Adjunctive Application of Systemic Antibiotics in Non-surgical Aggressive Periodontitis Treatment: Clinical and Microbiological Findings
Keywords:periodontal disease, aggressive periodontitis, non-surgical periodontal treatment, antibiotics
BACKGROUND: Aggressive periodontitis (AgP) is associated with an extensive and rapid destruction of periodontal tissues. Unpredictable treatment outcomes of the disease are consequences of various cross-linked factors. Antimicrobial adjunctive treatment is routinely used as a part of non-surgical periodontal treatment (NSPT) of AgP.
AIM: Therefore, the aim of this study was to compare the effects of active periodontal treatment (APT) combined with systemic antibiotics with mechanical debridement alone, in patients with generalized AgP (GAgP).
METHODS: Two groups, consisting of 10 participants each, were randomly formed. Both groups were clinically and microbiologically tested and monitored for 3 months. Test group received APT with antimicrobial supplementation (amoxicillin and metronidazole [AMX-MET]). Patients from the control group were treated by APT only. Clinical and microbiological parameters were recorded at baseline and 3 months following the NSPT. Clinical measurements involved probing depth, clinical attachment level, bleeding on probing, and plaque index. Samples of subgingival crevicular fluid were analyzed by qualitative polymerase chain reaction.
RESULTS: Significant improvement of all clinical parameters was observed 3 months following the NSPT (p < 0.05), but significant difference between groups was not found (p > 0.05). Periodontal pathogens’ detection between baseline and 3 months follow-up was also not statistically significant in both examined groups (p > 0.05).
CONCLUSION: Similarity of results obtained in both treatment groups underlined the key role of APT in the treatment of AgP. The AMX-MET supplementation did not improve clinical and microbiological outcomes, when compared to APT alone. Longer follow-up period, with larger sample, could provide a more comprehensive insight into this issue.
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Armitage GC, Cullinan MP, Seymour GJ. Comparative biology of chronic and aggressive periodontitis: Introduction. Periodontol 2000. 2010;53(1):7-11. https://doi.org/10.1111/j.1600-0757.2010.00359.x PMid:20403101
Albandar JM. Aggressive periodontitis: Case definition and diagnostic criteria. Periodontol 2000. 2014;65(1):13-26. https://doi.org/10.1111/prd.12014 PMid:24738584
Harks I, Koch R, Eickholz P, Hoffmann T, Kim TS, Kocher T, et al. Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial. J Clin Periodontol. 2015;42(9):832-42. https://doi.org/10.1111/jcpe.12441 PMid:26250060
Aimetti M, Romano F, Guzzi N, Carnevale G. One-stage full mouth disinfection as a therapeutic approach for generalized aggressive periodontitis. J Periodontol. 2011;82(6):845-53. https://doi.org/10.1902/jop.2010.100468 PMid:21091345
Van der Velden U. What exactly distinguishes aggressive from chronic periodontitis: Is it mainly a difference in the degree of bacterial invasiveness? Periodontol 2000. 2017;75(1):24-44. https://doi.org/10.1111/prd.12202 PMid:28758297
Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25(2):135-44. https://doi.org/10.1111/j.1600-051x.1998.tb02419.x PMid:9495612
Teughels W, Dhondt R, Dekeyser C, Qurynen M. Treatment of aggressive periodontitis. Periodontol 2000. 2014;65(1):107-33. https://doi.org/10.1111/prd.12020 PMid:24738589
Scharf S, Wohlfeil M, Siegelin Y, Schacher B, Dannewitz B, Eickholz P. Clinical results after nonsurgical therapy in aggressive and chronic periodontitis. Clin Oral Investig. 2014;18(2):453-60. https://doi.org/10.1007/s00784-013-1013-4 PMid:3749245
Mestnik MJ, Feres M, Figueiredo LC, Duarte PM, Lira EA, Faveri M. Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis. J Clin Periodontol. 2010;37(4):353-65. https://doi.org/10.1111/j.1600-051x.2010.01538.x PMid:20447259
Casarin RC, Ribeiro ED, Sallum EA, Nociti FH Jr., Goncalves RB, Casati MZ. The combination of amoxicillin and metronidazole improves clinical and microbiologic results of one-stage, full-mouth, ultrasonic debridement in aggressive periodontitis treatment. J Periodontol. 2012;83(8):988-98. https://doi.org/10.1902/jop.2012.110513 PMid:22288485
Ardila CM, Martelo-Cadavid JF, Boderth-Acosta G, Ariza Garces AA, Guzman IC. Adjunctive moxifloxacin in the treatment of generalized aggressive periodontitis patients: Clinical and microbiological results of a randomized, triple blind and placebo-controlled clinical trial. J Clin Perodontol. 2015;42(2):160-8. https://doi.org/10.1111/jcpe.12345 PMid:25469723
Teughels W, Feres M, Oud V, Martin C, Matesanz P, Herrera D. Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta-analysis. J Clin Periodontol. 2020;47(22):257-81. https://doi.org/10.1111/jcpe.13264 PMid:31994207
Borges I, Faveri M, Figueiredo LC, Duarte PM, Retamal-Valdes B, Montenegro SC, et al. Different antibiotic protocols in the treatment of severe chronic periodontitis: A 1-year randomized trial. J Clin Periodontol. 2017;44(8):822-32. https://doi.org/10.1111/jcpe.12721 PMid:28303587
Emingil G, Han B, Ozdemir G, Tervahartiala T, Vural C, Atilla G, et al. Effect of azithromycin, as an adjunct to nonsurgical periodontal treatment, on microbiological parameters and gingival crevicular fluid biomarkers in generalized aggressive periodontitis. J Periodontal Res. 2012;47(6):729-39. https://doi.org/10.1111/j.1600-0765.2012.01488.x PMid:22571226
Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: A randomized placebo-controlled clinical trial. J Clin Periodontol. 2005;32(10):1096-107. https://doi.org/10.1111/j.1600-051x.2005.00814.x PMid:16174275
Guerrero A, Nibali L, Lambertenghi R, Ready D, Suvan J, Griffiths JD, et al. Impact of baseline microbiological status on clinical outcomes in generalized aggressive periodontitis patients treated with or without adjunctive amoxicillin and metronidazole: An exploratory analysis from a randomized controlled clinical trial. J Clin Periodontol. 2014;41(11):1080-9. https://doi.org/10.1111/jcpe.12299 PMid:25139116
Khattri S, Nagraj SK, Arora A, Eachempati P, Kusum CK, Bhat KG, et al. Adjunctive systemic antimicrobials for the non surgical treatment of periodontitis. Cochrane Database Syst Rev. 2020;11:CD012568. https://doi.org/10.1002/14651858.cd012568.pub2 PMid:33197289
Haas AN, Silva-Boghossian CM, Colombo AP, Susin C, Albandar JM, Oppermann RV, et al. Adjunctive azithromycin in the treatment of aggressive periodontitis: Microbiological findings of a 12-month randomized clinical trial. J Dent. 2012;40(7):556-63. https://doi.org/10.1016/j.jdent.2012.03.004 PMid:22445846
Jentsch HF, Buchmann A, Friedrich A, Eick S. Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole. Clin Oral Investig. 2016;20(7):1765-73. https://doi.org/10.1007/s00784-015-1683-1 PMid:26685849
Araujo CF, Andere NM, Dos Santos NC, Mathias-Santamaria IF, Reis AA, de Oliveira RD, et al. Two different antibiotic protocols as adjuncts to one-stage full-mouth ultrasonic debridement to treat generalized aggressive periodontitis: A pilot randomized controlled clinical trial. J Periodontol. 2019;20(12):1431-40. https://doi.org/10.1002/jper.18-0399 PMid:31257591
Shaddox LM, Walker C. Microbial testing in periodontics: Value, limitations and future directions. Periodontol 2000. 2009;50:25-38. https://doi.org/10.1111/j.1600-0757.2008.00285.x PMid:19388951
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1-6. PMid:10863370
Noordhoek GT, Kaan JA, Mulder S, Wilke H, Kolk AH. Routine application of the polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples. J Clin Pathol. 1995;48(9):810-4. https://doi.org/10.1136/jcp.48.9.810 PMid:7490312
Aimetti M, Romano F, Guzzi N, Carnevale G. Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: A randomized, placebo-controlled trial. J Clin Periodontol. 2012;39(3):284-94. https://doi.org/10.1111/j.1600-051x.2011.01795.x PMid:22220822
Guerrero A, Echeverria JJ, Tonetti MS. Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients: Apilot retrospective study. J Clin Periodontol. 2007;34(10):897-902. https://doi.org/10.1111/j.1600-051x.2007.01130.x PMid:17711478
Rodrigues AS, Lourencao DS, Neto LG, Pannuti CM, Hirata RD, Hirata MH, et al. Clinical and microbiologic evaluation, by real time polymerase chain reaction, of non-surgical treatment of aggressive periodontitis associated with amoxicillin and metronidazole. J Periodontol. 2012;83(6):744-52. https://doi.org/10.1902/jop.2011.110333 PMid:22060046
Heller D, Varrela VM, Silva-Senem MX, Torres MC, Feres Filho EJ, Colombo AP. Impact of systemic antimicrobials combined with anti-infective mechanical debridement on the microbiota of generalized aggressive periodontitis: A 6-month RCT. J Clin Periodontol. 2011;38(4):355-64. https://doi.org/10.1111/j.1600-051x.2011.01707.x PMid:21303403
Sjödin B, Matsson L, Unell L, Egelberg J. Marginal bone loss in the primary dentition of patients with juvenile periodontitis. J Clin Periodontol. 1993;20(1):32-6. https://doi.org/10.1111/j.1600-051x.1993.tb01756.x PMid:8421113
Miller KA, Branco-de-Almeida RS, Wolf S, Hovencamp N, Treloar T, Harrison P, et al. Long-term clinical response to treatment and maintenance of localized aggressive periodontitis: A cohort study. J Clin Periodontol. 2017;44(2):158-68. https://doi.org/10.1111/jcpe.12640 PMid:27767222
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