Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.     

光动力疗法对慢性牙周炎龈下牙周致病菌的影响

目的：应用PeriowaveTM光动力杀菌系统对慢性牙周炎患者进行治疗,通过龈下菌斑中牙周致病菌比例的变化,评价光动力疗法（photodynamic therapy,PDT）治疗慢性牙周炎的临床效果。方法：选取60名慢性牙周炎患者,分别给予SRP＋1次PDT（A组）、SRP＋2次PDT（B组）或单纯SRP（C组）治疗。利用real-time PCR技术检测A、B、C三组在治疗前、治疗后6周、治疗后12周龈下菌斑中牙周致病菌P.g、A.a、T.f所占比例的变化。结果：治疗后6周,A、B两组牙周致病菌P.g在总菌中的比例都有非常显著降低（p〈0.01）,C组有显著降低（p〈0.05）;治疗后12周,A、B组仍有非常显著的降低（p〈0.01）,与C组相比有非常显著差异（p〈0.01）,但A、B两组之间没有差异（p〉0.05）;而仅在治疗后12周,B组的A.a相对于总菌的比例与基线相比有显著降低（p〈0.05）,且这一变化显著大于A、C两组（p〈0.05）;在治疗后6周,A、B组T.f相对于总菌含量的下降与基线相比,明显大于C组（p〈0.05）,治疗后12周,A、B两组T.f相对于总菌的含量仍有非常显著的下降（p〈0.01）,但A组和B组之间都没有差异。结论：PDT对P.g、A.a和T.f3种牙周致病菌都有杀灭作用,但P.g、T.f对PDT更为敏感,PDT可以作为治疗慢性牙周炎的辅助方法。     

Assessment of clinical efficacy of locally delivered 0.2% Thymoquinone gel in the treatment of periodontitis

Objectives

To evaluate the potential benefits of local application of Thymoquinone gel as an adjunctive to scaling and root planing (SRP) in subjects with chronic periodontitis.

Gingival crevicular fluid elastase-inhibitor complex: correlation with clinical indices and subgingival flora

This investigation analyzed, in a cross-sectional study, the possible relationship between gingival crevicular fluid (GCF) elastase-like protease (ELP) levels and the periodontal clinical parameters or the presence of specific bacteria in subgingival plaque. A total of 388 periodontal sites from 8 adult periodontitis patients were examined for plaque index (PII), gingival index (GI), pocket depth (PD) and alveolar bone loss (ABL). GCF ELP levels were determined as ELP alpha-1 protease inhibitor (ELP-alpha 1-PI) complex levels with a commercially available ELISA. Subgingival plaque samples were tested for the presence of Bacteroides gingivalis, B. intermedius and Actinobacillus actinomycetemcomitans by indirect immunofluorescence (IF) microscopy. GCF ELP-alpha 1-PI levels were then correlated with clinical periodontal indices and proportions of IF-positive bacteria per site. Statistically significant positive correlations were found between GCF ELP-alpha 1-PI concentrations and subgingival Bacteroides proportions. When the sites examined were analyzed depending on the level of each clinical parameter, the levels of these correlations changed. A. actinomycetemcomitans correlated highly (r = 0.716) with ABL for sites with low GI score. The correlations between GCF ELP-alpha 1-PI and B. gingivalis (r = 0.642) or B. intermedius (r = 0.774) were the highest for ABL less than or equal to 20% and PD less than or equal to 3 mm, respectively. The strong association between GCF ELP-alpha 1-PI concentrations and subgingival bacteria previously associated with advancing periodontitis indicates that measurement of GCF ELP-alpha 1-PI concentrations may be useful in the evaluation of periodontal sites, especially those with very little or no tissue destruction.     

Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients

OBJECTIVES: To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients. MATERIALS AND METHODS: Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola. RESULTS: Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p<0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p<0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028). CONCLUSION: SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP.     

Relationship of changes in interleukin-8 levels and granulocyte elastase activity in gingival crevicular fluid to subgingival periodontopathogens following non-surgical periodontal therapy in subjects with chronic periodontitis

OBJECTIVES: To determine the effect of scaling and root planing (SRP) on the interrelations of subgingival periodontopathogens and both interleukin-8 (IL-8) and granulocyte elastase activity in gingival crevicular fluid (GCF), and to assess their relations to the short-term treatment response in management of chronic periodontitis. MATERIAL AND METHODS: GCF and subgingival plaque were collected from 16 subjects with untreated chronic periodontitis at baseline and 4 weeks after SRP. IL-8 levels were determined by ELISA. Granulocyte elastase activity was analyzed with a specific substrate, pGluProVal-pNA, and the maximal rate of elastase activity (MR-EA) was calculated. 5 DNA-probes were used to detect the presence of A. actinomycetemcomitans (A. a.), B. forsythus (B.f.), P. gingivalis (P.g.), P. intermedia (P.i.), and T. denticola (T.d.), with a sensitivity = 103 cells/paper point. RESULTS: IL-8 and MR-EA levels in GCF decreased significantly after SRP (p < 0.001) with a corresponding reduction of total count of the species. Of the sites with probing depth (PD) >/= 5.0 mm and co-infection by B.f., P.g., P.i. & T.d. at baseline, the sites without persistent co-infection of these species after SRP exhibited a significant reduction of IL-8 levels (p < 0.02), MR-EA levels (p < 0.02) and PD (p < 0.01). No such change was found in the sites where such a co-infection persisted. Moreover, reduction of IL-8 levels in those pocket sites was accompanied by a concomitant reduction of MR-EA (p < 0.02) and PD (p < 0.01), while no significant change in MR-EA levels and PD was noted in those pocket sites that exhibited an increase of IL-8 levels after SRP. At baseline, the former group of sites showed significantly higher IL-8 levels than the latter group of sites (p < 0.02). CONCLUSIONS: IL-8-related granulocyte elastase activity was related to the change in infection patterns of the target periodontopathogens following scaling and root planing. Varying initial IL-8 levels in GCF and a corresponding shifting change of granulocyte elastase activity in GCF may characterize the different short-term treatment responses.     

Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study

BACKGROUND: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. METHODS: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) > or =5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. RESULTS: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. Moreover, the PD was reduced in the SRP + CHX treatment group compared to the SRP treatment group at 3 and 6 months, whereas the RAL was similar for both treatments at 3 months and was reduced in the SRP + CHX treatment group at 6 months. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001). The TBCs decreased significantly with both treatments. A similar, although less evident, pattern was noted when only the pockets with an initial PD > or =7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and 1 month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P <0.01 and P <0.05, respectively). Over time, both treatments generally reduced the percentages of sites positive for the eight putative periodontopathic bacteria, although greater reductions were seen often for the SRP + CHX treatment group. CONCLUSIONS: The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota.     

光动力疗法辅助治疗Ⅲ期、Ⅳ期牙周炎的临床效果评价

目的: 探讨光动力疗法（photodynamic therapy,PDT）辅助龈下刮治术（subgingival scaling and root planning,SRP）在Ⅲ、Ⅳ期牙周炎治疗中的临床效果。方法: 根据2018年牙周病新分类,选择Ⅲ期和Ⅳ期牙周炎患者,经龈上洁治1周后,记录牙周探诊深度（probing depth, PD）、牙龈指数（gingival index, GI）和探诊出血（bleeding on probing,BOP）为基线。将患者分为3组,SRP组进行SRP治疗;PDT1组在SRP后即刻对口内所有PD≥5 mm的位点进行PDT;PDT2组在SRP+PDT后6周,对原位点再进行1次PDT。基线治疗后3、6个月复查,比较PD、GI和BOP阳性率的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果: 共纳入30例患者、1 289个位点。SRP组、PDT1组和PDT2组各10例患者,位点数分别为476个（36.9%）、384个（29.8%）和429个（33.3%）。3组治疗后3个月、6个月复查时,PD、GI、BOP阳性率较基线均显著降低（P<0.05）; 6个月与3个月的复查结果无显著差异。PD≥5 mm的位点,PDT1组和PDT2组可以显著降低患牙的GI和BOP阳性率（P<0.05）;PD≥7 mm时,PDT2组PD显著降低（P<0.05）。结论: 对于Ⅲ、Ⅳ期牙周炎,PDT辅助SRP治疗可以获得比单纯SRP更好的临床效果。     

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.     

米诺环素对慢性牙周炎辅助治疗的疗效观察

目的 评价牙周袋局部应用米诺环素软膏联合刮治和根面平整治疗慢性牙周炎的疗效。方法 64名患中到重度慢性牙周炎的男性吸烟者随机分成SRP和SRP+M两组。对SRP组患者施行刮治和根面平整,对SRP+M组患者在刮治和根面平整的基础上,牙周袋局部应用米诺环素软膏。记录两组患者在基线、3个月和6个月时的菌斑指数（PlI）、牙龈指数（GI）、探诊出血（BOP）、探诊深度（PD）及附着丧失（AL）的变化并进行统计学分析。结果 治疗过程中有6例患者被排除,有效病例数为58例,每组29例。牙周治疗3个月和6个月后,两组患者的PlI、GI和BOP均无统计学差异（P>0.05）,但PD和AL有统计学差异（P<0.05）。治疗后3个月SRP组PD下降1.32 mm,AL减轻1.14 mm;而SRP+M组PD下降1.98 mm,AL减轻1.87 mm。对于基线检查PD≥7 mm的深牙周袋,治疗后3个月SRP组PD下降2.21 mm,AL减轻1.23 mm;而SRP+M组PD下降3.48 mm,AL减轻2.62 mm。治疗后6个月PD和AL状况与3个月相比变化不大。与SRP组相比,SRP+M组临床症状改善更明显。结论 龈下局部应用米诺环素软膏辅助治疗慢性牙周炎可取得较好的疗效,特别是对于有深牙周袋、吸烟的牙周炎患者,机械治疗联合局部应用缓释抗菌素较单纯机械治疗的疗效更好。     

Boric Acid Irrigation as an Adjunct to Mechanical Periodontal Therapy in Patients With Chronic Periodontitis: A Randomized Clinical Trial

Background: The purpose of this single‐masked, randomized, controlled clinical trial was to evaluate the effects of boric acid irrigation as an adjunct to scaling and root planing (SRP) on clinical and microbiologic parameters and compare this method with chlorhexidine irrigation and SRP alone in patients with chronic periodontitis (CP). Methods: Forty‐five systemically healthy patients with CP are included in this study. They were divided into three groups: 1) SRP + saline irrigation (C); 2) SRP + chlorhexidine irrigation (CHX); and 3) SRP + boric acid irrigation (B). To determine an ideal concentration of boric acid, a preclinical analysis was conducted. At baseline, 1 month, and 3 months after treatment, clinical measurements, including plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), were performed, and subgingival plaque samples were taken. Quantitative analysis of Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Treponema denticola (Td) was performed using real‐time polymerase chain reaction (PCR) procedures. Results: The concentration of boric acid is 0.75% in this study. All clinical parameters showed statistically significant reduction at all time points compared to baseline in all groups (P <0.001). Whole‐mouth PD and CAL reduction was similar in all groups at all time points after treatment (P >0.05). The PD and CAL reductions for moderately deep pockets (PD ≥5 and <7) were greater in the B group compared to other groups between baseline and 1 month (P <0.05). For deep pockets (PD ≥7), reductions were similar in the B and CHX groups (P >0.05). BOP (percentage) was significantly lower in the B group compared with the CHX and C groups in the first month after treatment (P <0.001). GI and PI scores were significantly lower in the B and CHX groups compared with the C group at all time points after treatment (P <0.05). The amounts of Pg, Tf, and Td were significantly reduced in all treatment groups after 1 month (P <0.05). No statistically significant differences were detected among the groups for microbiologic parameters at any time points after treatment (P >0.05). Conclusions: The results of this study suggest that boric acid could be an alternative to chlorhexidine, and it might be more favorable because boric acid was superior in whole‐mouth BOP as well as PD and CAL reduction for moderate pockets in early time periods.     

Povidone-iodine used as an adjunct to non-surgical treatment of furcation involvements

BACKGROUND: The aim of this clinical trial was to evaluate the effect of topically applied povidone-iodine (polyvinylpyrrolidone and iodine [PVP-I]) used as an adjunct to non-surgical therapy of furcation involvements. METHODS: Forty-four patients presenting at least one Class II furcation involvement that bled on probing with probing depth (PD)>or=5 mm were recruited. Patients were stratified into two treatment groups: 1) subgingival instrumentation by an ultrasonic device using PVP-I (10%) as the cooling liquid (test); and 2) identical treatment using distilled water as the cooling liquid (control). The following clinical outcomes were evaluated: plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PD, and relative horizontal attachment level (RHAL). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test was used to analyze the trypsin-like activity in dental biofilm. The clinical and biochemical parameters were evaluated at baseline and 1, 3, and 6 months after therapy. RESULTS: Both groups had similar means of PD reduction and RAL and RHAL gain. At 6 months, these variables were, respectively, 2.31, 1.17, and 1.00 mm in the control group and 2.31, 1.23, and 1.02 mm in the test group. There was also no difference between groups regarding the number of furcation sites presenting RAL gain>or=2 mm. The results of the BAPNA test failed to demonstrate significant differences between groups. CONCLUSION: Non-surgical therapy can effectively treat Class II furcation involvements, and the use of topically applied PVP-I as an adjunct to subgingival instrumentation does not provide additional benefits.     

Changes in subgingival microflora and humoral immune response following periodontal therapy

OBJECTIVES: To investigate the effect of scaling and root planing (SRP) on the microflora and humoral immune response in adult periodontitis. MATERIALS & METHODS: Clinical measurements, subgingival plaque samples, gingival crevicular fluid and sera were taken from 4 sites in 28 adult periodontitis patients before and after SRP. Polymerase chain reaction was used to determine the presence of A. actinomycetemcomitans, P. gingivalis, B. forsythus, P. intermedia, and T. denticola. ELISA was used to investigate the systemic and local antibody titres to these organisms, and thiocyanate dissociation for the determination of serum antibody avidity. RESULTS: SRP produced a good clinical improvement. On a subject basis there was little significant change in the microflora. However, on a site basis, there were significant reductions in P. intermedia, B. forsythus and T. denticola. There was little change in systemic and local antibody titres following SRP, although there was a significant reduction in antibody avidity to P. gingivalis and P. intermedia CONCLUSION: Post-therapy clinical improvement was associated with a reduction in bacterial prevalence, but statistical significance was only reached at a site level and this microbial reduction was not significant for all organisms. No significant post-therapy effects on the humoral immune response were noted other than a reduced antibody avidity to P. gingivalis and P. intermedia. The lack of a clear pattern in the humoral immune response may reflect a failure of the host response to produce adequate levels of biologically functional antibodies, and complex interactions between the subgingival flora and the host response.     

Repeated local metronidazole-therapy as adjunct to scaling and root planing in maintenance patients

The purpose of this investigation was to evaluate the effect of local antibiotic therapy with metronidazole adjunctively to scaling and root planing (SRP) versus mechanical treatment alone. 30 maintenance-patients were included in this single-blind study. The subjects had to comply with the following criteria: 2 non-adjacent sites with a probing depth > or =6 mm with bleeding on probing in separate quadrants, no periodontal therapy within the last 3 months, and no antibiotic therapy within the last 6 months. After randomization, the study sites were assigned to one of the following 2 treatments: SRP plus subgingival application of metronidazole 25% dental gel (Elyzol) 5x during 10 days (test site) or SRP alone (control site). Subgingival microbiological samples were taken prior to, and 21 days and 3 months after scaling. The samples were analyzed with a commercial chair-side ELISA (Evalusite) for Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans. Probing pocket depth (PPD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and 3 months later. PPD reduction and AL-gain were statistically significant (p<0.001) after both treatments. However, there were no statistically significant differences between them. The same observation was made for BOP. P. gingivalis was reduced significantly after both treatments without statistically significant differences. P. intermedia was reduced significantly only after SRP. A. actinomycetemcomitans was not reduced significantly after either treatment. In conclusion, the repeated local application of metronidazole as an adjunct to SRP and the mechanical treatment alone showed similar clinical and microbiological effects without statistically significant differences with the exception of P. intermedia.     

Longitudinal clinical evaluation of adjunct minocycline in the treatment of chronic periodontitis

BACKGROUND: The clinical benefits of minocycline in combination with thorough scaling and root planing (SRP) have been examined in multicenter studies. The aim of this longitudinal investigation was to evaluate the clinical response to scaling and root planing combined with the use of locally delivered minocycline microspheres for 720 days in individuals with advanced chronic periodontitis. METHODS: A total of 26 individuals aged 26 to 69 years (mean: 46.8+/-12.1 years) were included in this double-blind randomized clinical trial. After randomization, 13 individuals were selected for the test group (TG) and treated with SRP plus subgingival minocycline at baseline and 90, 180, and 270 days, and 13 individuals were selected for the control group (CG) and received SRP plus vehicle at the same timepoints. Two homologous sites with probing depth (PD)>or=6 mm were chosen in each subject. To evaluate the clinical response after treatment, PD, plaque index (PI), and gingival index (GI) were assessed at baseline and 90, 180, 270, 360, and 720 days. RESULTS: No statistical differences were found between test and control groups in relation to PD at the different timepoints. The mean values of PD demonstrated a higher reduction in the test group at 270 and 360 days. No statistical differences were observed at 90, 180, and 720 days between TG and CG (P<0.05; Wilcoxon test). There were no statistically significant differences between TG and CG concerning PI and GI (P<0.05; analysis of variance and t test) at all evaluated timepoints. CONCLUSION: Our findings demonstrated that both therapies reduced mean PD from 90 to 360 days; however, SRP combined with the use of subgingival minocycline showed a higher reduction at 270 and 360 days following therapy.     

Timing affects the clinical outcome of adjunctive systemic antibiotic therapy for generalized aggressive periodontitis

BACKGROUND: Systemic antibiotics improve the outcome of scaling and root planing (SRP) in patients exhibiting severe periodontitis. This study evaluated the influence of timing of adjunctive systemic antibiotics in the sequence of periodontal therapy. METHODS: Two cohorts of patients with generalized aggressive periodontitis and treated by SRP, adjunctive antibiotics, and supportive periodontal therapy (SPT) were analyzed retrospectively. Cohort A (17 patients; 36 +/- 5 years of age) received systemic amoxicillin/metronidazole immediately after SRP ("immediate"); cohort B (17 patients; 36 +/- 4 years of age) received the same regimen 3 months after SRP, following SPT, including subgingival reinstrumentation ("late"). Clinical parameters, including probing depth (PD), relative attachment level (RAL), bleeding on probing (BOP), and suppuration, were recorded with a pressure-sensitive electronic probe at baseline and 3 and 6 months after SRP. RESULTS: Significant time*group interactions were found for all clinical parameters except BOP, i.e., timing of antibiotic therapy affected the course of clinical changes over time. Immediate antibiotic therapy produced significantly higher initial changes (0 to 3 months) in PD and RAL. Late antibiotic therapy at 3 months resulted in additional significant improvements in all clinical parameters between 3 and 6 months. In initially deep sites (baseline PD >6 mm), improvements in PD and RAL over 6 months were significantly higher with immediate antibiotic therapy compared to late antibiotic therapy. CONCLUSION: Within the limits of a retrospective analysis, these findings indicate that administration of amoxicillin/metronidazole immediately after initial SRP provides more PD reduction and RAL "gain" in initially deep sites than late administration at SPT with reinstrumentation after 3 months.     

Relationship of subgingival and salivary microbiota to gingival overgrowth in heart transplant patients following cyclosporin A therapy

BACKGROUND: Severe gingival overgrowth (GO) is induced in patients taking cyclosporin A (CsA) following organ transplantation. Determining which patient will develop GO is still not possible. The purpose of this study was to establish an association between CsA and gingival overgrowth in heart transplant patients taking into account periodontal and microbiological conditions. METHODS: Thirty patients (10 female, 20 male; range: 13 to 67 years; mean age: 44.89) undergoing CsA treatment were evaluated using the gingival index (GI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Subgingival samples collected from the deepest site of each quadrant and saliva samples were submitted to microbial analysis. All patients had at least 12 teeth. Exclusion criteria were the use of antibiotics and/or having undergone periodontal treatment 6 months prior to the study. Patients were divided in two groups: with gingival (GO+) and without gingival overgrowth (GO-). RESULTS: There were no statistically significant differences between the GO+ and GO- groups when CsA dosage, time since transplant, GI, PI, PD, and CAL were compared. Microbiological examination of the subgingival samples detected the following microorganisms: Actinobacillus actinomycetemcomitans (23%), Porphyromonas gingivalis (36%), Prevotella intermedia (93%), Fusobacterium sp. (66%), Campylobacter rectus (30%), Micromonas micros (66%), enteric rods (0%), and yeasts (30%). A positive association between M. micros and the GO+ group was found (P < 0.001). Yeasts were detected in 30% of the subgingival and saliva samples. CONCLUSIONS: Clinical parameters were not sufficient to determine which patients would develop GO. However, colonization by M. micros might play a role in the etiology of GO.     

The effects of adjunctive use of a desiccant agent in the treatment of stage III periodontitis (Randomized controlled clinical trial)

IntroductionSeveral bacterial species inhabiting the dental plaque biofilms are associated with periodontitis.ObjectiveThe main objective of this study was to compare the efficacy of the desiccant agent HYBENX (HBX) as an adjunct to scaling and root planning (SRPX) versus scaling and root planning (SRP) alone in the treatment of periodontitis.Materials and MethodsThe study sample comprised 25 patients with periodontitis stage Ш (grades A and B). Each maxillary quadrant was randomly allocated to two groups: SRPX group, including 25 quadrants treated with SRP plus HYBENX, and SRP group, including 25 quadrants treated with SRP alone. The following clinical periodontal parameters were recorded at baseline (immediately after treatment, T0), and 1 month (T1), 3 months (T3), and 6 months (T6) after treatment: probing pocket depth (PPD), relative attachment level (RAL), plaque index (PLI), gingival index (GI), gingival height (GH), and bleeding on probing index (BOP).ResultsComparisons within each study group showed that all clinical parameters significantly improved (P < 0.001) at all follow-up intervals. In contrast, a statistically significant difference (P < 0.001) was observed in RAL, PPD, BOP, and GI indices at all follow-up intervals between the SRPX and SRP groups. In contrast, no significant differences (P > 0.05) were found in GH and PLI between the study groups.ConclusionBoth treatment groups showed improved periodontal parameters. However, applying desiccant gel as an adjunct to SRP was significantly effective in the treatment of stage III periodontitis.     

Efficacy of Subgingivally Delivered 1.2% Atorvastatin in the Treatment of Chronic Periodontitis in Patients With Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial

Background: The present study was designed to evaluate effectiveness of 1.2% atorvastatin (ATV) gel, as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects in chronic periodontitis (CP) in patients with type 2 diabetes mellitus (t2DM). Methods: Seventy‐five patients were categorized into two treatment groups: 1) SRP plus 1.2% ATV and 2) SRP plus placebo. Clinical parameters including modified sulcus bleeding index, probing depth (PD), and relative attachment level (RAL) were recorded at baseline and 3, 6, and 9 months. Percentage radiographic defect depth reduction was evaluated using computer‐aided software at baseline and 6 and 9 months. Results: Mean PD reduction and mean RAL gain was greater in the ATV group than the placebo group at 3, 6, and 9 months. Furthermore, ATV group sites presented with a significantly greater percentage of radiographic defect depth reduction at 6 and 9 months. Conclusion: Locally delivered ATV was found to be effective in treatment of intrabony defects in CP in patients with t2DM.     

Adjunctive antimicrobial therapy of periodontitis: long-term effects on disease progression and oral colonization

BACKGROUND: This study assessed the long-term effects of adjunctive antimicrobial therapy on periodontal disease progression and oral colonization. METHODS: Patients with previously untreated chronic periodontitis and subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to subgingival scaling without (control group) or with systemic amoxicillin plus metronidazole and CHX irrigation (test group). Relative attachment levels were determined and subgingival and mucosal plaque samples were taken at baseline, at 10 days (plaque only) and at 3, 6, 9, 12, 18, and 24 months following initial therapy. During maintenance therapy, patients received supragingival debridement only. RESULTS: After 24 months, the 18 test group patients showed at sites with initial probing depths (PD) > or =7 mm a significantly (P <0.05) higher frequency of 2 mm or more attachment gain (37.3% +/- 4.6%) and lower frequency of attachment loss (7.2% +/- 3.1%) compared to the 17 controls (8.2% +/- 3.9% and 19.1% +/- 13.1%, respectively). Compared to controls, the intraoral prevalence of A. actinomycetemcomitans (up to 18 months) and P. gingivalis (up to 3 months) decreased and that of Eikenella corrodens (at 10 days) increased in test patients (P <0.05). In both treatment groups, the detection frequency of Tannerella forsythensis decreased transiently, while an overall increase was recorded for Treponema ssp. CONCLUSIONS: Over the 24-month period, a single course of the administered adjunctive antimicrobial therapy led to a relative risk reduction of 62% for attachment loss at deep sites. However, with the exception of A. actinomycetemcomitans, it failed to induce long-term changes in the prevalence profiles of oral colonization.