Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial

• Published in: Journal of clinical periodontology Vol. 40; no. 3; pp. 242 - 251
• Main Authors: Silva-Senem, Mayra Xavier e, Heller, Débora, Varela, Victor Macedo, Torres, Maria Cynesia Barros, Feres-Filho, Eduardo Jorge, Colombo, Ana Paula Vieira
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-03-2013
• Subjects: aggressive periodontitis; Aggressive Periodontitis - drug therapy; Aggressive Periodontitis - microbiology; Aggressive Periodontitis - therapy; Amoxicillin - administration & dosage; Amoxicillin - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Anti-Infective Agents, Local - administration & dosage; Anti-Infective Agents, Local - therapeutic use; Antibiotics; antimicrobials; Bacterial Load - drug effects; checkerboard; Chlorhexidine - administration & dosage; Chlorhexidine - therapeutic use; Clinical outcomes; Dental Scaling - methods; Dentistry; DNA probes; Double-Blind Method; Drug Combinations; Follow-Up Studies; Gram-Negative Bacteria - classification; Gram-Negative Bacteria - drug effects; Gram-Positive Bacteria - classification; Gram-Positive Bacteria - drug effects; Gum disease; Humans; Metronidazole - administration & dosage; Metronidazole - therapeutic use; Mouthwashes - administration & dosage; Mouthwashes - therapeutic use; Periodontal Debridement - methods; Periodontal Pocket - drug therapy; Periodontal Pocket - microbiology; Periodontal Pocket - therapy; periodontal therapy; Placebos; RCT; Root Planing - methods; subgingival microbiota; Therapeutic Irrigation; Toothbrushing - methods; Treatment Outcome; Ultrasonic Therapy - methods
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/jcpe.12052

Aim
To compare the 1‐year clinical and microbiological outcomes of an enhanced anti‐infective therapy with versus without systemic antimicrobials in patients with generalized aggressive periodontitis (GAP).
Methods
In this 12‐month randomized, double‐blinded, placebo‐controlled trial, 35 individuals assigned to a control (n = 17) or test group (n = 18) received full‐mouth supra and subgingival ultrasonic debridement followed by scaling and root planing with chlorhexidine rinsing, brushing, and irrigation. Subjects received either amoxicillin (AMX, 500 mg) + metronidazole (MET, 250 mg) or placebos, TID for 10 days. Subgingival samples were obtained and analysed for their composition by checkerboard. Data were subjected to non‐parametric tests.
Results
Both therapeutic protocols resulted in similar significant clinical improvement for most parameters at 1 year (p < 0.01). The AMX + MET group exhibited shallower residual pockets than the placebo (p = 0.05). Most periodontal pathogens decreased, whereas beneficial bacteria increased in counts in both groups over time (p < 0.0012). High levels of some periodontal and other microbial pathogens were associated with disease persistence regardless treatment.
Conclusions
The enhanced anti‐infective mechanical therapy is comparable with its combination with systemic AMX+MET for most clinical parameters and for maintaining low levels of periodontal pathogens for up to 1 year after treatment of GAP.