Comparative Effectiveness of Toothbrushing, Flossing and Mouthrinse Regimens on Plaque and Gingivitis: A 12-week virtually supervised clinical trial

Purpose:Various mechanical and chemotherapeutic methods are used to control dental plaque accumulation and prevent or reduce gingivitis. The purpose of this 12-week clinical trial was to investigate the effects of various combinations of supervised mechanical and chemotherapeutic regimens on the prevention and reduction of plaque, gingivitis, and gingival bleeding.Methods:Volunteers presenting with some evidence of gingivitis and no severe periodontitis were randomized into four groups: brush only (BO); brush/rinse (BR); brush/floss (BF); brush/floss/rinse (BFR) for this examiner-blinded clinical trial. Toothbrush, toothpaste, floss and a mouthrinse containing a fixed combination of four essential oils (EO) and training/instructions were provided to participants as per their assigned group. Participants performed their regimen at home, under virtual supervision, once each weekday; the second daily and weekend uses were unsupervised. Assessments included oral hard and soft tissue, plaque, gingivitis, and gingival bleeding (weeks 4, 12); probing depth and bleeding on probing (week 12).Results:Of 213 enrolled participants, 209 completed the study. After 12 weeks, plaque, gingivitis, and gingival bleeding were significantly reduced in groups BR (35.8%, 50.8%, and 71.0% respectively, p<0.001) and BFR (32.8%, 54.1%, and 78.2% respectively, p<0.001) compared to BO. After 12 weeks, gingivitis and gingival bleeding were significantly reduced in the BF group (9.2%, p=0.013 and 17.5%, p=0.003, respectively), however there were no significant reductions in plaque in the BF group as compared to the BO group (p=0.935).Conclusions:Oral care regimens that included a mouthrinse containing a fixed combination of four EOs (BR and BFR), demonstrated statistically significantly reduced plaque, gingivitis, and gingival bleeding as compared to BO and BF after 12 weeks. The BF regimen statistically significantly reduced gingivitis and gingival bleeding but did not statistically significantly reduce plaque compared to BO after 12 weeks.

Efficacy of Flossing and Mouthrinsing Regimens on Plaque and Gingivitis: A randomized clinical trial

Purpose:Flossing is a well-known component of daily recommended oral care regimens, but patients often find it challenging to perform effectively on a regular basis. The purpose of this 12-week supervised clinical trial was to investigate the effects of twice daily rinsing with a mouthrinse containing a fixed combination of four essential oils (4EO) and supervised daily dental flossing regimens as compared to a negative control 5% hydroalcohol rinse (NC) on the prevention and reduction of plaque, gingivitis, and gingival bleeding.Methods:Volunteer participants who met the inclusion criteria were randomized into the following groups for the 12- week trial: 1) NC; 2) mouthrinse containing 4EO; 3) professional flossing performed by a dental hygienist (FBH); 4) supervised self-flossing (FUS). All participants received a professional dental prophylaxis prior to beginning the trial. On weekday mornings, all participants brushed on site. After brushing, the rinse groups used their products under supervision, and the floss groups had their teeth flossed by a dental hygienist or self-flossed under supervision. Participants performed their assigned regimen in the evenings and the twice-daily weekend use at home. Each individual assessment of oral hard and soft tissue, plaque, gingivitis, and gingival bleeding at weeks 4 and 12, probing depth and bleeding on probing at week 12 was made by the same calibrated examiner.Results:Of 156 randomized participants, 149 completed the trial. Use of the 4EO mouthrinse statistically significantly reduced plaque, gingivitis, and gingival bleeding on probing after 12 weeks as compared to the NC rinse. Both flossing interventions statistically significantly reduced interproximal gingivitis and gingival bleeding at 12 weeks compared to the NC rinse; neither flossing intervention significantly reduced interproximal plaque after 12 weeks compared to the NC rinse.Conclusions:Rinsing with a 4EO mouthrinse statistically significantly improved all oral health outcome measures at all time points compared to a NC rinse in this 12-week clinical trial. While professional and supervised flossing improved gingival health compared to use of the NC rinse, statistically significant plaque reduction with dental flossing was not attained at the end of the 12-week trial.

Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance

Purpose: The purpose of this study was to evaluate the effects of repeated scaling and root planing (SRP), with or without locally-delivered minocycline microspheres (MM) on residual pockets in patients undergoing periodontal maintenance (PMT).Methods: Patients on PMT were randomized into two groups for treatment of one posterior interproximal inflamed pocket (≥5 mm) with a history of bleeding on probing every 6 months: SRP plus MM (n=30) or exclusively SRP (n=30). Baseline and 24-month measurements included radiographic interproximal alveolar bone height, probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival crevicular fluid (GCF), and salivary interleukin (IL) - 1β, (24 month only). Results were analyzed for baseline data or change in measurements after 24 months of treatment between different treatment groups, as well as whether significant changes occurred after 24 months of treatment for each treatment group individually.Results: Alveolar bone height and GCF IL-1β remained stable over the 24 months. The SRP + MM and SRP groups each demonstrated reduced PD (0.8 ± 0.9 mm and 1.1 ±0.6 mm, respectively, p < 0.001 each), CAL (0.8 ± 0.9 mm and 1.0 ± 0.6 mm, respectively, p < 0.001 each) and BOP (55% and 48%, respectively, p = 0.001 each). However, there were no differences between groups over the 24-month study period.Conclusion: Scaling and root planning alone, of moderately inflamed periodontal pockets at 6-month intervals, produced stable interproximal alveolar bone height as well as sustained improvements in probing depths, clinical attachment level, bleeding on probing over 24 months; minocycline microspheres were not shown to enhance these results.

Case Series Report of 66 Refractory Maintenance Patients Evaluating the Effectiveness of Topical Oxidizing Agents

OBJECTIVE

To evaluate the clinical effects of a prescription tray application of hydrogen peroxide gel as an adjunct to frequent maintenance appointments for refractory periodontal patients.

METHODS

Case series data were analyzed from 66 failing periodontal maintenance patients who had exhausted treatment options before using prescription trays with a 1.7% hydrogen peroxide gel once or twice daily for two-and-a-half to five years. Data included pocket probing depths (PPD), bleeding on probing (BOP), smoking status, and compliance with tray usage. Data were collected prior to tray usage and after tray delivery at six months, one year, and annual intervals.

RESULTS

A clinical and statistical reduction in BOP was maintained over the length of the study (p ≤ 0.01). No differences were seen in patients who used trays two times or one time a day or in patients who smoked or did not smoke. The 1.7% peroxide delivered via a prescription tray was most effective in shallow pockets. Aggregate PPD distribution did not change significantly. Of clinical relevance, only one tooth out of 1,745 teeth studied was lost due to periodontal disease during the study period.

CONCLUSION

Prescription tray application of peroxide gel, as an adjunct to frequent periodontal maintenance appointments for refractory patients, demonstrated significant reductions in BOP'for smokers and non-smokers who used tray delivery once or twice a day.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial

AIM

To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP).

MATERIALS AND METHODS

Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals.

RESULTS

Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy.

CONCLUSION

Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

A clinico-biochemical evaluation of the role of a herbal (Ayurvedic) immunomodulator in chronic periodontal disease: a pilot study

BACKGROUND

Host modulation is fast gaining popularity as a preferred therapeutic modality for periodontal disease. Recent research in the medical field into herbal immunomodulators such as Septilin® has spurred an interest in evaluating its efficacy in periodontitis for the first time.

AIM

The aim of the study was to assess the immunomodulatory effects of the herbal immunomodulator Septilin® (Himalaya Drug Company, Bangalore, India) when used as an adjunct to scaling and root planing in chronic periodontal disease.

METHODS

Forty systemically healthy patients aged between 25 and 55 years of age and with chronic periodontitis were randomly divided into two groups. The test group was administered Septilin® tablets for two weeks following scaling and root planing whereas the control group was treated by scaling and root planing alone. Changes in gingival index (GI), gingival bleeding index (GBI), serum C-reactive protein (CRP) levels and salivary tumour necrosis factor-alpha (TNF-α) levels were assessed at day 0, at two weeks, and at three and six months.

RESULTS

The GI and GBI showed a statistically significant reduction at two weeks, three months and six months (P<0.001) in both groups. Salivary TNF-α level reduction was significant in the test group only (P<0.001). No significant change was found in serum CRP levels in both groups (P>0.05).

CONCLUSION

In this pilot evaluation, Septilin® was found to be a safe and effective immunomodulator as an adjunct to routine periodontal therapy. Further long-term studies to test Septilin® on larger sections of the population are recommended.

Treatment of periodontitis as a manifestation of neutropenia with or without systemic antibiotics: a systematic review

The purposes of this paper were to systematically review the clinical presentations and management of periodontitis patients with neutropenia and present a patient with severe autoimmune neutropenia. Twenty-four case reports describing a total of 33 patients were identified. The reported signs and symptoms occurred in either a generalized or localized pattern. Improvements in periodontal condition were observed in 86% of patients who were administered adjuvant systemic antibiotics compared to 47% of patients who were not given supplemental therapy. Granulocyte-colony stimulating factor was administered to 67% of the neutropenic patients, and both improvement and progression of the hematological condition were monitored. Scaling and root planing, in combination with systemic antibiotics to supplement therapy for the underlying disease, have been successful in most cases.

Treatment of peri-implantitis using nonsurgical debridement with bioresorbable nanospheres for controlled release of doxycycline: case report

Peri-implantitis treatment is often surgical; however, in this case report, an alternative approach has been documented using a combination of nonsurgical debridement with the local controlled release of doxycycline by bioresorbable nanospheres in the peri-implant defect. After 15 months, remission on clinical inflammatory parameters of bleeding and suppuration on probing, as well as reduction of probing depths, was observed. This alternative approach may enhance clinical parameter improvements in some cases of peri-implantitis without the need for a surgical approach for implant decontamination.

Oral manifestations as first clinical sign of acute myeloid leukemia: report of a case

Leukemia is the most common malignancy in children younger than 15 years old. Acute myeloid leukemia frequently presents with early oral manifestations. The purpose of this study was to report the case of a 6-year-old male patient who showed persistent and severe hemorrhage after a tooth extraction and generalized gingival enlargement over a short period of time. Referral to the Oncohematology Service confirmed the diagnosis of an acute myeloid leukemia. This emphasizes the need for a dentist who can provide an opportunity for timely diagnosis, early referral, and proper treatment of an underlying leukemia to be aware of early oral signs and symptoms.

A case of Evans' syndrome following influenza vaccine

BACKGROUND

Evans' syndrome is an uncommon condition defined by the combination (either simultaneously or sequentially) of immune thrombocytopenia purpura and autoimmune hemolytic anemia with a positive direct antiglobulin test in the absence of known underlying etiology.

OBJECTIVES

We present a case of Evans' syndrome following influenza vaccination.

CASE REPORT

A 50-year-old man with no prior medical history developed Evans' syndrome 4 days after receiving influenza immunization. The patient improved following treatment with oral prednisone and intravenous immunoglobulin.

CONCLUSION

Influenza vaccine is one of the most commonly used vaccines worldwide, with millions of people being vaccinated annually. Despite its wide use, only sparse information has been published concerning any hematological effects of this vaccine. The rarity of such effects supports the safety of using this vaccine.

The effectiveness of scaling and root planing with adjunctive time-release minocycline using an open and closed approach for the treatment of periodontitis

The purpose of this study was to determine the effectiveness of scaling and root planing using a closed and open approach (papilla reflection) with and without a locally delivered antibiotic (minocycline hydrochloride microspheres) in the treatment of moderate to advanced chronic periodontitis. Twenty-five periodontal recall patients with four or more probing depths of 5.0 to 9.0 mm and bleeding on probing (BOP) participated in this double-blind trial. Each of four sites per patient was randomly assigned a different treatment: scaling/root planing only; scaling/root planing followed by minocycline placement; gingival papilla reflection followed by scaling/root planing and flap closure; and gingival papilla reflection, scaling/root planing, minocycline placement, and flap closure. At baseline and each subsequent appointment, probing depth, BOP, and clinical crown length were recorded. Patients returned at three months for measurements and supportive periodontal therapy, and at six months for final measurements. Patients followed their usual oral hygiene regimens. Data were analyzed for significant differences using a repeated measure ANOVA and a Student t-test. All treatments resulted in reduction of probing depths (average of 1.76 mm) and a marked reduction in BOP at six months. While the papilla reflection plus minocycline showed the greatest reduction in probing depth (1.91 mm) and the greatest decrease in BOP (20% at three months and 28% at six months), the differences were not significant (p > 0.05). Clinical crown lengths did not change significantly in the treatment sites; therefore, improvements in probing depth can be attributed to improved clinical attachment levels (long junctional epithelium). The combination therapies did not differ significantly from scaling/root planing alone in decreasing probing depths and BOP.

Randomized controlled trial of 0.454% stannous fluoride dentifrice to treat gingival bleeding

PURPOSE

To evaluate the effects of a highly bioavailable 0.454% stannous fluoride dentifrice on established gingival bleeding over a 3-month period.

MATERIALS AND METHODS

A randomized controlled clinical trial was conducted. In total, 100 adults with mild-to-moderate gingivitis and an average of 15 bleeding sites were assigned to either the stannous fluoride or regular control pastes for at-home use. Of these, 99 received study treatment and 97 completed the study.

RESULTS

The stannous fluoride group experienced 50% to 74% reductions in bleeding sites relative to baseline or the control, differing significantly (P < 0.001) at all time points. Most subjects in the stannous fluoride group (94%) had measured improvements in bleeding, and nearly one half completed treatment with one or no bleeding sites.

CONCLUSION

These study results suggest that incorporation of this 0.454% stannous fluoride dentifrice into daily oral hygiene maybe expected to yield less gingival bleeding at subsequent dental check-ups, and therefore reduce the risk of progressive periodontal disease.

Benefits of additional courses of systemic azithromycin in periodontal therapy

The use of systemic antimicrobials such as doxycycline, metronidazole, and azithromycin in conjunction with debridement has achieved results superior to those produced by debridement alone. The purpose of the present study was to determine if previous results could be improved upon by administering repeated doses of azithromycin during the hygiene phase. One hundred patients with moderate to advanced periodontitis were treated with scaling and root planing plus three courses of azithromycin during the hygiene phase. All patients then were re-evaluated and periodontal surgery and/or extractions involving 96 teeth were performed in 32 patients. All patients then entered a maintenance program that lasted up to 192 weeks, with four-month recalls. Clinical parameters were recorded at baseline, at re-evaluation (week 6 after baseline), and at 96 and 192 weeks into maintenance. The results indicated that probing depths, bleeding upon probing, and suppuration were reduced significantly at re-evaluation. In addition, 14 teeth that displayed a Class III mobility at baseline improved to either Class I or Class II . There was no relapse during the maintenance phase. Multivariate analysis after 192 weeks indicated no change in the number of sites that bled upon probing, or had pockets that were 5.0-6.0 mm or ≥ 7 mm. Ninety-five percent of the sites that initially bled upon probing did not do so four years post-treatment. The results indicate that three courses of azithromicin in conjunction with root instrumentation during the hygiene phase led to long-lasting beneficial effects on all clinical parameters for at least 192 weeks.

Subgingival delivery of oral debriding agents: a proof of concept

OBJECTIVE

This study is a proof of concept to determine the efficacy of a custom-fabricated tray in placing antimicrobial and debriding agents in the periodontal pockets of persons with active gingival infections. Localized subgingival delivery of antimicrobial and antibiotic agents is routinely employed as adjunctive therapy for the treatment and management ofperiopathogens associated with periodontal disease. Because these delivery techniques often face time constraints and impose temporary restrictions on patient brushing and flossing, a custom-formed prescription dental tray can be used to deliver and maintain medications in periodontal pockets between office visits and without brushing or flossing restrictions. The ability of this tray to maintain sufficient concentrations of medication in the periodontal pockets to have a therapeutic effect is evaluated here with theoretical modeling and practical application.

METHODS

Hydrogen peroxide is an oral debriding agent and oral wound cleanser with antimicrobial properties. The debriding effect of 1.7% hydrogen peroxide gel was tested in vitro on Streptococcus mutans biofilm using glass carriers for collection. Diffusion modeling tested the potential of the customized tray to place hydrogen peroxide gel into the sulcus in the presence of crevicular fluid flow. Changes in periodontal microflora with scanning electron microscopy analysis of in vivo paper point site sampling were analyzed before and after a thin ribbon of 1.7% hydrogen peroxide gel (approximately 0.7 gm) and a subtherapeutic dose (three drops) of Vibramycin (50 mg/5 ml) were placed via Perio Trays into periodontal pockets, ranging from 4-8 mm at daily prescribed intervals for two to five weeks.

RESULTS

In vitro results indicate that 1.7% hydrogen peroxide gel breaks down the exopolysaccharide slime and cell walls ofS. mutans, and begins to debride the cells from glass carriers within 10 minutes. Diffusion modeling indicates that hydrogen peroxide can penetrate into the deeper pockets (9 mm), but also its concentration in these deep pockets will increase over wearing time in the absence of degradation by peroxidases and catalase. Site sampling data confirm diffusion modeling results, with evidence that medication delivered with the prescription tray reduced subgingival bacterial loads and enhanced healing of corresponding oral tissues.

CONCLUSION

The prescription Perio Tray effectively placed medication in the gingival sulcus. Mathematical modeling indicated Perio Tray placement of hydrogen peroxide gel in periodontal pockets with depths up to 9 mm over 15 minutes treatment time was theoretically possible. Pathology reports reveal reductions in subgingival bacterial loads and improvements in pretreatment pocket depths of up to 8 mm after 1.7% hydrogen peroxide and Vibramycin Syrup were prescribed for use with the Perio Tray. The in vitro analysis indicating that hydrogen peroxide is the active and effective oral debriding agent needs to be confirmed with additional studies.

Amoxicillin/metronidazole or scaling and root planing in the treatment of chronic periodontitis

The aim of the present study was to evaluate the treatment with amoxicillin or metronidazole in comparison to scaling and root planing in the treatment of chronic periodontitis. Randomised clinical trials were searched in the databases MEDLINE, EMBASE, SciELO, Cochrane and Scopus from 1989 to 2010. The search started with 2895 articles. From this initial number of articles, 10 publications were selected and included in the study according to fixed criteria. Studies included adult patients of both sexes aged between 21 and 80, diagnosed with chronic periodontitis and treated with amoxicillin and/or metronidazole or scaling and root planning. From each article, details were abstracted relating to sample size, design, sex, age, oral hygiene habits, the exposure to drug (doses, schedule), and results such as clinical effect, analysis methods, stratification variables.

CONCLUSION

this meta-analysis showed absence of statistically significant difference between the effects studied.

Topical use of a metronidazole gel in the treatment of sites with symptoms of recurring chronic inflammation

BACKGROUND

Bacterial plaque accumulation at the dentogingival junction and in periodontal pockets is the major etiologic factor in all manifestations of periodontal disease. The aim of this study was to evaluate whether a locally delivered 25% metronidazole gel after scaling and root planing (SRP) would enhance the treatment outcome over SRP alone in periodontal pockets with symptoms of recurring chronic inflammation.

METHODS

Twenty-one maintenance-care patients, 10 men and 11 women, having at least one pair of contralateral anatomically matching proximal tooth surfaces showing probing depth > or = 5 mm and bleeding on probing (BOP), were included in the study. The sites were randomized to be treated with SRP plus 25% metronidazole gel (test sites) or with SRP alone (control sites) in a split-mouth design. Clinical evaluations were performed immediately pretreatment (baseline) and at 3 and 6 months post-treatment.

RESULTS

Both treatments yielded a statistically significant (P = 0.001) reduction in probing depth (1.9 and 1.8 mm), gain of attachment level (1.6 and 1.0 mm), and reduction of BOP (38.1% and 33.3%) for test and control sites, respectively, at 6 months. There was no statistically significant difference between the treatments for any of the clinical parameters.

CONCLUSION

This study indicates that a locally applied 25% metronidazole gel does not improve the treatment outcome over SRP alone in sites with recurring chronic inflammation in maintenance-care patients.

Subgingival triclosan-polydimethylsiloxane gel as an adjunct to scaling and root planing

PURPOSE

To evaluate the influence of a triclosan-polydimethylsiloxane-containing gel when used as an adjunct to scaling and root planing on the treatment of chronic periodontal disease.

METHODS

A 3-month, double-blind, randomized parallel design clinical trial was performed in 20 subjects with chronic periodontitis. The subjects, presenting at least three anterior sites with probing depth (PD) +/- 5 mm and bleeding on probing (BoP), were randomly assigned to two experimental groups: Group SRP-T: scaling/root planing plus test gel application (triclosan 1% + polydimethylsiloxane 13%) or Group SRP: scaling/root planing plus control gel application (polydimethylsiloxane 13%). Immediately following mechanical therapy, each assigned gel was applied to the selected sites and once a week during the following 3 weeks. Re-examinations were carried out on days 45 and 90 after the last irrigation.

RESULTS

Significant reductions in PD and clinical attachment level (CAL) were observed for both groups in both periods (P < 0.05). However, SRP-T showed lower means of PD than SRP at Day 45 (3.60 +/- 0.87 versus 4.77 +/- 1.38, respectively, P = 0.035) and CAL at both 45 days (4.63 +/- 1.17 versus 6.07 +/- 1.43, P = 0.023) and 90 days (4.45 +/- 1.19 versus 5.91 +/- 1.37, P = 0.021). No differences were found for bleeding on probing, plaque index and gingival recession (P > 0.05) between groups.

Minocycline HCl Microspheres Reduce Red-Complex Bacteria in Periodontal Disease Therapy

BACKGROUND

The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis.

METHODS

Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject.

RESULTS

MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved.

CONCLUSION

These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Niridazole biodegradable inserts for local long-term treatment of periodontitis: possible new life for an orphan drug

Periodontal pocket inserts of niridazole (NZ) made with Resomer(R) (grades RG 503H and RG858, designated as RH and RG, respectively) were studied. Various formulation variables were evaluated to obtain a biodegradable delivery systems showing device degradation and drug depletion parallel to each other in vitro. Drug release from the prepared inserts was evaluated using a static dissolution setup (for 1 month). Incorporation of 3 parts of RG in 1 part of RH inserts caused a 50% decrease in the initial release rate. The RH-NZ inserts showed a spurt in release around the 10th day of the study, which coincided with the decrease in device weight, suggesting onset of device degradation. Pilot-scale clinical trials in 12 patients indicated improvements in clinical indices from the baseline values. The average pocket depth was reduced significantly (alpha = 0.05) from 6.34 +/- 1.86 mm at baseline to 5.94 +/- 0.28 mm after 28 days of treatment.

Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis

AIM

To evaluate and compare the effects of adjunctive metronidazole plus amoxicillin, doxycycline and metronidazole on clinical and microbiological parameters in patients with generalized aggressive periodontitis.

MATERIAL AND METHODS

Forty-three patients participated in this randomized clinical trial divided into four groups. Six weeks after scaling and root planning (SRP), groups 1-3 received adjunctive metronidazole, plus amoxicillin, doxycycline and metronidazole respectively, and group 4 acted as controls. Clinical recordings concerning probing depth, probing attachment level and bleeding on probing were performed at baseline, 6 weeks after SRP and 6 months from baseline. Subgingival samples were analysed using the 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia and Treponema denticola.

RESULTS

All treatments resulted in improvement of clinical parameters (ANOVA p > 0.05). Systemic administration of metronidazole plus amoxicillin or metronidazole resulted in statistically significant greater reduction of the proportion of sites > 6 mm than SRP (z-test, p < 0.05). These antimicrobials yielded a significant effect on levels of important periodontal pathogens for 6 months.

CONCLUSION

Adjunctive metronidazole plus amoxicillin or metronidazole alone (when A.actinomycetemcomitans is not involved) is effective in deep pockets of aggressive periodontitis patients.

Effectiveness of a chlorhexidine dentifrice in orthodontic patients: a randomized-controlled trial

This blind and randomized-controlled trial analysed chlorhexidine dentifrices in relation to dental plaque, gingivitis, bleeding, calculus and enamel extrinsic staining development. Volunteers in fixed orthodontic therapy used the following dentifrices: 1100 ppmF, NaF (group A, n=27); experimental, 1100 ppmF, NaF and chlorhexidine 0.95% (group B, n=28); and experimental, chlorhexidine 0.95% (group C, n=28). At baseline, after 6, 12 and 24 weeks, clinical examinations were carried out. The gingivitis, bleeding and plaque data were tested by anova and Tukey's post hoc tests. Stain and calculus data were analysed by Kruskal-Wallis and Dunn's post hoc tests (p<0.05). Plaque, gingivitis and bleeding scores improved in all three groups, but up to the 6 and 12 weeks examination the products containing chlorhexidine were statistically better. The chlorhexidine dentifrices significantly increased the mean of the stain index, although most of the patients did not notice the stains. The calculus index was not significantly modified. In summary, this study suggests that the use of dentifrices containing chlorhexidine seems to be effective for the treatment of gingivitis in orthodontic patients, although the intense motivating contact that the volunteers had with the researchers may have also played a role.

Supportive periodontal therapy using mechanical instrumentation or 2% minocycline gel: a 12 month randomized, controlled, single masked pilot study

OBJECTIVE

To compare the short-term performance of subgingival local delivery of 2% minocycline gel and conventional subgingival debridement in supportive periodontal therapy (SPT) patients.

METHODS

Forty adult patients having completed active treatment for moderate to advanced chronic periodontitis were included in a randomized, controlled, single masked maintenance care pilot study. Sites with residual pocket probing depths > or =5 mm and bleeding on probing were treated with either minocycline gel (minocycline-group) or scaling and root planing only (debridement-group) at baseline, 3, 6, and 9 months. Clinical and microbiological examinations were performed at baseline, 3, 6, 9, and 12 months.

RESULTS

Full-mouth plaque and bleeding scores remained <10% and <20%, respectively, for both groups throughout the study. In both groups there was a persistent reduction in number of teeth and sites with probing pocket depths > or =5 mm (p<0.05) with no significant differences between the groups. The prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens, remained at levels < or =10(5) in the majority of patients and sites in both groups.

CONCLUSION

This pilot study failed to show a difference between local delivery of 2% minocycline gel as mono-therapy and traditional subgingival debridement in patients on SPT.

Local Oxygen Therapy for Treating Acute Necrotizing Periodontal Disease in Smokers

BACKGROUND

The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study.

METHODS

Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test.

RESULTS

In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction.

CONCLUSIONS

Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.

The clinical application of hyaluronic acid in gingivitis therapy

OBJECTIVE

The efficacy of a topical application of hyaluronic acid (HA) was tested for treating gingivitis.

METHOD AND MATERIALS

Sixty nonsmoking outpatients in good general condition, with clinical signs of gingivitis, were included in the study. Forty patients (HA group, 20 men, 20 women; age: 32.8 +/- 11.3 years) used a spray containing HA 5 times daily over a period of 1 week. The control group consisted of 20 patients (10 men, 10 women; age: 31.3 +/- 9.3 years). The clinical parameters DMF-T (decayed, missed, filled teeth) index, approximal plaque index, sulcus bleeding index, papilla bleeding index, and gingival crevicular fluid were measured at baseline (T1), after 3 days (T2), and after 7 days (T3).

RESULTS

A reduction in the sulcus bleeding index of the HA group (T1: 72.9 +/- 19.5%) to 50.3 +/- 21.1% was noted at T2, and at T3 the sulcus bleeding index was 40.7 +/- 23.0%. The papilla bleeding index values of the HA group were 1.6 at T1, 1.0 at T2, and 0.7 at T3. The gingival crevicular fluid showed significant reductions in the HA group. At T1 the recorded mean value was 16.3, at T2 it was 11.8, and at T3 it was 7.9. Only insignificant changes were observed in the respective indices of the control group. There were no significant alterations in the plaque values of either group throughout the study period.

CONCLUSION

The results obtained by this study demonstrate that the topical application of an HA-containing preparation represents a potentially useful adjunct in the therapy of gingivitis, although its use does not diminish the need for plaque reduction as a primary therapeutic measure.

Clinical Response of Azithromycin as an Adjunct to Non-Surgical Periodontal Therapy in Smokers

BACKGROUND

Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers.

METHODS

Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months.

RESULTS

The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted.

CONCLUSIONS

The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.

Efficacy of subantimicrobial-dose doxycycline in the treatment of periodontal diseases: a critical evaluation

Controlled clinical trials that evaluate the benefits of adjunctive subantimicrobial-dose doxycycline (SDD) with conventional therapy were selected for review. It was deemed important to distinguish between statistically significant and clinically relevant results related to SDD use to help guide clinicians in selecting appropriate therapies. Several investigations demonstrated that SDD prescribed as an adjunct to conventional therapy provides a statistically significant improvement with respect to probing depth reduction, gain of clinical attachment, decreased bleeding on probing, and reduced incidence of disease progression in patients with chronic periodontitis. However, conflicting data were also noted in some studies. Furthermore, it is suggested that the clinical relevance of improvements obtained with SDD beyond those obtained with conventional therapy is debatable. Therefore, clinicians should interpret the data cautiously and differentiate between statistically significant and clinically relevant findings before altering treatment regimens.

Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients

OBJECTIVES

The present controlled, single-blind study was performed to assess and compare the clinical healing and the microbiological findings following repeated intrasulcular applications of 1% metronidazole or 1% chlorhexidine gels in persistent periodontal pockets previously treated by scaling and root planing (SRP).

MATERIAL AND METHODS

Sixty-three systemically healthy subjects, 25 males and 38 females (mean age 48.4+/-7.2 years), diagnosed for chronic periodontitis were enrolled in this study. They underwent SRP and received oral hygiene instructions (OHI). Three months later, at baseline, a single persistent pocket with a probing depth (PD) of 5-9 mm was chosen as the experimental site in each patient; the subjects were stratified into three matched experimental groups on the basis of the treatment to be performed, which consisted of the subgingival administration of 1% metronidazole gel (MG, n=19), 1% chlorhexidine gel (CG, n=20) or placebo gel (PG, n=24). The treatments consisted of four repeated administrations of subgingival gels, each separated by 7 days, starting at the baseline. Clinical assessment was performed at the baseline and at the 180-day follow-up, after the end of treatment. For microbiological evaluations, subgingival plaque was sampled from the experimental sites at baseline, prior to the first subgingival gel administration, and at 7, 15, 30 and 90 days after the end of the treatment (days 28, 36, 51 and 111 from baseline).

RESULTS

Plaque accumulation did not change significantly in all three groups. Bleeding on probing and clinical attachment levels reduced in the MGs and CGs only. PD was significantly reduced by the same amount in all experimental groups. In the MGs and CGs a remarkable reduction in the frequencies of detection of several periodontopathic micoorganisms was recorded after the treatment. The same was not seen for the PGs.

CONCLUSIONS

Subgingival administration of MG or CG, both at 1%, may have a role in the management of persistent pockets during chronic periodontitis.

Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A Clinical Study

BACKGROUND

The aim of this clinical study was to evaluate the association of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers.

METHODS

Forty-three patients with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, relative attachment level (RAL), and probing depth (PD) were recorded at baseline, 45 days, and 3 and 6 months. Differences between baseline and each period were considered for analysis.

RESULTS

At 6 months, no difference was found between groups regarding plaque, bleeding reduction, gingival recession or PD (P > 0.05). However, RAL gain was greater for SRP-D (1.63 +/- 0.93 mm) than for SRP (1.04 +/- 0.71 mm) (P = 0.025). In addition, deep pockets (> or = 7 mm) showed a significant reduction (3.78 +/- 1.41 versus 2.60 +/- 1.28 mm, P = 0.039) and RAL gain (2.54 +/- 1.27 mm versus 1.29 +/- 0.95 mm, P = 0.01) when doxycycline was applied. The proportion of sites showing RAL gain of 1 to 2 mm was 36.8% versus 21.7% for SRP-D and SRP, respectively (P = 0.01).

CONCLUSION

The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers.

Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months

BACKGROUNDS/AIMS

The aim of our study was to evaluate the clinical, radiological and microbiological response to the local delivery of tetracycline (TE) of sites with persistent periodontal lesions.

MATERIALS AND METHODS

The study was conducted in a split-mouth design. Nineteen patients with at least four bilateral pockets 4-5 mm and bleeding on probing (BOP) were treated with scaling and root planing (SRP) plus TE fibres (test sites) or with SRP alone (control sites). Clinical and radiological measurements were taken at baseline, 6 months and 12 months post-operatively. Subgingival plaque samples were collected at baseline, at fibres removal, 6 and 12 months following treatment and analysed by polymerase chain reaction.

RESULTS

Both treatments yielded a statistically significant (p<0.05) reduction of probing depth (2.05 and 1.21 mm), gain of clinical attachment level (1.71 and 0.53 mm) and reduction of BOP scores (23.68% and 57.89%) for TE and SRP groups, respectively, when comparing 12-month data with baseline. The differences between two groups were significant. The prevalence of Treponema denticola and Bacteroides forsythus decreased after therapy in both groups but only in the test sites Actinobacillus actinomycetemcomitans and Prevotella intermedia were not yield detected. The pathogens could be eliminated from five periodontal pockets by SRP alone, while 21 TE sites were not recolonized at 12 months.

CONCLUSIONS

SRP plus TE fibres gave the greatest advantage in the treatment of periodontal persistent lesions at least 12 months following treatment.

Topically applied minocycline microspheres: why it works

This article presents the results of a single-arm, open-label, multicenter clinical trial of the topical use of sustained-release minocycline hydrochloride (HCl) microspheres as an adjunct to scaling and root planing. The objective of this study was to evaluate the long-term safety and efficacy of the subgingival application of resorbable minocycline microspheres as an adjunct to scaling and root planing in the treatment of chronic periodontitis. The primary outcome measures were the reduction in probing pocket depth at 9- and 12-month evaluations, and the percent of bleeding upon probing. A total of 173 patients with moderate-to-severe chronic periodontitis were enrolled in this multicenter clinical trial. All patients received full-mouth scaling and root planing plus minocycline microspheres in all periodontal pockets that probed > or = 5 mm. All sites treated at baseline and any new sites > or = 5 mm again received minocycline microspheres at 3- and 6-month follow-up appointments with no further scaling and root planing. Significant improvements in all clinical parameters measured were found at all time points (1, 3, 6, 9 and 12 months). The product was found to be well-tolerated by patients, safe, and easy to deliver. Scaling and root planing with the topical application of minocycline microspheres appeared to give better results than would have been expected with scaling and root planing alone.

Clinical outcome observed in subjects with recurrent periodontal disease following local treatment with 25% metronidazole gel

BACKGROUND

The aim of this study was to evaluate the clinical outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel.

METHODS

Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing, a total of 40 sites, 2 in each patient, with probing depth > or = 5 mm were selected. One site randomly selected was treated with metronidazole gel (test) and the other site with a placebo gel (control). Baseline and follow-up measurements included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL).

RESULTS

There were no statistically significant differences in PI, GI, BOP, PD, or CAL between test and control sites.

CONCLUSION

This study showed that local treatment with 25% metronidazole gel did not seem to influence the clinical healing in this group of subjects with recurrent periodontal disease.

The effect of alendronate sodium on alveolar bone loss in periodontitis (clinical trial)

Alendronate sodium is a potent inhibitor of bone resorption which has been effectively used to control osteolysis, and to treat Paget's disease and osteoporosis. The objective of this study was to investigate the effect of alendronate sodium, systemically induced in the treatment of patients with periodontitis. Twenty-four adult periodontitis patients were included in the study (for six months) and were divided into two groups. Group I, included twelve patients who received one tablet of fosamax (alendronate sodium, MSD) every morning for six months. Group II, also included twelve patients who received no drug during the study period. All patients received initial periodontal therapy. Bone mineral density (BMD) of the maxilla and mandible was measured for all subjects using a dual energy absorptiometer (DEXA) at the beginning of the study and at the end of six months using DPX. MD Scanner. Clinical periodontal measurements were carried out for all patients at the initial appointment and six months later in the form of pocket depth, attachment level and gingival index. A statistically significant difference in bone density (P < 0.001) was observed favouring the alendronate group (Group I). Alendronate sodium had no effect on the clinical parameters and could play an important role as an adjunct to conventional periodontal therapy in management of periodontal diseases.

Local antimicrobial therapy after initial periodontal treatment

AIM

The aim of this single-blind, randomized, parallel-designed clinical trial (RCT) was to evaluate the clinical and microbiological effects of three sustained-release biodegradable polymers delivered into periodontal pockets following initial periodontal therapy.

METHODS

Forty-seven patients (28 females and 19 males) with a mean age of 51 years (range 29-71) underwent a periodontal examination at baseline (i.e. Week 0) and after 18 weeks. This included the assessment of the Plaque Index (PlI), Bleeding on Probing (BOP), Pocket Probing Depths (PPD) and Probing Attachment Levels (PAL) at six sites per tooth. Two to 4 months prior to baseline, all subjects had received initial periodontal therapy including motivation, instruction in oral hygiene practices and full-mouth scaling and root planing. At the treatment appointment (i.e. Week 2), the patients were randomly assigned to receive either Atridox trade mark, Elyzol Dental Gel or PerioChip at all residual periodontal pockets with a probing depth >/= 5 mm and concomitant BOP. In accordance with the manufacturer's recommendations, Elyzol Dental Gel was applied for a second time 7 days later. In addition to the clinical evaluation, subgingival microbiological samples were collected prior to treatment (i.e. Week 2) and at Weeks 4 and 18. Analysis of variance/covariance was used to evaluate changes from baseline to Week 18 for the clinical parameters.

RESULTS

Between the baseline and 18-week examinations, subjects treated with Atridox showed a significantly greater gain in mean PAL of 0.33 mm +/- 0.09 (SD) than subjects treated with Elyzol Dental Gel [0.03 mm +/- 0.09 (SD)](p = 0.03). However, the gain in PAL of 0.16 mm +/- 0.10 (SD) found after PerioChip application did not differ significantly from that obtained following the application of Atridox(p = 0.27). Of the sites treated with Atridox, 42% gained >/= 1 mm PAL and 9% >/= 2 mm PAL as opposed to the sites treated with Elyzol Dental Gel, in which 34% gained >/= 1 mm PAL and 8% gained >/= 2 mm PAL. Of the sites treated with PerioChip, 36% gained >/= 1 mm and 6% gained >/= 2 mm PAL following a completed initial periodontal therapy.

CONCLUSIONS

The application of the three biodegradable sustained release devices tested following initial periodontal therapy resulted in a statistically significant gain in mean PAL for AtridoxTM and a significant reduction in PPD for all three devices during the study period. Furthermore, when sites treated with Atridox were compared with sites treated with Elyzol, a significant difference in mean PAL gain (0.3 mm) was observed.

Effect of locally delivered minocycline microspheres on markers of bone resorption

BACKGROUND

Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), a bone-specific degradation product, and interleukin 1-beta (IL-1), a potent bone-resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL-1.

METHODS

Forty-eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD < or = 3 mm) and 4 deep (PD > or = 5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL-1 were determined using radioimmunoassay and enzyme-linked immunosorbent assay techniques, respectively.

RESULTS

Significant differences (P<0.001) in GCF levels of ICTP and IL-1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL-1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL-1 levels (P <0.02) at 1 month compared to the SRP + V group.

CONCLUSIONS

Results of this study indicate that GCF levels of ICTP and IL-1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short-term reduction in GCF IL-1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long-term reductions in GCF ICTP and IL-1 levels.

Minocycline microspheres: a complementary medical-mechanical model for the treatment of chronic periodontitis

Locally delivered antimicrobials represent an expanding class of therapeutics that may complement conventional mechanical treatments for chronic periodontitis. Currently available locally delivered antimicrobials include a tetracycline fiber, chlorhexidine chip, doxycycline gel, and newly approved minocycline microspheres. This last therapeutic is formulated to contain 3 mg polyglycolide-co-dl lactide (PGLA) copolymer and 1 mg of minocycline per unit (pocket) dose. As the polymer microspheres resorb, minocycline is released locally within the periodontal pocket at effective concentrations for at least 14 days. Recently, three phase 3 human clinical trials were conducted to assess the efficacy and safety of minocycline microspheres in patients with moderate-to-advanced chronic periodontitis. Data from an open-label trial involving 173 subjects indicated that minocycline microspheres plus scaling and root planing (SRP) at baseline produced significant improvements in pocket depth (PD) (> or = 1.5 mm) at 1 and 3 months. Retreatment with minocycline microspheres at 3 and 6 months maintained these improvements for 12 months. Two concurrent, blinded studies cumulatively recruited 748 periodontitis subjects who were randomized to SRP plus minocycline microspheres, SRP plus vehicle (placebo), or SRP alone at baseline. Minocycline microspheres or the vehicle were readministered per the randomization at 3 and 6 months. Patients receiving minocycline microspheres plus SRP exhibited significantly greater PD reduction at 1, 3, 6, and 9 months compared to patients receiving SRP plus vehicle or SRP alone. Overall, mean PD reduction with adjunctive minocycline-microsphere treatment increased when patients with more advanced periodontitis (mean PD > or = 6 mm or 7 mm) were considered. Similarly, significant improvements in clinical attachment level and percent bleeding on probing were observed among advanced periodontitis patients treated with SRP plus minocycline microspheres relative to controls. Patients treated with minocycline microspheres plus SRP were 50% more likely to shift to an overall mean PD < 5 mm or to a more maintainable case definition. No increased incidence of adverse events or tetracycline resistance were observed with minocycline-microsphere treatment. The data from these clinical trials indicate that minocycline microspheres plus SRP are safe in patients and more effective than SRP alone in reducting the signs of chronic periodontitis.

Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study

BACKGROUND AND AIM

Several studies have reported adjunctive benefits to scaling and root planing (SRP) of systemic amoxycillin and metronidazole in the treatment of periodontal diseases. To date no comparisons have been made of these antimicrobials alone or in combination. The aim of this study was to compare the adjunctive benefits to SRP of amoxycillin and metronidazole alone and combined.

METHODS

66 subjects <46 years of age with advanced chronic periodontal disease participated in this randomised, double blind, 4 parallel treatment group designed study. All subjects received quadrant SRP and then were prescribed amoxycillin capsules (250 mg) and metronidazole tablets (200 mg) (AM) or lactate capsules and metronidazole (PM) or amoxycillin and calcium lactate tablets (AP) or lactate and calcium lactate (PP). All medication was 3 of each per day for 7 days. Subgingival plaque samples were obtained and probing depth (PD), loss of attachment (LOA), bleeding on probing (BOP), suppuration (SUPP) and plaque (DEP) were recorded pre-treatment, 1, 3 and 6 months post-treatment.

RESULTS

Final group sizes were: AM=15, PM=16, AP=16 and PP=15. PD improved in all groups. Treatment effects were highly significantly different and always greatest in the AM and least in the PP groups. Benefits of PM and AP over PP were also noted. LOA improved in all groups and showed the same highly significant treatment differences, again favouring AM. BOP improved in all groups, particularly in AM compared to the other groups. SUPP improved in all groups and was virtually eradicated in AM with differences among treatments highly significant. DEP changed little in any group and there were no significant differences among groups. Microbiological data showed significant differences in favour of AM compared to PP and PM for total aerobes and anaerobes at 1 month. P. intermedia counts were always lower in active groups compared to PP and reached significance for AM and AP at 1 month and AM and PM at 3 months.

CONCLUSION

The significant differences among treatment groups and the overall trend in the data, in line with other studies, support the considerable adjunctive benefits to SRP of amoxycillin and metronidazole combined in the treatment of advanced chronic periodontal disease.

Local application of n-3 or n-6 polyunsaturated fatty acids in the treatment of human experimental gingivitis

BACKGROUND

Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4).

AIMS

The aim of this clinical study was to evaluate the effects of topical application of n-6 or n-6 polyunsaturated fatty acids in patients with experimental gingivitis.

METHODS

In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography.

RESULTS

After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n-6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)).

CONCLUSION

The topical application of n-6 or n-6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n-6 fatty acids could reduce the level of GCF in established experimental gingivitis.

Effectiveness of metronidazole gel on cyclosporine-induced gingival overgrowth in heart transplant patients

To evaluate the efficacy of metronidazole on cyclosporine-induced gingival overgrowth (GO), a prospective intra-subject double-blind longitudinal study was performed on six heart transplant patients with GO. All patients underwent scaling and root planing before any treatment. Metronidazole gel (Elyzol, Cabon) was then applied in two of the four anterior hemi-sextants of each subject, following a balanced random pre-programmed list, with a placebo gel being applied to the remaining two hemi-sextants. Plaque index (PI), bleeding on probing (BP) and probing depth (PD) were recorded for all teeth of the four anterior hemi-sextants before and at 1, 2, 3, and 4 months after gel application. A general linear model was fitted and ANOVA for repeated measurements with split-plot design and Chi-square analysis were used for statistical analysis. PD significantly decreased after 1 month following both treatments. Analogous results were obtained as regards PI and BP. No statistically significant difference was detected between results obtained with metronidazole and placebo. However, PD in the group of teeth treated with placebo significantly increased after 4 months, while PD values obtained from teeth treated with metronidazole remained statistically unchanged with respect to the 1st month. In conclusion, short-term results suggest that metronidazole and placebo are equally effective in reducing periodontal parameters and GO when associated with scaling and root planing. Long-term results, however, showed greater efficacy of metronidazole with respect to placebo in controlling cyclosporine-induced GO.

The effects of subgingival calculus on the clinical outcomes of locally-delivered controlled-release doxycycline compared to scaling and root planing

BACKGROUND/AIM

The effect of subgingival calculus on the clinical outcomes of the local delivery of antimicrobials is unknown. This study examines the clinical outcomes of treatment with locally delivered controlled-release doxycycline (DH) or scaling and root planing (SRP) in subsets of adult periodontitis patients with known baseline levels of subgingival calculus.

METHODS

The data examined were obtained from 393 patients who participated in 2 multi-center trials. All patients had baseline subgingival calculus levels assessed and were then treated at baseline and month 4 with either DH or SRP. Clinical attachment levels (CAL), pocket depth (PD) and bleeding on probing (BOP) were assessed at baseline and months 1, 2, 4, 5, 6, 8 and 9.

RESULTS

Treatment with either DH or SRP resulted in significant statistical and clinical improvements in CAL, PD and BOP. These clinical outcomes were equivalent regardless of the extent of subgingival calculus present at baseline.

CONCLUSIONS

The results indicate that the primary clinical effects of these therapies are the result of a disruption and reduction of the subgingival plaque and not the effect of the removal of subgingival calculus and contaminated cementum.

The long-term effect of systemic tetracycline used as an adjunct to non-surgical treatment of advanced periodontitis

AIM

In the present study both the short- and the long-term effects were evaluated of a treatment that, during the phase of basic therapy, included administration of systemic tetracycline and non-surgical intervention.

MATERIAL AND METHODS

35 adult human subjects with advanced periodontitis, 19 females and 16 males, aged between 24 and 60 years, were included in a test group. 80 age- and sex-matched adult periodontitis subjects were recruited for a control group (42 females and 38 males). A baseline examination included assessment of the following parameters: number of teeth, plaque, bleeding on probing, probing attachment level, probing pocket depth. In radiographs, the distance between the cemento-enamel junction and the alveolar bone crest was determined at all interproximal sites. The subjects were given oral hygiene instruction. The members of the test group were provided with tablets with 250 mg of tetracycline hydrochloride and were instructed to take 1 tablet 4x per day for a period of 3 weeks. No antibiotic was given to the subjects in the control group. During the 3-week interval, all participants received 4-6 sessions of non-surgical periodontal therapy. All subjects were subsequently enrolled in a maintenance care program and were provided with supportive periodontal therapy (SPT) 3-4x per year. Clinical re-examinations were performed after 1, 3, 5 and 13 years.

RESULTS

The present investigation demonstrated that tetracycline administered during a 3-week period concomitant with non-surgical treatment enhanced the outcome of mechanical therapy. At the re-examination 1 year after active therapy, there was in the test group an average gain in probing attachment that was almost 3x higher than the gain that occurred in an age and sex matched Control group. Re-examinations after 3, 5, and 13 years of SPT disclosed that this short-term benefit was not maintained in the longer perspective.

CONCLUSION

The beneficial effect of systemically administered tetracycline on probing attachment level occurred in the first year post-therapy. Annual rates of probing attachment level change from 1 to 13 years did not differ between groups.

Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis

BACKGROUND

Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips.

METHODS

Using a 4-quadrant design, 4 test teeth in 24 patients were treated with either root planing and single strip application; root planing and multiple strip application; root planing alone; or an untreated control.

RESULTS

Single and multiple strip placement resulted in a significant reduction in probing depth (P = 0.033) compared to root planing and untreated groups. The multiple strip group significantly decreased bleeding on probing (P = 0.05) compared to all other treatment groups. There was no treatment effect on GCF; however, there was a significant reduction in the GCF volume over time (P = 0.001). The time required for placement was, on average, 1.9 minutes for single strips and 3.25 minutes for multiple strips.

CONCLUSIONS

Our data suggest that multiple strips are superior to a single strip in reducing bleeding on probing, and that local delivery of tetracycline is superior to root planing alone in reducing probing depth.

Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial

BACKGROUND

Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline.

METHODS

Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months.

RESULTS

Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups.

CONCLUSIONS

Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Comparative clinical and microbiological effects of subgingival metronidazole application in adult periodontitis; 12-months results

The aim of the present study was to evaluate the clinical and microbiological effects of subgingival application of 25% metronidazole dental gel as an adjunct to scaling and root planing (SRP) in the treatment of adult periodontitis. Eighty teeth in 18 patients were evaluated using a split mouth design. The test teeth received SRP and a 25% metronidazole gel applied subgingivally on days 0 and 7. The control teeth received SRP only. Clinical and microbiological examinations were carried out before treatment and on weeks 1, 3, 7, 13, 26, 38 and 52 of the experimental period. Colony forming units of Porphyromonas gingivalis and Prevotella intermedia / Prevotella nigrescens were determined. Both treatments provided significant improvements in all the clinical and microbiological parameters (P<0.05). However, none of the differences between the study groups were statistically significant (P > 0.05). As a conclusion, the present study does not provide evidence in favour of the routine use of adjunctive metronidazole dental gel in the treatment of adult periodontitis.

Change in subgingival microbial profiles in adult periodontitis subjects receiving either systemically-administered amoxicillin or metronidazole

AIM

The current investigation evaluated changes in levels and proportions of 40 bacterial species in subgingival plaque samples during, immediately after and up to 1 year after metronidazole or amoxicillin therapy combined with SRP.

METHOD

After baseline clinical and microbiological monitoring, 17 adult periodontitis subjects received full mouth SRP and 14 days systemic administration of either metronidazole (250 mg, TID, n=8) or amoxicillin (500 mg, TID, n=9). Clinical measurements including % of sites with plaque, gingival redness, bleeding on probing and suppuration, pocket depth (PD) and attachment level (AL) were made at baseline, 90, 180 and 360 days. Subgingival plaque samples were taken from the mesial surface of all teeth in each subject at baseline, 90, 180 and 360 days and from 2 randomly selected posterior teeth at 3, 7, and 14 days during and after antibiotic administration. Counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. Significance of differences over time was determined using the Quade test and between groups using ANCOVA.

RESULTS

Mean PD was reduced from 3.22+/-0.12 at baseline to 2.81+/-0.16 (p<0.01) at 360 days and from 3.38+/-0.23 mm to 2.80+/-0.14 mm (p<0.01) in the amoxicillin and metronidazole treated subjects respectively. Corresponding values for mean AL were 3.21+/-0.30 to 2.76+/-0.32 (p<0.05) and 3.23+/-0.28 mm to 2.94+/-0.23 mm (p<0.01). Levels and proportions of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were markedly reduced during antibiotic administration and were lower than baseline levels at 360 days. Counts (x10(5), +/-SEM) of B. forsythus fell from baseline levels of 0.66+/-0.16 to 0.04+/-0.02, 0.13+/-0.04, 0.10+/-0.03 and 0.42+/-0.19 in the amoxicillin group at 14, 90, 180 and 360 days respectively (p<0.001). Corresponding values for metronidazole treated subjects were: 1.69+/-0.28 to 0.02+/-0.01, 0.20+/-0.08, 0.22+/-0.06 and 0.22+/-0.08 (p<0.001). Counts of Campylobacter species, Eubacterium nodatum, Fusobacterium nucleatum subspecies, F. periodonticum and Prevotella nigrescens were also detected at lower mean levels during and immediately after therapy, but gradually increased after withdrawal of the antibiotics. Members of the genera Actinomyces, Streptococcus and Capnocytophaga were minimally affected by metronidazole. However, amoxicillin decreased the counts and proportions of Actinomyces species during and after therapy.

CONCLUSIONS

The data suggest that metronidazole and amoxicillin are useful in rapidly lowering counts of putative periodontal pathogens, but must be accompanied by other procedures to bring about periodontal stability.

Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study

BACKGROUND, AIMS

The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement.

METHODS

49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days.

RESULTS

At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of > or = 7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category > or = 7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth > or = 5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p < or = 0.005). In contrast, the changes in the proportions of sites with a probing pocket depth > or = 5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12% respectively.

CONCLUSIONS

This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.

A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis

BACKGROUND

In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts.

METHODS

The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2-step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full-mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty-eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP.

RESULTS

After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step.

CONCLUSIONS

The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2-step nonsurgical procedure of scaling and root planing in RPP patients.

The clinical and microbiological effects of systemic ornidazole in sites with and without subgingival debridement in early-onset periodontitis patients

BACKGROUND

The purpose of this study was to evaluate the clinical and microbiological effects of systemic ornidazole (ORN) in sites with or without subgingival debridement in early-onset periodontitis (EOP) patients.

METHODS

Two pooled bacterial samples consisting of 4 sites each (scaled and non-scaled sites) were obtained from 30 individuals exhibiting EOP. All patients received oral hygiene instruction (OHI), supragingival scaling and ORN. Subgingival scaling and root planing (SRP) was carried out only in scaled sites. Bacterial samples were taken at baseline (BL) and 1 week and 2, 6, and 12 months after systemic ornidazole administration (500 mg/bid for 7 days). One more sample was taken at scaled sites, one week after SRP.

RESULTS

One week following SRP (scaled sites) Gram-negative facultative and anaerobic rods were significantly reduced while Gram-positive facultative cocci were significantly increased. After ORN administration, P. gingivalis, P. denticola, P. intermedia, B. forsythus, C. rectus, and S. sputigena were no longer detectable in either scaled or non-scaled sites. A statistically significant long-term (2, 6, and 12 months) reduction of P. gingivalis, P. intermedia, P. loescheii, B. forsythus, and C. rectus and a pronounced increase of S. milleri, S. oralis, and S. sanguis counts in both scaled and non-scaled sites were detected in comparison to baseline. A sustained reduction of bleeding tendency and of probing depth was also observed in both scaled and non-scaled sites.

CONCLUSIONS

ORN combined with SRP effects beneficial shifts in the bacterial population associated with substantial clinical improvement, thereby indicating that ORN is effective adjunct in the treatment of EOP deep periodontal pockets where anaerobic bacteria are predominant.

Clinical evaluation of subgingival application of metronidazole 25%, and adjunctive therapy

The effect of topical application of a metronidazole gel (ELYZOL DENTAL GEL), and adjunctive therapy in the treatment of adult periodontitis was assessed clinically. A single, masked examiner performed clinical assessments. Fourteen patients were involved, each one received four different treatments including control, and the four treatments were randomly applied to at least one tooth in each quadrant for each patient in a comparative split-mouth design. Clinical examinations were carried out before treatment and 90 days after treatment. All patients had at least one tooth in each quadrant with probing pocket depth of > or = 5mm. The four treatment groups were: (I) One session of one hour of scaling and root planning, (II) metronidazole 25% dental gel (ELYZOL DENTAL GEL) applied on day 0 and day 7, (III) scaling adjunctive to metronidazole 25%, and (IV) No treatment. Instruction in oral hygiene was given to all subjects at base line examination. At the end of the study (day 90), all groups had statistically significant improvement in probing pocket depth (P < 0.02), and in plaque and bleeding indices (P < 0.05) when compared to day 0. However, group III had statistically significantly greater improvement (P < 0.03) in probing pocket depth than groups I, II and IV. Both groups I and II had statistically significantly greater improvement (P < 0.05) in probing pocket depth than control group. On the other hand, both groups were not statistically significantly different from each other in probing pocket depth improvement. It is suggested that topical Elyzol treatment may improve periodontal health as well as subgingival scaling and root planning therapy, and adjunctive treatment could obtain an additional therapeutic effect.

[Clinical and bacteriologic response to irrigation with a chlorhexidine solution in the treatment of periodontal pockets]

Most of parodontal diseases have a bacterial aetiology. Their episodic and asynchronic evolution differs from site to site. The "in situs" antimicrobian used in the parodontal bags reduces the systemic administration. Various antibiotics or antiseptics slow liberation systems were experimented. Two patients suffering from advanced parodontitis were treated after radicular scraping by subgingival irrigation with a syringe filled with chlorhexidine. Each patient presented at last four parodontal bags more or less six millimetres (6 mm) deep. The following clinical parameters were noted: Patch index, bleeding index, bag depth. A bacteriological analysis was realized at the beginning and of the treatment. Controls were made at D60. Results showed a significant improvement of clinical parameters. It seems that the chlorhexidine irrigation improves the parodontal treatment efficiency.

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis

BACKGROUND

In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP.

METHODS

Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline

RESULTS

In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events.

CONCLUSIONS

The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.