Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial

Abstract Little is known about the factors that may be used in clinical practice to predict the therapeutic response of aggressive periodontitis patients. The aim of this study was to determine predictors of clinical outcomes after non-surgical treatment of aggressive periodontitis. A total of 24 patients (aged 13-26 years) received oral hygiene instructions, as well as subgingival scaling and root planing. Twelve subjects received systemic azithromycin at random. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Baseline microbiological assessment was performed by checkerboard DNA-DNA hybridization. Multivariable models used generalized estimating equations. There were significant improvements in the entire sample in regard to pocket depth, clinical attachment level and bleeding on probing. Significant predictors of a reduction in mean pocket depth were: use of azithromycin, non-molar teeth, generalized disease and baseline pocket depth. Absence of plaque predicted a 0.22 mm higher attachment gain, whereas a baseline pocket depth ≥7 mm predicted a 1.36 mm higher attachment loss. Azithromycin, plaque, and baseline pocket depth were significant predictors of bleeding on probing. The concomitant presence of all three red complex species predicted a 0.78 mm higher attachment loss. It may be concluded that dental plaque, tooth type, disease extent, baseline pocket depth, and use of azithromycin were significant predictors of the clinical response to treatment for aggressive periodontitis in young individuals. Moreover, the presence of multiple periodontal pathogens may predict challenges in achieving a favorable outcome for aggressive periodontitis.

A population-based cohort study of oral health in South Brazil: The Porto Alegre Study / Um estudo de coorte de base populacional de saúde bucal no sul do Brasil: Estudo de Porto Alegre

Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies.

Poucos estudos de coorte de base populacional têm sido estabelecidos em Odontologia e isso é especialmente verdade para a América Latina. Nós conduzimos um estudo prospectivo de base populacional focando em saúde bucal em Porto Alegre, sul do Brasil, e aqui descrevemos a metodologia do estudo e discutimos direções futuras da pesquisa. A coorte foi estabelecida em 2001 utilizando uma amostra probabilística múltiplo-estágio de 1.465 dentados e 121 desdentados. Um acompanhamento de 5 anos foi realizado em 2006 e incluiu 755 indivíduos. Os objetivos principais do estudo foram determinar o padrão e os fatores de risco para progressão de doença periodontal e incidência de perda dentária. Um protocolo de exame de boca completa foi utilizado, incluindo registros periodontais em 6 sítios por dente. Os desfechos primários foram perda de inserção periodontal e perda dentária. Lesões de mucosa bucal, placa visível, gengivite, cálculo supragengival, profundidade de sondagem, recessão gengival e cárie dentária também foram acessados. Este é o primeiro estudo de coorte de base populacional a focar em doença periodontal na América Latina. Os achados deste estudo contribuirão para o entendimento da epidemiologia da doença periodontal e fornecerão dados valiosos para planejamento e implementação de estratégias preventivas e terapêuticas.

Comparação da resposta clínica do uso coadjuvante de azitromicina em dentes molares e não-molares no tratamento não-cirúrgico da periodontite agressiva / Comparison of the clinical response of adjunctive azithromycin in molars and non-molars on nonsurgical treatment of aggressive periodontitis

Objetivo: comparar a resposta clínica do uso coadjuvante de azitromicina em molares e não molares no tratamento da periodontite agressiva. Material e métodos: 28 pacientes com periodontite agressiva (13 a 26 anos) receberam tratamento periodontal supra e subgengival. Os pacientes foram alocados aleatoriamente em dois grupos. O grupo teste usou 500 mg de azitromicina uma vez ao dia durante três dias, enquanto o grupo controle recebeu placebo. As variáveis clínicas foram obtidas no início, 3, 6, 9 e 12 meses. As médias de profundidade de sondagem (PS), perda de inserção (PI) e sangramento à sondagem (SS) foram comparadas entre os grupos teste e controle, separadamente em molares e não-molares. Resultados: houve redução significativamente maior da PS no grupo azitromicina (molares 2,61±0,34mm; não molares 3,02±0,22mm), comparado ao placebo (molares 1,50±0,40mm; não molares 2,00±0,39mm), após 12 meses em ambos os grupos dentários. O ganho de inserção no grupo azitromicina foi significativamente maior (1,69±0,26mm) comparado ao placebo (0,80±0,33mm) somente em molares. Considerando somente as bolsas inicialmente profundas (7+mm), o efeito clínico da azitromicina foi significativamente maior do que o placebo somente em molares tanto para PS quanto para PI. Não houve diferença significativa na redução de SS entre os grupos nos dois grupos dentários. Conclusão: o efeito benéfico adicional da azitromicina em comparação a placebo é mais evidente em dentes molares de pacientes com periodontite agressiva

Aim: to compare the clinical response of adjunctive azithromycin in molars and non-molars on the treatment of aggressive periodontitis. Material and methods: 28 subjects with aggressive periodontitis (13 to 26 years-old) received both supra and subgingival periodontal treatment. Individuals were randomly assigned in two groups. The test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. Means of probing depth (PD), clinical attachment lost (CAL) and bleeding on probing (BOP) were compared between test and control groups separately for molars and non-molars. Results: there was a significantly higher PD reduction in azithromycin group (molars 2.61±0.34mm; non-molars 3.02±0.22mm) compared to placebo (molars 1.50±0.40mm; non-molars 2.00±0.39mm) after 12 months in both tooth types. The gain of clinical attachment in the azithromycin group was significantly higher (1.69±0.26mm) compared to placebo (0.80±0.33mm) only in molars. Considering only initially deep pockets (7+mm), the clinical effect of azithromycin was significantly higher than placebo only in molars, for PD and CAL. There were no significant differences in BOP changes between azithromycin and placebo in any of the tooth types. Conclusion: the additional benefits of azithromycin compared to placebo are more evident in molar teeth of aggressive periodontitis patients.