here was to conduct a methodological analysis within the field of dentistry, regarding the risk of bias in open-access RCTs available in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database.

DESIGN AND SETTING

This was a methodology study conducted at Universidade Federal de São Paulo (Unifesp) that assessed the risk of bias in RCTs, using the following dimensions: allocation sequence generation, allocation concealment, blinding, and data on incomplete outcomes.

RESULTS

Out of the 4,503 articles classified, only 10 studies (0.22%) were considered to be true RCTs and, of these, only a single study was classified as presenting low risk of bias. The items that the authors of these RCTs most frequently controlled for were blinding and data on incomplete outcomes.

CONCLUSION

The effective presence of bias seriously weakened the reliability of the results from the dental studies evaluated, such that they would be of little use for clinicians and administrators as support for decision-making processes.

Occurrence of Aggregatibacter actinomycetemcomitans in Brazilians with chronic periodontitis

Studies have suggested that A. actinomycetemcomitans is involved in the aetiology of aggressive periodontitis as well as in chronic periodontitis. This study was aimed at elucidating the occurrence of A. actinomycetemcomitans in a Brazilian population with chronic periodontitis. A total of 555 (mean age 33.04 +/- 12.45) individuals, living in two large areas of the São Paulo State, namely "Baixada Santista" and "Vale do Paraíba", and diagnosed with mild [180 (mean age 29.59 +/- 10.94)], moderate [241 (mean age 31.18 +/- 11.45)] or severe [134 (mean age 33.04 +/- 12.45)] chronic periodontitis were enrolled in this survey. Clinical exams including measurements of Probing Depth, Clinical Attachment Loss, Plaque and Gingival indices and subgingival microbiological assessments were performed at all population. The genomic DNA of A. actinomycetemcomitans was identified by Polymerase Chain Reaction from periodontal pocket samples. The occurrence of A. actinomycetemcomitans among chronic periodontitis subjects as well as its association with age and gender were statistically analysed using the Chi-square and Odds Ratio tests. The significance of differences was established at 5% (p < 0.05). A. actinomycetemcomitans was detected in 102 (18.37%) individuals: 29 (16.11%) mild; 42 (17.42%) moderate; and 31 (23.13%) severe chronic periodontitis with no statistical difference among groups. A higher occurrence of the searched bacterium was found both in the youngest group (p < 0.05) as well as in the female group (p < 0.05). This study elucidated that A. actinomycetemcomitans harbored subgingival pockets of our target group of chronic periodontitis subjects and that this bacterium seems to be inversely related to age, but related to the female gender.

Clinical status and detection of periodontopathogens and Streptococcus mutans in children with high levels of supragingival biofilm

Knowledge about the presence of some important oral pathogens is an important step in better identifying children at risk for periodontal and/or caries diseases in later life. The purpose of this study was to detect the presence of Streptococcus mutans (Sm), Aggregatibacter actinomycetemcomitans (Aa), Campylobacter rectus (Cr), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Tannerella forsythia (Tf) in gingival biofilm samples from 196 children, and to assess whether any of these pathogens are more associated with gingival inflammation extension and the Decayed/Missing/Filled teeth (DMFT/dmft) index. The subjects presented plaque index greater than 80% and were divided in 3 groups according to the bleeding index (BI): I) Low bleeding (< 30%), II) Medium bleeding (31 - 59%) and III) High bleeding (> 60%). The presence of each pathogen was determined by PCR. The prevalence of Sm was 71.9% and the mean dmft/DMFT was 6.68. The prevalence in low, medium and high bleeding groups was 43.5%, 34.5% and 46.7% for Aa; 43.5%, 37.9%, and 36.7% for Cr; 99.1%, 100%, and 96.7% for Pg; 56.5%, 56.9%, and 66.7% for Pi; and 58.3%, 60.3%, and 56.7% for Tf, respectively. Pg (99.0%) was the most prevalent periodontal pathogen detected followed by Tf (58.7%), Pi (58.2%), Aa (41.3%) and Cr (40.8%). Our study indicated that in this high plaque index population studied, a high prevalence of Sm and high mean DMFT were observed. In addition, the presence of Pi was associated with the presence of inflammation (P < 0.05) whereas Cr was associated with periodontal health (P < 0.05).

Longitudinal Clinical Evaluation of Adjunct Minocycline in the Treatment of Chronic Periodontitis

BACKGROUND

The clinical benefits of minocycline in combination with thorough scaling and root planing (SRP) have been examined in multicenter studies. The aim of this longitudinal investigation was to evaluate the clinical response to scaling and root planing combined with the use of locally delivered minocycline microspheres for 720 days in individuals with advanced chronic periodontitis.

METHODS

A total of 26 individuals aged 26 to 69 years (mean: 46.8+/-12.1 years) were included in this double-blind randomized clinical trial. After randomization, 13 individuals were selected for the test group (TG) and treated with SRP plus subgingival minocycline at baseline and 90, 180, and 270 days, and 13 individuals were selected for the control group (CG) and received SRP plus vehicle at the same timepoints. Two homologous sites with probing depth (PD)>or=6 mm were chosen in each subject. To evaluate the clinical response after treatment, PD, plaque index (PI), and gingival index (GI) were assessed at baseline and 90, 180, 270, 360, and 720 days.

RESULTS

No statistical differences were found between test and control groups in relation to PD at the different timepoints. The mean values of PD demonstrated a higher reduction in the test group at 270 and 360 days. No statistical differences were observed at 90, 180, and 720 days between TG and CG (P<0.05; Wilcoxon test). There were no statistically significant differences between TG and CG concerning PI and GI (P<0.05; analysis of variance and t test) at all evaluated timepoints.

CONCLUSION

Our findings demonstrated that both therapies reduced mean PD from 90 to 360 days; however, SRP combined with the use of subgingival minocycline showed a higher reduction at 270 and 360 days following therapy.