Non-surgical periodontal therapy with adjunctive topical doxycycline: a double-blind randomized controlled multicenter study

AIM: Evaluation of the clinical effect of topical application of doxycycline adjunctive to non-surgical periodontal therapy. METHODS: A total of 111 patients suffering from untreated or recurrent moderate to severe periodontitis at 3 different centers (Heidelberg, Frankfurt, Nijmegen) were treated in this double-blind split-mouth study. In each patient, 3 different treatment modalities were assigned randomly to 3 test teeth: scaling and root planing alone (SRP), SRP with subgingival vehicle control (VEH), and SRP with subgingival application of a newly developed biodegradable 15% doxycycline gel (DOXI). At baseline, clinical parameters were measured at all single rooted teeth using a reference splint: PlI, PPD, relative attachment level (RAL-V), GI. 3 strata were generated according to baseline PPD: (i) 5-6 mm, (ii) 7-8 mm, (iii) > or =9 mm. Not more than 50% active smokers were allowed to each stratum. 3 and 6 months after therapy re-examination was performed by examiners blinded to baseline data and test sites. The statistical comparison of RAL-V gain and PPD reduction between the treatments was based on a repeated measures ANOVA with correction according to Huynh & Feldt. The comparison of SRP versus DOXI was considered as the main study question. RESULTS: 110 patients finished the 3 months and 108 the 6 months examination. The study did not show adverse effects of VEH or DOXI except for one singular inflammation that occurred 2 months after application of the doxycycline gel. DOXI provided statistically significantly more favorable PPD reduction (SRP: -2.4+/-1.4 mm, VEH: -2.7+/-1.6 mm, DOXI: -3.1+/-1.2 mm; SRP versus DOXI p=0.0001, VEH versus DOXI p=0.0066) and RAL-V gain (SRP: 1.6+/-1.9 mm, VEH: 1.6+/-2.2 mm, DOXI: 2.0+/-1.7 mm; SRP versus DOXI p=0.027, VEH versus DOXI p=0.038) than SRP and VEH after 6 months. CONCLUSIONS: Adjunctive topical subgingival application of a biodegradable 15% doxycycline gel was safe and provided more favorable RAL-V gain and PPD reduction than SRP alone and VEH. Thus, by use of topical doxycycline the threshold for surgical periodontal therapy might be moved toward deeper pockets.     

Subgingival topical doxycycline versus mechanical debridement for supportive periodontal therapy: a single blind randomized controlled two-center study

PURPOSE: To evaluate the clinical effects of topical subgingival application of a doxycycline gel compared to conventional mechanical debridement in supportive periodontal therapy. METHODS: 37 patients with residual or recurring periodontitis after systematic periodontal treatment at two centers (Heidelberg, Frankfurt) participated in this study. They had to exhibit at least one single-rooted tooth with either a probing depth (PPD) = 5 mm and bleeding-on-probing (BOP) or with PPD > or = 6 mm. The patients were randomly assigned to one of the two different treatment regimes: DOXY (exclusively subgingival application of a 14% doxycycline gel) or SRP (scaling and root planing with a sonic scaler). Clinical examinations (plaque index [P1I], PPD, vertical relative attachment level [RAL-V], gingival index [GI]) were performed before, 3, and 6 months after therapy. RESULTS: In 37 patients (19 female), aged 30-76 years with a total of 168 teeth were treated (DOXY: 79; SRP: 89). Six months after therapy, both groups exhibited statistically significant (P< 0.001) reductions of PPD (DOXY: -1.43 +/- 0.22 mm; SRP: -1.14 +/- 0.18 mm) and gains of RAL-V (DOXY: 0.79 +/- 0.22 mm; SRP: 0.72 +/- 0.19 mm). Multilevel regression analyses, considering the therapy of different numbers of teeth in different patients, failed to show statistically significant differences concerning PPD reduction and RAL-V gain between both therapies (DOXY/SRP). For both therapies, PPD reduction was significantly better in deeper pockets (PPD > or = 7 mm) than in shallow pockets (PPD: 5-6 mm).     

Periodontal status of teeth with crown–root fractures: results two years after adhesive fragment reattachment

Aim: This series of case reports evaluated the impact of adhesive crown–root fragment reattachment in periodontally healthy teeth suffering from crown–root fractures on various parameters of periodontal health over a time course of 2 years.
Material and Methods: A total of 20 teeth with crown–root fractures in 18 periodontally healthy subjects were evaluated. After open-flap access, crown–root fragments were adhesively reattached to the root stub. In all cases, the vertical difference between the alveolar bone crest and the fracture line was 1 mm, i.e. violating the biological width. Subsequently, clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BoP) and gingival index (GI) scores were recorded at 6, 12 and 24 months postoperatively for the restored teeth as well as plaque index (PlI) and periodontal screening index (PSI) values for the whole dentition.
Results: Two years after therapy, recorded CAL, PPD, BoP, GI, PlI and PSI scores revealed healthy periodontal conditions in 18 out of 20 treated teeth. Two teeth had suffered again from fragment fracture due to new traumata.
Conclusions: Adhesive fragment reattachment in periodontally healthy teeth affected by crown–root fractures had no detrimental impact on periodontal health over a time course of 2 years.     

Periodontal disease progression in subjects with orofacial clefts over a 25-year follow-up period

Aims: To assess rates of periodontal disease progression in subjects with cleft lip, alveolus and palate (CLAP) over a 25-year period without regular maintenance care in a specialist setting and to compare those with those of subjects without alveolar clefts, i.e. cleft lip (CL) or cleft palate (CP).
Material and Methods: Ten subjects with CLAP and 10 subjects with CL/CP were examined in 1979, 1987, 1993 and 2004. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP) and plaque control record (PCR) scores were recorded in all 20 subjects.
Results: High plaque and BoP scores were recorded at all examinations in both groups. Over 25 years, a statistically significant loss of mean full-mouth CAL of 1.52 ± 0.12 mm (SD) and 1.66 ± 0.15 mm occurred in the CLAP and CL/CP group respectively ( p <0.05). A statistically significant increase ( p <0.05) in mean full-mouth PPD of 0.35 ± 0.12 mm was observed in the CL/CP group, whereas only a trend for a mean full-mouth increase in PPD of 0.09 ± 0.11 mm was observed in the CLAP group. In subjects with CLAP, a statistically significant increase ( p <0.05) in PPD of 0.92 ± 1.13 mm at cleft sites was observed compared with that of 0.17 ± 0.76 mm at control sites. With respect to CAL, the loss at the corresponding sites amounted to 2.71 ± 1.46 and to 2.27 ± 1.62 mm, respectively ( p =0.36).
Conclusions: When stringent and well-defined supportive periodontal therapy was not provided, subjects with orofacial clefts were at high risk for periodontal disease progression. Over 25 years, alveolar cleft sites tended to have more periodontal tissue destruction compared with control sites.     

Clinical results after nonsurgical therapy in aggressive and chronic periodontitis

Aim

This study aims to analyze factors influencing treatment results in aggressive (AgP) and chronic (ChP) periodontitis.

Methods

ChP [probing pocket depth (PPD)?≥?3.5 mm, attachment loss?≥?5 mm at >30 % of sites; age?>?35 years] and AgP (clinically healthy; PPD?≥?3.5 mm at >30 % of sites, radiographic bone loss?≥?50 % at 2 teeth; age?≤?35 years) were examined prior and 3 months after nonsurgical therapy according to the full-mouth disinfection concept. Adjunctive systemic antibiotics were used if Aggregatibacter actinomycetemcomitans had been detected at baseline.

Results

In 31 ChP (12 female, 10 smokers; 4,808 sites) and 28 AgP (16 female, 9 smokers; 4,769 sites), overall mean PPD reductions were less favorable in AgP (0.9?±?0.5 mm) than in ChP (1.3?±?0.4 mm; p?=?0.033). PPD reductions and relative vertical probing attachment level gain were more favorable at sites with initial PPD?≥?6 mm, bleeding on probing, and for adjunctive systemic antibiotics. Furthermore, PPD reductions were more favorable for increased baseline tooth mobility and maxillary teeth, whereas AgP, female sex, and multirooted teeth were associated with less favorable PPD reduction.

Conclusion

Regarding PPD reduction, AgP responded less favorably to nonsurgical treatment than ChP.     

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.     

IL-6 and IL-8 levels in GCF of the teeth supporting fixed partial denture

Objectives:  To evaluate the gingival crevicular fluid (GCF) contents of interleukin-6 (IL-6) and interleukin-8 (IL-8) and the clinical parameters of the teeth supporting fixed partial denture (FPD) and the contralateral teeth and to assess the effect of scaling and root planning (SRP) on clinical parameters and the GCF levels of cytokines.
Materials and methods:  The study population included 23 patients. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) were recorded, and GCF samples were collected for analysis of cytokine levels from the teeth with FPD (Test Group), the contralateral teeth (Control Group) of each participant at baseline. After initial measurements, all participants received primary phase of non-surgical treatment including oral hygiene instruction and scaling and root planning (SRP). At the 1st month and the 3rd month after SRP, these procedures were repeated.
Results:  In both groups, all clinical parameters and the total amount of IL-8 showed decreases from initial to the 3rd month ( P  < 0.05), but from the 1st month to the 3rd month; PD, PI, and GI values significantly increased in the test group ( P  < 0.05).
Conclusion:  The non-surgical periodontal treatment reduced the total amount of IL-8, not IL-6, and the clinical parameters of the teeth with FPD and contralateral teeth. But, there was a trend to the higher levels of PD, PI, and GI in the teeth with FPD. Therefore, a regular program for dental prophylaxis is also important for the maintenance of periodontal health in patients with FPD.     

Antimicrobial Photodynamic Therapy as an Adjunct to Non‐Surgical Treatment of Aggressive Periodontitis: A Split‐Mouth Randomized Controlled Trial

Background: The management of aggressive periodontitis (AgP) represents a challenge for clinicians because there are no standardized protocols for an efficient control of the disease. This randomized controlled clinical trial evaluated the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in patients with AgP. Methods: Using a split‐mouth design, 20 patients with generalized AgP were treated with aPDT + SRP (test group) or SRP only (control group). aPDT was applied at four periods. All patients were monitored for 90 days. Clinical, microbiologic, and immunologic parameters were statistically analyzed. Results: In deep periodontal pocket analysis (probing depth [PD] ≥7 mm at baseline), the test group presented a decrease in PD and a clinical attachment gain significantly higher than the control group at 90 days (P <0.05). The test group also demonstrated significantly less periodontal pathogens of red and orange complexes and a lower interleukin‐1β/interleukin‐10 ratio than the control group (P <0.05). Conclusion: The application of four sessions of aPDT, adjunctive to SRP, promotes additional clinical, microbiologic, and immunologic benefits in the treatment of deep periodontal pockets in single‐rooted teeth in patients with AgP.     

Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapy

OBJECTIVES: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing - SRP). MATERIAL AND METHODS: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths >/=5 mm and with radiographic angular bone defects >3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t-tests) was used to compare response to treatment in control versus experimental sites. RESULTS: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3+/-0.5 mm for control sites and 2.0+/-0.3 mm for experimental sites. The mean CAL gain was 1.8+/-0.4 mm for control sites, and 1.4+/-0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p>0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months. CONCLUSION: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP.     

Treatment of periodontal disease by photodisinfection compared to scaling and root planing

OBJECTIVE: The aim of the present study was to compare the effectiveness of a photodisinfection process to that of scaling and root planing (SRP) for non-surgical periodontal treatment. METHODOLOGY: Thirty-three subjects with moderate to advanced periodontal disease were randomly treated in one of three study arms with either photodisinfection (PD) alone (Group 1) using a diode laser and photosensitizer combination, with SRP alone (Group 2), or with SRP and PD combined (Group 3). Clinical assessments of bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were made at baseline, three weeks, six weeks, and 12 weeks following therapy. RESULTS: No difference in any of the investigated parameters was observed at baseline between the three groups. The mean value of BOP decreased in the PD group (Group 1) from baseline by 71% at six weeks and 73% at 12 weeks, and in the SRP alone group (Group 2) from baseline by 43% at six weeks and 56% at 12 weeks. The BOP in the combined SRP + PD group (Group 3) decreased from baseline by 65% at six and 59% at 12 weeks. The sites treated with PD alone demonstrated mean CAL gains of 0.09 +/- 0.38 mm and 0.14 +/- 0.65 mm at six and 12 weeks, respectively. Those sites treated with SRP alone demonstrated mean CAL gains of 0.37 +/- 0.34 mm and of 0.36 +/- 0.35 mm at six and 12 weeks, respectively. The final group of SRP + PD demonstrated mean CAL gains of 0.92 +/- 0.62 mm and 0.86 +/- 0.61 mm at six and 12 weeks, respectively (p < 0.01 for six weeks and p < 0.02 for 12 weeks when compared to SRP alone). The sites treated with PD alone demonstrated mean PPD reductions of 0.69 +/- 0.33 mm and of 0.67 +/- 0.44 mm at six and 12 weeks, respectively. Those sites treated with SRP alone demonstrated mean PPD reductions of 0.78 +/- 0.47 mm and 0.74 +/- 0.43 mm at six and 12 weeks, respectively. The final group of SRP + PD demonstrated mean PPD reductions of 1.16 +/- 0.39 mm and 1.11 +/- 0.53 at six and 12 weeks, respectively (p < 0.06 for six weeks and p < 0.05 for 12 weeks when compared to SRP alone). CONCLUSION: Within the limits of the present study, it can be concluded that SRP combined with photodisinfection leads to significant improvements of the investigated parameters over the use of SRP alone.     

Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study

Aim: To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis.
Material and Methods: Twenty-five patients presenting at least eight teeth with a probing pocket depth (PPD) of 5 mm and bleeding on probing (BOP) were selected and randomly assigned to quadrant-wise scaling and root planing or one session of full-mouth periodontal debridement. The following clinical outcomes were assessed: plaque index, BOP, position of gingival margin, relative attachment level (RAL) and PPD. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis and Tannerella forsythia . The enzyme-linked immunosorbent assay permitted the detection of IL-1 β , prostaglandin E₂, INF- γ and IL-10 in gingival crevicular fluid (GCF). All the parameters were evaluated at baseline, and at 3 and 6 months after treatment.
Results: Both the groups had similar means of PPD reduction and attachment gain over time. Besides a significant reduction in the bacterial level after treatment in both groups, microbiological analysis failed to demonstrate significant differences between them. Finally, no difference was observed between groups with respect to the levels of inflammatory mediators in GCF.
Conclusion: Periodontal debridement resulted in a similar clinical, microbiological and immunological outcome when compared with standard scaling and root planing and therefore may be a viable approach to deal with severe chronic periodontitis.     

KTP laser therapy as an adjunctive to scaling and root planing in treatment of chronic periodontitis

Objective. The main goal of periodontal treatment is to control infection and, thereby, curb disease progression. Recent studies have suggested that the use of a laser as an adjunct to scaling and root planing (SRP) might improve the effectiveness of conventional periodontal treatment. The aim of this study was to evaluate and compare the clinical effects of potassium-titanyl-phosphate (KTP) laser therapy in the treatment of chronic periodontitis in combination with traditional SRP. Materials and methods. Twenty-four patients with untreated chronic periodontitis were treated using a split-mouth study design in which each side was randomly treated by SRP alone (control group) or KTP laser (0.8W, time on 50 ms, time off 50 ms, 30 s, 532 nm) followed by SRP (test group). In the distribution of the teeth (total = 124 teeth) in the patients, 106 (86%) were molars and 18 (14%) were premolars. The selected teeth were probed with a pressure-controlled probe, guided by stents. Clinical periodontal parameters including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were recorded at baseline and at 2 and 12 months following therapy. Results. Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). BOP and PPD reductions and PAL gains were statistically significant both between baseline and 2 months and between baseline and 12 months in both groups (p < 0.05). The test group showed a greater reduction in PPD compared to the control group (p < 0.05). In addition, the test group showed a greater probing attachment gain compared to the control group (p < 0.05). Conclusions. In patients with chronic periodontitis, clinical outcomes of conventional periodontal treatment can be improved by using an adjunctive KTP laser.     

Supportive periodontal therapy of furcation sites: non-surgical instrumentation with or without topical doxycycline

Objectives: Evaluation of the clinical effect of topical subgingival application of doxycycline gel adjunctively to scaling and root planing (SRP) at furcation sites during supportive periodontal therapy (SPT).
Material and Methods: In 39 SPT patients exhibiting at least four pockets 5 mm with bleeding on probing, SRP was rendered in all pockets 4 mm. Additionally, 14% doxycycline gel was applied subgingivally in 20 patients after random assignment (SRP&DOXY). Clinical parameters were assessed at baseline, 3, 6, and 12 months after therapy. Additional benefit of topical doxycycline was evaluated as a short-term (3 months) improvement of furcation involvement and influence on the frequency of re-instrumentation up to 12 months.
Results: A total of 323 furcation sites (class 0: 160; class I: 101; class II: 18; and class III: 44) were treated (SRP: 165, SRP&DOXY: 158). SRP&DOXY resulted in better improvement of furcation involvement than SRP alone 3 months after treatment ( p =0.041). However, SRP&DOXY failed to show a significant difference between both groups in the number of re-instrumentations.
Conclusion: Single subgingival application of doxycycline in addition to SRP had a short-term effect on furcation involvement. However, it failed to reduce the frequency of re-instrumentation up to 12 months at furcation sites.     

Open flap debridement and guided tissue regeneration after 10 years in infrabony defects

Objective: Evaluation of the 10-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) therapy of infrabony defects in a randomized controlled clinical trial.
Materials and Methods: In 16 periodontitis patients OFD or polylactide acetyltributyl citrate barriers (GTR; n =23) were assigned randomly to 44 infrabony defects. In a subgroup of 10 patients exhibiting 2 contra-lateral defects each OFD and GTR was assigned to either side (split-mouth). At baseline, 12, and 120 ± 12 months after surgery clinical parameters were obtained.
Results: Fifteen patients (41 defects) were available at 120 months. Twelve and 120 ± 12 months after therapy both groups showed statistically significant ( p <0.01) attachment gain (split-mouth: OFD: 12 months: 3.60 ± 2.67 mm; 120 months: 3.65 ± 3.36 mm; GTR: 12 months: 3.50 ± 1.90 mm; 120 months: 2.85 ± 2.24 mm; parallel: OFD: 12 months: 3.47 ± 2.80 mm; 120 months: 3.41 ± 2.75 mm; GTR: 12 months: 3.67 ± 2.11 mm; 120 months: 2.89 ± 2.12 mm). From 12 to 120 months both groups experienced insignificant attachment changes, however, six teeth (two OFD, four GTR) were lost (all for prosthodontic reasons). The study failed to show statistically significant attachment gain differences between both groups after 120 months.
Conclusions: Ten years after OFD and GTR in infrabony defects 35 of 41 teeth were still in place.     

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.     

Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis

Objective: The aim of this study was to evaluate clinical efficacy of different chlorhexidine gluconate (CHX) preparations applied subgingivally as an adjunct to scaling and root planing (SRP).

Material and methods: A total of 120 periodontal pockets was included in this randomized, controlled, split mouth designed study. According to protocols used in treatment, periodontal pockets were assigned to experimental and control groups as follows: CHX solution as an addition to SRP versus control SRP group; CHX gel as an addition to SRP versus control SRP; CHX chip as an addition to SRP versus control SRP group. Following clinical parameters were recorded at baseline, one and three months after the baseline: plaque index (PI), probing pocket depth (PPD), bleeding index (BI) and clinical attachment level (CAL).

Results: The most significant improvements were found concerning PI in CHX solution with SRP and CHX gel with SRP groups over controls at one month recall, as well as concerning BI and PPD in CHX chip with SRP group over SRP alone at three-month recall.

Conclusion: Results of this study favour combination therapy using CHX chip as an adjunct to SRP due to greater improvements in BI and PPD compared to those obtained by SRP alone in the treatment of chronic periodontitis.     

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.     

Aggressive periodontitis in an urban population in southern Brazil

BACKGROUND: There are limited data about the epidemiology and risk factors for aggressive periodontitis (AgP) in Latin American and Brazilian populations. The aim of this study was to assess the prevalence of AgP and the risk associated with demographic variables, smoking behavior, and other periodontal variables in a young urban population in southern Brazil. METHODS: A representative sample of 612 subjects aged 14 to 29 years were sampled using a multistage probability method. A full-mouth clinical examination of six sites per tooth and an interview were performed in a mobile examination center. Subjects in the age groups 14 to 19 years and 20 to 29 years were classified with AgP if they had four or more teeth with attachment loss > or =4 mm or > or =5 mm, respectively. RESULTS: AgP was found in 5.5% of the subjects. The disease occurred equally among males and females, but was twice as prevalent among non-whites than whites. In the age groups 20 to 24 years and 25 to 29 years, the AgP subjects had a significantly higher prevalence of tooth loss (90.2% versus 40.4% and 86.1% versus 43.4%, P <0.01) and mean number of missing teeth (2.6 versus 0.9 and 3.4 versus 1.5, P <0.05) than subjects without attachment loss. The AgP subjects also had significantly higher percentages of sites with dental plaque (P <0.0001), gingival bleeding (P <0.05), and supragingival calculus (P <0.0001) than normal subjects. The risk for AgP was higher in the 25- to 29-year than the 14- to 19-year age groups (odds ratio [OR] = 6.2), in the low than middle or high socioeconomic status (OR = 4.5), in moderate or heavy smokers than nonsmokers (OR = 3.1), and in subjects with > or =10% versus <10% sites with supragingival calculus (OR = 3.6). CONCLUSION: Socioeconomic status, smoking, and dental calculus were significant risk indicators of aggressive periodontitis in this population. Suitable periodontal prevention programs implementing these risk indicators may prevent or reduce the prevalence of aggressive periodontitis in this and similar populations.     

Clinical changes following four different periodontal therapies for the treatment of chronic periodontitis: 1-year results

OBJECTIVE: To compare clinical changes occurring in chronic periodontitis subjects receiving SRP alone or with systemically administered azithromycin, metronidazole or a sub-antimicrobial dose of doxycycline. MATERIAL AND METHODS: 92 chronic periodontitis subjects were randomly assigned to receive SRP alone (N=23) or combined with 500 mg azithromycin per day for 3 days (N=25), 250 mg metronidazole tid for 14 days (N=24) or 20 mg doxycycline bid for 3 months (N=20). Gingival redness, bleeding on probing, suppuration, pocket depth and attachment level were measured at baseline and 3, 6 and 12 months post therapy. The significance of changes in clinical parameters within groups over time was sought using the Friedman test and among groups using ANCOVA or the Kruskal Wallis test. RESULTS: All groups showed clinical improvements at 12 months, with subjects receiving adjunctive agents showing a somewhat better response. Sites with initial pocket depth > 6 mm showed significantly greater pocket depth reduction and greater attachment gain in subjects receiving metronidazole or azithromycin than subjects in the other groups. Some subjects showed attachment loss at 12 months in each group ranging from 15% to 39% of subjects in the SDD and SRP only groups respectively. CONCLUSION: This study, demonstrated that periodontal therapy provides clinical benefits and that antibiotics provide a clinical benefit over SRP alone, particularly at initially deeper periodontal pockets.     

Progression of chronic periodontitis can be predicted by the levels of Porphyromonas gingivalis and Treponema denticola in subgingival plaque

Introduction:  Chronic periodontitis is an inflammatory disease of the supporting tissues of the teeth associated with bacteria. Diagnosis is achieved retrospectively by clinical observation of attachment loss. Predicting disease progression would allow for targeted preventive therapy. The aim of this study was to monitor disease progression in patients on a maintenance program and determine the levels of specific bacteria in subgingival plaque samples and then examine the ability of the clinical parameters of disease and levels of specific bacteria in the plaque samples to predict disease progression.
Methods:  During a 12-month longitudinal study of 41 subjects, 25 sites in 21 subjects experienced disease progression indicated by at least 2 mm of clinical attachment loss. Real-time polymerase chain reaction was used to determine the levels of Porphyromonas gingivalis , Treponema denticola , Tannerella forsythia , Fusobacterium nucleatum , and Prevotella intermedia in subgingival plaque samples.
Results:  No clinical parameters were able to predict periodontal disease progression. In sites undergoing imminent periodontal disease progression within the next 3 months, significant partial correlations were found between P. gingivalis and T. forsythia ( r  = 0.55, P  < 0.001) and T. denticola and T. forsythia ( r  = 0.43, P  = 0.04). The odds of a site undergoing imminent periodontal disease progression increased with increasing levels of P. gingivalis and T. denticola .
Conclusion:  Monitoring the proportions of P. gingivalis and T. denticola in subgingival plaque has the potential to help identify sites at significant risk for progression of periodontitis, which would assist in the targeted treatment of disease.