Locally delivered doxycycline as an adjunct to mechanical debridement at retreatment of periodontal pockets

BACKGROUND: The aim of this study was to evaluate if adjunctive, locally delivered controlled-release doxycycline might improve the outcome of reinstrumentation of pathologic pockets persisting after initial periodontal therapy. METHODS: Subjects with chronic periodontitis underwent initial treatment including full-mouth ultrasonic debridement and oral hygiene instructions. At the 3-month reexamination, 32 subjects with remaining pathologic sites were assigned randomly to one of two retreatment protocols: ultrasonic instrumentation alone (control) or ultrasonic instrumentation plus application of an 8.8% doxycycline gel (test). Clinical examinations of plaque, probing depth (PD), relative attachment level (RAL), and bleeding on probing were performed before retreatment (baseline) and after 3 and 9 months. Primary efficacy variables were the percentage of closed pockets, i.e., PD < or =4 mm, and changes in PD and RAL. RESULTS: Baseline examination revealed no significant difference in mean PD between treatment groups. The mean PD reduction at 3 months was 0.9 mm (95% confidence interval [CI]: 0.6 to 1.2) in the control group and 1.0 mm (95% CI: 0.7 to 1.3) in the test group (P >0.05). At 9 months, both treatment groups showed a mean PD reduction of 1.1 mm. The mean RAL gain was 0.6 mm at 3 months and approximately 0.8 at 9 months for both groups. The probability of pocket closure was not improved by the adjunctive antibiotic therapy. Only factors at the tooth site level (plaque presence, furcation involvement, and presence of an intrabony defect) were identified by multilevel analysis as significant for the treatment outcome. CONCLUSION: Locally delivered doxycycline failed to improve the healing outcome of reinstrumentation of periodontal pockets showing a poor initial response to pocket/root debridement.     

Tetracycline gel as an adjunct to surgical root debridement

PURPOSE: To evaluate the influence of tetracycline gel, brushed on tooth surfaces, on periodontal clinical parameters following root debridement. METHODS: 20 subjects diagnosed with chronic periodontitis and presenting a minimum of two proximal sites on anterior teeth (maxillary or mandibular) with probing depth +/- 5 mm, were selected. Following oral hygiene instructions and ultrasonic supragingival instrumentation, subjects were assigned to one of the following groups: RDS--root debridement with Gracey curettes and root brushing with saline solution; and RDT--root debridement with Gracey curettes and root brushing with 40% tetracycline gel. Full-thickness flaps were reflected and instrumentation was performed using a clinical microscope to optimize calculus detection. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) measures were registered at five visits: baseline and days 30, 60, 90 and 120 postoperative. RESULTS: Both approaches were able to markedly reduce the PD values from baseline in all periods (P < 0.0001). No differences were found for RAL values in any of the groups. No differences were found between groups. In conclusion, the application of tetracycline gel does not seem to provide any additional improvement on clinical periodontal parameters after root debridement.     

Topical metronidazole as an adjunct to subgingival debridement in the treatment of chronic periodontitis

Abstract The purpose of this study was to evaluate the clinical effects of a single application of a 5% metronidazole collagen device in periodontal pockets deeper than 5 mm, in association with debridement and without reinforcement of home care and hygiene as practiced by the patient at any time. Pocket depth, attachment level, bleeding on probing, gingival index and plaque index were assessed at baseline, and on days 15, 30 and 90. Analysis of data from 28 patients indicated the both debridement and metronidazole therapy decreased pocket depth, bleeding on probing and gingival index, but results were significantly better with metronidazole. These results indicate that topical metronidazole provides an effective adjunctive treatment of advanced periodontitis.     

Citric acid as an adjunct to periodontal surgery

This review focuses on the effect of acid demineralisation of the root surface as an adjunct to periodontal surgery in order to obtain new attachment. Several animal studies have shown that the treatment facilitates attachment of connective tissue to the root surface. Clinical studies, however, have failed to demonstrate the effectiveness of citric acid as an adjuvant to surgical debridement.     

The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment

Background: The aim of this study is to evaluate the effect of low‐level laser therapy (LLLT) as an adjunct to non‐surgical periodontal therapy of smoking and non‐smoking patients with moderate to advanced chronic periodontitis. Methods: All 36 systemically healthy patients who were included in the study initially received non‐surgical periodontal therapy. The LLLT group (n = 18) received GaAlAs diode laser therapy as an adjunct to non‐surgical periodontal therapy. A diode laser with a wavelength of 808 nm was used for the LLLT. Energy density of 4 J/cm² was applied to the gingival surface after periodontal treatment on the first, second, and seventh days. Each of the LLLT and control groups was divided into two groups as smoking and non‐smoking patients to investigate the effect of smoking on treatment. Gingival crevicular fluid samples were collected from all patients and clinical parameters were recorded on baseline, the first, third, and sixth months after treatment. Matrix metalloproteinase‐1, tissue inhibitor matrix metalloproteinase‐1, transforming growth factor‐β1, and basic‐fibroblast growth factor levels in the collected gingival crevicular fluid were measured. Results: The primary outcome variable in this study was change in gingival bleeding and inflammation. At all time points, the LLLT group showed significantly more improvement in sulcus bleeding index (SBI), clinical attachment level, and probing depth (PD) levels compared to the control group (P <0.001). There were clinically significant improvements in the laser‐applied smokers' PD and SBI levels compared to smokers to whom a laser was not applied, between the baseline and all time points (P <0.001) (SBI score: control group 1.12, LLLT group 1.49; PD: control group 1.21 mm, LLLT group 1.46 mm, between baseline and 6 months). Transforming growth factor‐β1 levels and the ratio of matrix metalloproteinase‐1 to tissue inhibitor matrix metalloproteinase‐1 decreased significantly in both groups at 1, 3, and 6 months after periodontal therapy (P <0.001). Basic‐fibroblast growth factor levels significantly decreased in both groups in the first month after the treatment, then increased in the third and sixth months (P <0.005). No marker level change showed significant differences between the groups (P <0.05). Conclusion: LLLT as an adjunctive therapy to non‐surgical periodontal treatment improves periodontal healing.     

局部应用甲硝唑辅助治疗深牙周袋的疗效分析

目的：比较局部应用25％甲硝唑牙科用凝胶剂（依俐周）辅助龈下刮治与单纯龈下刮治,治疗深牙周袋的疗效。方法：18例中,重度成人牙周炎患者,选择其左右侧对应牙,牙周袋探诊深度（Probing Depth,PD)大于等于7mm但小于等于10mm,且探诊出血的位点,进行随机,单盲,对照试验,0天时试验牙接受龈下刮治及依俐周局部用药,对照牙只接受龈下刮治,于基线,后线,治疗后21天,91天,时,进行PD和柏出血（Bleebing On Probing BOP)及龈下菌斑涂片检查,结果：依俐周局部用药部位,其D害治疗后91天,改善了2．91mm,明显大于对照组改善值1．83mm,治疗后21天,试验组BOP由基线时的100．0降至86．4％,而对照组BOP无明显改善,治疗后21天试验组龈下菌斑中螺旋体的百分离由基线之24．1％降至6．2％,而对照组无显著变化。结论：局部应用25％甲硝唑牙科用凝胶辅助龈下辞治疗 深牙周袋,可获得较好的临床效果。     

On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets

In a previous study, we observed that root debridement was inefficient in eliminating Actinobacillus actinomycetemcomitans from adult periodontitis lesions. The present report describes the effects on A. actinomycetemcomitans of subsequent treatments of 6 patients that had at least 2 separate sites still harboring A. actinomycetemcomitans 6 months following debridement. 1 site or more in each individual was treated with renewed root debridement and at least 1 other site was treated by surgical excision of the gingival tissue. The results indicated that retreatment with either repeated root debridement or with surgical excision of the gingival tissue was not more effective in eliminating A. actinomycetemcomitans than initial debridement. The possible reasons for this limited therapeutic effect on the subgingival presence of A. actinomycetemcomitans are discussed.     

Clinical and microbiological effects of root debridement in periodontal furcation pockets

The aim of the present study was to investigate longitudinally over 52 weeks the clinical and microbiological effects of plaque control and root debridement at molar furcation sites. The results were compared with changes at non-molar sites. 24 non-molar sites and 31 grade II molar furcation sites with probing depth greater than or equal to 5.0 mm were monitored in 11 patients. Clinical measurements consisted of plaque scores, probing depths, and changes in probing attachment level. Microbiological monitoring was carried out with phase-contrast microscopy and anaerobic culturing. The debridement resulted in improvement in probing measurements and microbiological counts for both groups of sites. A slightly less favorable clinical response was noted for molar furcation sites. Higher post-operative microbiological counts were found throughout the 52-week observation period for molar furcation sites. Sites with probing attachment loss showed higher microbial counts and higher proportions of spirochetes, black pigmented colony forming units (CFU), and Bacteroides gingivalis CFU than sites with probing attachment gain. Individual site analysis, however, demonstrated marked variations of the microbiological counts at the different postoperative time points. In the few available sites undergoing probing attachment loss, no apparent association between target micro-organisms and periodontal deterioration was observed.     

Clinical effects of electromagnetic stimulation as an adjunct to periodontal therapy

The clinical effects of electromagnetic stimulation (EMS) on periodontal soft tissues and alveolar bone level were studied among 23 patients. The sides of the arch to receive EMS were randomly selected and exposed for a period of eight weeks following periodontal surgery. The contralateral control sides received surgery only. The electromagnetic signal was a multiple pulse signal with 21 asymmetrical quasirectangular pulses per burst and a burst frequency of 16.9 Hz. The peak magnetic field strength reached 0.46 Gauss. Changes from baseline in clinical attachment level, probing depth, and radiographic alveolar bone level were assessed at six, 12, and 18 months postsurgically. A greater gain of clinical attachment level following EMS was observed only for pockets with initial depth of 1 to 3 mm. There were no consistent differences between test (EMS) and control sides in the change of clinical attachment level or probing depth for pockets deeper than 4 mm. Radiographically, the test sides demonstrated statistically significant gain of alveolar bone level compared with the control sides at six months following surgery. Hereafter, the rates of change were similar in the stimulated and unstimulated sides, and the total gain of alveolar bone level remained greater in the test side throughout the observation period. Within the limitations of this study, it was concluded that electromagnetic stimulation does not promote gains in clinical attachment or alveolar bone level to the extent that it can be recommended as an adjunct to conventional periodontal therapy.     

Nonsurgical treatment as an adjunct to surgery

Although some temporomandibular joint problems require surgical intervention, nonsurgical modalities are essential in the treatment of most joint afflictions, including internal derangements, inflammatory conditions, and arthritides. These approaches are crucial for presurgical management of these conditions and are an important adjunct in postsurgical care.     

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.