Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the effects of non-surgical periodontal therapies on smokers with chronic periodontitis, involving multiple adjunctive applications of antimicrobial photodynamic therapy (aPDT), and systemic metronidazole (MTZ) with amoxicillin (AMX). METHODS: All participants were treated with scaling and root planing (SRP). Seventeen patients received 400 mg of MTZ and 500 mg of AMX three times per day for 7 days (MTZ + AMX). Additionally, 17 patients received a placebo, and 17 patients were treated with three applications of aPDT (immediately, 48 h and 96 h after SRP). Clinical and microbiological examinations were performed at baseline and at 90 and 180 days post-therapy. Subgingival samples were analyzed using real-time polymerase chain reaction. RESULTS: After 180 days, the patients in groups MTZ + AMX and aPDT had significantly lower mean probing depths, more clinical attachment level gains and less bleeding on probing. At 180 days, in the moderate pocket there was a reduction in the levels of Porphyromonas gingivalis and Prevotella nigrescens in the MTZ + AMX group, while group aPDT showed a reduction in Prevotella nigrescens. Furthermore, at 180 days, in the deep pocket a reduction in Porphyromonas gingivalis, Prevotella intermedia and Prevotella nigrescens was observed in group MTZ + AMX, as well as a reduction in the levels of Prevotella intermedia and Prevotella nigrescens in group aPDT. CONCLUSION: In smokers with periodontitis, the MTZ + AMX and aPDT treatments significantly improved the effects of SRP.

Comparison of repeated applications of aPDT with amoxicillin and metronidazole in the treatment of chronic periodontitis: A short-term study.

AIM: The aim of this study was to compare the clinical effects of Metronidazole (MTZ) combined with Amoxicillin (AMX) and repeated applications of antimicrobial photodynamic therapy (aPDT) as an adjuvant for the treatment of chronic periodontitis. METHODS: A double-blind controlled and randomized clinical trial was conducted in 34 patients. All of the patients were treated with scaling and root planing (SRP) and separated into 2 groups: the MTZ+AMX Group (n=17), who received SRP and the systemic use of MTZ (400mg 3×per day for 7days) and AMX (500mg 3×per day for 7days), and the aPDT Group (n=17), who received SRP and three aPDT applications at all sites with a probing depth≥5mm immediately, at 48 and 96h after scaling and placebo pills over the span of 7days. Clinical examinations were performed at baseline and 90days post-therapy. The clinical parameters of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. The aPDT was conducted using methylene blue and a low-level laser (GaAlAs 660nm, 100mW, 48s, and 160J/cm2) in all sites with a probing depth≥5mm. A statistical analysis was also performed (α=5%). RESULTS: There was a significant improvement in CAL only in the intermediate pocket in the aPDT group compared to the MTZ+AMX group between baseline and 90days post-treatment (p=0.01). There was a reduction of both BOP and the percentage of residual pockets at 90days after treatment compared with baseline in both groups (p<0.05). CONCLUSION: Both proposed adjuvant therapies associated with conventional mechanical treatment in patients with chronic periodontitis were equally effective in terms of the gain of clinical insertion, control of inflammation and elimination of residual pockets.

Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis.

The aim of this study was to perform a systematic review and meta-analysis to examine the effect of systemic antibiotics in the periodontal treatment of smokers. The selection criteria were as follows: controlled randomized clinical trials; studies published in English; studies with smoker patients diagnosed with chronic periodontitis; patients without systemic diseases; studies that used systemic antibiotic therapy associated with periodontal treatment; studies that presented results for the test and control groups and assessments of clinical periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). The differences in average weights were calculated with a confidence interval (CI) of 95% for PD reduction, CAL gain and BOP. The means of the periodontal clinical parameters were compared between the baseline and post-treatment periods between the test groups and the control groups. The heterogeneity was assessed using the Cochran Q test (Q (df = 3), α = 5%). A total of 67 articles were found, and after the selection process, three randomized controlled trials were included in the meta-analysis. The results indicate that SRP associated with systemic antibiotics promoted additional benefits when compared to SRP alone, with a greater reduction of PD (p = 0.0359, CI = -0.42, -0.01) and a gain of CAL (p = 0.0161, CI = -0.39, -0.04). There was a modest PD reduction (PD, DM -0.21) and a modest CAL gain (CAL, DM -0.22). The results of our meta-analysis reveal the clinical benefits of systemic antibiotics as an adjunct to the non-surgical periodontal treatment of smokers. These clinical improvements, although statistically significant, appeared to be of little clinical relevance.

Uso da doxiciclina no tratamento periodontal de pacientes diabéticos / Use of doxycycline in the periodontal treatment of diabetic patients ­ systematic review

O paciente diabético tem uma resposta desfavorável ao tratamento periodontal devido à alteração da resposta imunoinflamatória e da cicatrização. Tendo isso em vista, alguns estudos clínicos em humanos têm avaliado o efeito do uso de antibioticoterapia como coadjuvante ao tratamento periodontal. Portanto, objetivou-se realizar uma revisão sistemática para avaliar a eficácia da antibioticoterapia com doxiciclina no tratamento periodontal de pacientes diabéticos. A pesquisa compreendeu o período de dezembro de 1994 a janeiro de 2017. A revisão sistemática foi conduzida de acordo com as recomendações do Cochrane Collaboration. Os critério de seleção utilizado foi: estudos clínicos controlados randomizados que utilizaram a terapia antibiótica com doxiciclina no tratamento periodontal de pacientes diabéticos. As médias dos parâmetros clínicos periodontais foram comparadas entre os períodos iniciais e após o tratamento, entre o grupo-teste e o grupo-controle. Depois do processo de seleção, oito estudos clínicos controlados randomizados foram incluídos na revisão. Os resultados da maioria dos estudos selecionados com doxiciclina sistêmica não demonstraram benefícios adicionais, quando comparados com a raspagem isolada, nos parâmetros clínicos periodontais. Desta forma, pôde-se concluir que o número limitado de trabalhos, a heterogeneidade dos estudos e a grande variação de dosagem requerem a realização de outros estudos clínicos controlados randomizados para esclarecer controvérsias sobre o uso da doxiciclina como terapia coadjuvante ao tratamento periodontal mecânico em pacientes diabéticos.

The diabetic patient has an unfavorable response to periodontal treatment due to impaired immuno-infl ammatory response and healing. With this in view, some clinical studies have evaluated the effect of the use of antibiotic therapy as a adjuvant to periodontal treatment. Therefore, a systematic review was carried out to evaluate the efficacy of antibiotic therapy with doxycycline in the periodontal treatment of diabetic patients. The study comprised the period from December 1994 to January 2017. The systematic review was conducted according to the recommendations of the Cochrane Collaboration. The selection criteria used were: randomized controlled trials that used doxycycline antibiotic therapy in periodontal treatment in diabetic patients. The means of periodontal clinical parameters were compared between the initial and post-treatment periods, between the test and control groups. After the selection process, eight randomized controlled trials were included in the review. The results of most of the studies selected with systemic doxycycline did not demonstrate any additional benefits when compared to scaling alone, in periodontal clinical parameters. Therefore, it can be concluded that the limited number of studies, the heterogeneity of the studies, as well as the great variation of dosage, require the execution of other randomized controlled clinical studies to clarify controversies about the use of doxycycline as adjunctive therapy to mechanical periodontal treatment in diabetic patients.

Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis

Abstract The aim of this study was to perform a systematic review and meta-analysis to examine the effect of systemic antibiotics in the periodontal treatment of smokers. The selection criteria were as follows: controlled randomized clinical trials; studies published in English; studies with smoker patients diagnosed with chronic periodontitis; patients without systemic diseases; studies that used systemic antibiotic therapy associated with periodontal treatment; studies that presented results for the test and control groups and assessments of clinical periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). The differences in average weights were calculated with a confidence interval (CI) of 95% for PD reduction, CAL gain and BOP. The means of the periodontal clinical parameters were compared between the baseline and post-treatment periods between the test groups and the control groups. The heterogeneity was assessed using the Cochran Q test (Q (df = 3), α = 5%). A total of 67 articles were found, and after the selection process, three randomized controlled trials were included in the meta-analysis. The results indicate that SRP associated with systemic antibiotics promoted additional benefits when compared to SRP alone, with a greater reduction of PD (p = 0.0359, CI = -0.42, -0.01) and a gain of CAL (p = 0.0161, CI = -0.39, -0.04). There was a modest PD reduction (PD, DM -0.21) and a modest CAL gain (CAL, DM -0.22). The results of our meta-analysis reveal the clinical benefits of systemic antibiotics as an adjunct to the non-surgical periodontal treatment of smokers. These clinical improvements, although statistically significant, appeared to be of little clinical relevance.

Influência da quimioterapia com 5-Fluorouracil na osseointegração de implantes instalados em tíbias de ratos: avaliação biomecânica, microtomográfica, histomorfométrica, histoquímica e imunoistoquímica / Influence of chemotherapy with 5-Fluorouracil on implants osseointegration installed at the rat tibia: biomechanical, microtomography, histomorphometry, histochemistry and immunohistochemistry evaluation

O propósito do presente estudo foi avaliar a influência do tratamento quimioterápico com 5-Fluorouracil (5-FU) durante o processo inicial de osseointegração e na fase de maturação do tecido ósseo, em áreas de implantes osseointegradros, instalados em tíbias de ratos por meio das análises: biomecânica, microtomográfica, histomorfométrica, histoquímica e imunoistoquímica, pela detecção dos imunomarcadores TRAP e OCN. Foram utilizados 60 animais submetidos a um procedimento cirúrgico para instalação de um implante de titânio em suas tíbias. Os animais foram separados aleatoriamente nos seguintes grupos experimentais: Grupo C15/30D (n=10) - os animais receberam a primeira injeção com solução salina fisiológica (SSF) 15 dias após a instalação dos implantes; Grupo 5FU15/30D (n=10) - os animais receberam a primeira dose do 5-FU 15 dias após a instalação dos implantes, os animais dos grupos 30D foram eutanasiados 45 dias após a instalação dos implantes; Grupo C15/45D (n=10) - os animais receberam a primeira injeção com SSF 15 dias após a instalação dos implantes; Grupo 5FU15/45D (n=10) - os animais receberam a primeira dose do 5-FU 15 dias após a instalação dos implantes; Grupo C30/45D (n=10) - os animais receberam a primeira injeção com SSF 30 dias após a instalação dos implantes; Grupo 5FU30/45D (n=10) - os animais receberam a primeira dose do 5-FU 30 dias após a instalação dos implantes, os animais dos grupos 45D foram eutanasiados 45 dias após a instalação dos implantes. As tíbias direita e esquerda foram coletadas e fixadas em formol tamponado a 4% e álcool 70% respectivamente. As peças obtidas foram processadas para se efetuar as análises biomecânica, microtomográfica, histomorfométrica, histoquímica e imunoistoquímica (TRAP e OCN). Na Análise biomecanica e histométrica o grupo 5FU15/30D obteve resultados inferiores aos grupos 5FU15/45D(p<0,05) e 5FU30/45D(p<0,05), já na análise microtomográfica o grupo5FU15/30D apresentou menor volume ósseo quando comparado ao...

The purpose of the present study was to evaluate the influence of chemotherapy treatment with 5- fluorouracil(5-FU) during the initial process of osseointegration, and influence of chemotherapy treatment with 5-FU on osseous tissue maturation phase, on osseointegrated implants, installed at the rat tibia, through biomechanics, microtomography, histomorphometry, histochemistry and immunohistochemistry evaluation, through the detection of immunomarkers tartrate-resistant acid phosphatase (TRAP), osteocalcina (OCN). Sixty animals were submitted to a surgical procedure to install a titanium implant on their right and left tibia. The animals were randomly separated on the following experimental groups: Group C15/30D (control; n=10) – The animals received the first physiological saline (PS) 15 days after the implants installation; Group C15/45D (control; n=10) – The animals received the first OS 15 days after the implants installation and were euthanized 45 days after the implants installation; Group 5FU15/30D (n=10) – The animals received the first 5-FU chemotherapic shot 15 days after the implants installation and were euthanized 30 days after the implants installation. Group 5FU15/45D (n=10) – The animals received the first shot of 5-FU chemotherapic 15 days after the implants installation and were euthanized 45 days after the implants installation. Group C30/45D (control; n=10) received the first OS shot 30 days after the implants were installed and were euthanized 45 days after the implants installation. Group 5FU30/45D (n=10) – the animals received the first 5-FU chemoterapic shot 30 days after the installation of the implants and were euthanized 45 days after the implants installation. Both left and right tibias were collected and fixed in buffered formalin 4% and 70% ethanol respectively. The pieces were processed to do the biomechanical, microtomography, histomorphometry, histochemistry and immunohistochemistry evaluation. At the biomechanics and...