Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study

Background and Objective The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically a...

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Published in:	Journal of periodontal research Vol. 51; no. 1; pp. 50 - 59
Main Authors:	Bergamaschi, C. C., Santamaria, M. P., Berto, L. A., Cogo-Müller, K., Motta, R. H. L., Salum, E. A., Nociti Júnior, F. H., Goodson, J. M., Groppo, F. C.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-02-2016
Subjects:	adjunctive periodontal therapy Chronic Periodontitis - drug therapy Dental Scaling Dentistry Follow-Up Studies Humans Metronidazole Periodontal Attachment Loss - drug therapy Periodontal Debridement Periodontal Index Periodontal Pocket - drug therapy periodontitis Pilot Projects Smoking adjunctive periodontal therapy metronidazole periodontitis smoking
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Summary:	Background and Objective The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. Material and Methods This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl®) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real‐time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. Results There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). Conclusion Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post‐treatment. Further studies are necessary to confirm the clinical relevance of these findings.
Bibliography:	ark:/67375/WNG-2NG7NBLS-V istex:4A8AC2E71F12F325BBE13E79D67DB15DF7269929 FAPESP - No. 06/01492-0; No. 06/0898-9 ArticleID:JRE12278 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0022-3484 1600-0765
DOI:	10.1111/jre.12278