Adjunctive moxifloxacin in the treatment of generalized aggressive periodontitis patients: clinical and microbiological results of a randomized, triple-blind and placebo-controlled clinical trial.

AIM: The aim of the present study was to evaluate the clinical and microbiological efficacy of moxifloxacin (MOX) in one-stage scaling and root planing (SRP) in treating generalized aggressive periodontitis (GAgP). MATERIALS AND METHODS: Forty subjects were randomly allocated to two treatment groups. The two treatment groups consisted of SRP combined with systemically administered MOX at the dosage of 400 mg once daily for 7 days or SRP + placebo once daily for 7 days. Subgingival plaque samples were analysed for cultivable bacteria. RESULTS: Both groups resulted in significant reduction of probing depth (PD) and clinical attachment level (CAL) compared with baseline (p < 0.0001), and this difference was maintained at 6 months from baseline in both groups. However, subjects receiving MOX showed the greatest improvements CAL, and PD. Subjects in both groups at 6 months displayed the greatest reduction from baseline in frequency of sites with PD ≥ 6 mm (p < 0.001), favouring the MOX group. Adjunctive antibiotic protocol reduced subgingival Aggregatibacter actinomycetemcomitans to undetectable levels, after 3 and 6 months, and there was a significant reduction in the levels of Porphyromonas gingivalis and Tannerella forsythia in the MOX group compared to the placebo group. CONCLUSIONS: The results from this study suggest that moxifloxacin as and adjunct to one-stage full-mouth SRP leads to a better clinical and microbiological advantages compared to mechanical treatment.

The effects of stress on periodontal treatment: a longitudinal investigation using clinical and biological markers.

AIM: To investigate the effects of psychosocial stress on the outcome of non-surgical periodontal treatment (NPT). METHODS: Patients were categorized as stressed or unstressed, and the degree of stress was measured. One deep bleeding and one deep non-bleeding site ≥6 mm were selected in each patient for detailed investigation, and the clinical parameters were recorded before and at 6 months after NPT. Elastase and C-terminal teleopeptide of type I collagen (ICTP) were measured in gingival crevicular fluid (GCF) samples at both intervals. RESULTS: The baseline, clinical parameters and biological markers were similar in both stressed and unstressed groups, other than for GCF elastase levels, which were significantly higher in the stressed group of patients (p < 0.05). The effect of stress on the changes for clinical measurements and elastase levels in GCF was statistically significant for deep bleeding sites, with the response to treatment being poorer in the stressed group. The effects of smoking and the degree of stress were not statistically significant for any of the clinical or biological parameters (p > 0.05). CONCLUSIONS: Patients under psychosocial stress had a poorer outcome following NPT. The assessment of psychosocial stress may be valuable in the holistic management of periodontal disease.

A clinico-biochemical evaluation of the role of a herbal (Ayurvedic) immunomodulator in chronic periodontal disease: a pilot study.

BACKGROUND: Host modulation is fast gaining popularity as a preferred therapeutic modality for periodontal disease. Recent research in the medical field into herbal immunomodulators such as Septilin® has spurred an interest in evaluating its efficacy in periodontitis for the first time. AIM: The aim of the study was to assess the immunomodulatory effects of the herbal immunomodulator Septilin® (Himalaya Drug Company, Bangalore, India) when used as an adjunct to scaling and root planing in chronic periodontal disease. METHODS: Forty systemically healthy patients aged between 25 and 55 years of age and with chronic periodontitis were randomly divided into two groups. The test group was administered Septilin® tablets for two weeks following scaling and root planing whereas the control group was treated by scaling and root planing alone. Changes in gingival index (GI), gingival bleeding index (GBI), serum C-reactive protein (CRP) levels and salivary tumour necrosis factor-alpha (TNF-α) levels were assessed at day 0, at two weeks, and at three and six months. RESULTS: The GI and GBI showed a statistically significant reduction at two weeks, three months and six months (P<0.001) in both groups. Salivary TNF-α level reduction was significant in the test group only (P<0.001). No significant change was found in serum CRP levels in both groups (P>0.05). CONCLUSION: In this pilot evaluation, Septilin® was found to be a safe and effective immunomodulator as an adjunct to routine periodontal therapy. Further long-term studies to test Septilin® on larger sections of the population are recommended.

Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study.

BACKGROUND: The aim of this randomized clinical study is to evaluate the effect of a 980-nm diode laser as an adjunct to scaling and root planing (SRP) treatment. METHODS: Thirty-five patients with chronic periodontitis were selected for the split-mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. RESULTS: The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18-week (P <0.05) and 6- to 18- week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). CONCLUSION: The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980-nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).

Clinical effects of an essential oil solution used as a coolant during ultrasonic root debridement.

AIM: The use of chlorhexidine and povidone iodine solutions applied as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis has been described. Hitherto, this application has not yet been extensively investigated for essential oil solutions. The goal was to clinically explore this and to compare to water irrigation. MATERIALS AND METHODS: Thirty-five chronic periodontitis patients participated in a single-blind randomized controlled clinical study. Patients were randomly allocated to the control group (n=18) or test group (n=17) receiving oral hygiene instructions and ultrasonic root debridement using water as a coolant, respectively, a pure essential oil solution. Oral hygiene was reinforced if necessary at each occasion, and clinical parameters were collected at baseline and after 1 and 3 months. RESULTS: Significant pocket reduction (control, 1.02 mm; test, 0.89 mm) and clinical attachment gain (control and test, 0.48 mm) were shown in both groups. However, there were no significant differences between the groups at any point in time for any of the parameters. CONCLUSION: Essential oil solutions do not offer a clinical benefit over water when used as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis.

Honeybee propolis extract in periodontal treatment: a clinical and microbiological study of propolis in periodontal treatment.

OBJECTIVE: This study was conducted to evaluate by clinical and microbiological parameters the effect of subgingival irrigation with propolis extract. MATERIALS AND METHODS: Twenty patients diagnosed with chronic periodontitis, each presenting three non-adjacent teeth with deep pockets, were selected. Subgingival plaque sampling and clinical recording (at baseline) and scaling and root planing was performed. Two weeks later the selected periodontal sites were submitted to one of the following treatments: Irrigation with a hydroalcoholic solution of propolis extract twice a week for 2 weeks (group A); irrigation with a placebo twice a week for 2 weeks (group B); or no additional treatment (group C). Clinical and microbiological data was collected at baseline and after 4, 6, and 8 weeks. RESULTS: A decrease in the total viable counts of anaerobic bacteria (P=.007), an increase in the proportion of sites with low levels (≤105 cfu/mL) of Porphyromonas gingivalis (P=.044), and an increase in the number of sites negative for bleeding on probing was observed in group A sites as compared to group B and C sites. CONCLUSION: Subgingival irrigation with propolis extract as an adjuvant to periodontal treatment was more effective than scaling and root planing as assessed by clinical and microbiological parameters.

Sudden death due to cerebral leukemic hemorrhage occurring after acupuncture treatment for gingival bleeding.

A 45-year-old woman who experienced stomalgia and gingival bleeding for several days died unexpectedly after acupuncture treatment. At autopsy, trivial injuries on the liver and the stomach and mild hemoperitoneum due to improper acupuncture were found. Also,acute lymphoblastic leukemia and hyperleukocytosis were diagnosed by postmortem examinations. Intracranial hemorrhage due to undiagnosed acute lymphoblastic leukemia was identified as the cause of death.Moreover, the relationship between therapeutic misadventure and death was also determined. We suggest that undiagnosed leukemia should be considered as a differential diagnosis when sudden death occurs owing to intracranial hemorrhage. If therapeutic misadventure was involved,it is also of great importance to assess the relationship between that and death in forensic expertise.

Reduction of tooth loss associated with periodontal treatment.

Comparing tooth loss for populations comprising subjects with periodontal disease has been limited by broad and different definitions of disease severity. Numeric scores for periodontal disease severity and risk were used to enhance the precision of comparing tooth loss for two populations. Both populations received routine dental care, but only one received comprehensive periodontal treatment. The analysis provides evidence that adding periodontal treatment to routine dental care is associated with less tooth loss and more patients who do not lose any teeth. Furthermore, it may be possible to nearly eliminate tooth loss associated with periodontal disease.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial.

AIM: To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS: Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS: There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION: The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Microbiologic results after non-surgical erbium-doped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: a randomized clinical trial.

BACKGROUND: The purpose of this study is to assess clinical and microbiologic effects of the non-surgical treatment of peri-implantitis lesions using either an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser or an air-abrasive subgingival polishing method. METHODS: In a 6-month clinical trial, 42 patients with peri-implantitis were treated at one time with an Er:YAG laser or an air-abrasive device. Routine clinical methods were used to monitor clinical conditions. Baseline and 6-month intraoral radiographs were assessed with a software program. The checkerboard DNA-DNA hybridization method was used to assess 74 bacterial species from the site with the deepest probing depth (PD) at the implant. Non-parametric tests were applied to microbiology data. RESULTS: PD reductions (mean ± SD) were 0.9 ± 0.8 mm and 0.8 ± 0.5 mm in the laser and air-abrasive groups, respectively (not significant). No baseline differences in bacterial counts between groups were found. In the air-abrasive group, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus anaerobius were found at lower counts at 1 month after therapy (P <0.001) and with lower counts in the laser group for Fusobacterium nucleatum naviforme (P = 0.002), and Fusobacterium nucleatum nucleatum (P = 0.002). Both treatments failed to reduce bacterial counts at 6 months. Porphyromonas gingivalis counts were higher in cases with progressive peri-implantitis (P <0.001). CONCLUSIONS: At 1 month, P. aeruginosa, S. aureus, and S. anaerobius were reduced in the air-abrasive group, and Fusobacterium spp. were reduced in the laser group. Six-month data demonstrated that both methods failed to reduce bacterial counts. Clinical improvements were limited.

Efficacy and safety of adjunctive local moxifloxacin delivery in the treatment of periodontitis.

BACKGROUND: Moxifloxacin exerts excellent antibacterial activity against most putative periodontal pathogens and has been shown to kill bacteria in biofilm and host cells. METHODS: Patients with chronic periodontitis were randomly assigned to receive a single subgingival application of a 0.125%, 0.4%, or 1.25% moxifloxacin gel or placebo gel immediately after full-mouth scaling and root planing (SRP). Clinical efficacy measurements were assessed in sites with baseline probing depth (PD) of ≥5.4 mm at 6 weeks and 3 months and any adverse events were determined. In addition, putative periodontal pathogens and resistance of subgingival bacteria against moxifloxacin were assessed. RESULTS: Data of 57 patients were included in the statistical analysis. In all treatment groups, the PD decreased from baseline to 3 months, with the greatest reduction seen in patients treated with moxifloxacin 0.4% (1.5 ± 0.6 mm; P = 0.023 compared to placebo), followed by patients receiving moxifloxacin 1.25% (1.2 ± 0.4), moxifloxacin 0.125% (1.1 ± 1.1), and placebo (1.0 ± 0.6). No linear trend for PD reduction with increasing moxifloxacin concentrations was found. Porphyromonas gingivalis showed the greatest reduction in prevalence among the assessed pathogens, without any significant intergroup differences. No correlation or systematic relationship between adverse events, including bacterial resistance against moxifloxacin, and the investigational gels was found. CONCLUSIONS: In periodontal pockets with PD of ≥5.4 mm, a single subgingival administration of a 0.4% moxifloxacin gel as an adjunct to SRP may result in additional PD reduction compared to SRP alone. In addition, the investigated moxifloxacin gels seem to be safe.

Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24-month follow-up. MATERIALS AND METHODS: Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD) ≥5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) - OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months. RESULTS: After follow-up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05). CONCLUSION: It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.

Periodontal therapy and low birth weight: preliminary results from an alternative methodologic strategy.

BACKGROUND: The purpose of this study is to present the use of a non-randomized experimental design with multiple controls, with emphasis on a historical control group, as an alternative methodologic resource for studies on the association between periodontal disease and prematurity/low birth weight. METHODS: The sample consisted of 234 pregnant women: 54 in the Test Group (treatment of periodontal disease); 68 in Control Group I (without periodontal disease); and 112 in Control Group II (historical control group, with untreated periodontal disease). The diagnosis of periodontal disease was established by means of a complete clinical examination, using measurements of probing depth, gingival recession, clinical attachment loss, and bleeding index. The women in the Test Group were treated for periodontitis and followed-up with periodontal support therapy throughout their pregnancies. After delivery, they were reevaluated regarding their periodontal condition, and information on the newborn's birth weight was obtained. This was also done for Control Groups I and II. Descriptive analyses on the study variables were performed using the χ(2) and Fisher exact tests. Association measurements (relative risk) were obtained using a significance level of 5%. RESULTS: The frequency of low birth weight among the Test Group was similar to Control Group I and lower than Control Group II. CONCLUSION: The results suggest that successful periodontal therapy in pregnant women suffering from periodontitis is a protective factor promoting the birth of children with normal weight.

Adjunctive treatment of chronic periodontitis with daily dietary supplementation with omega-3 Fatty acids and low-dose aspirin.

BACKGROUND: Host modulatory therapy has been proposed as a treatment for periodontal diseases. Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The goal of this study was to test an innovative strategy for periodontal treatment in a clinical experiment. METHODS: Eighty healthy subjects (40 in each group) with advanced chronic periodontitis were enrolled in Mansoura, Egypt, in a parallel-design, double-masked clinical study. The control group was treated with scaling and root planing (SRP) and a placebo, whereas the ω-3 group was treated with SRP followed by dietary supplementation of fish oil (900 mg EPA + DHA) and 81 mg aspirin daily. Saliva samples were obtained from all patients at baseline and 3 and 6 months for evaluation of receptor activator of nuclear factor-kappa B ligand (RANKL) and matrix metalloproteinase-8 (MMP-8). Plaque and gingival indices, bleeding on probing, probing depths, and attachment levels were recorded at the same time points. RESULTS: Statistical analyses demonstrated a significant reduction in probing depths and a significant attachment gain after 3 and 6 months in the ω-3 group compared to baseline and the control group (P <0.05). Salivary RANKL and MMP-8 levels showed significant reductions in the ω-3 group in response to treatment at 3 and 6 months and compared to the control group at 6 months (P <0.01). Supplementation with ω-3 + aspirin resulted in a significant shift in the frequency of pockets with probing depths <4 mm (P <0.05). CONCLUSION: The results of this preliminary clinical study suggest that dietary supplementation with ω-3 PUFAs and 81 mg aspirin may provide a sustainable, low-cost intervention to augment periodontal therapy.

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial.

AIM: This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. MATERIALS AND METHODS: A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. RESULTS: Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. CONCLUSIONS: The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with erbium:YAG laser and scaling and root planing.

BACKGROUND: This study compared erbium-doped: yttrium, aluminum, and garnet (Er:YAG) laser irradiation (100 mJ/pulse; 10 Hz; 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for treatment of periodontal pockets. METHODS: Nineteen patients with pockets from 5 to 9 mm were included. In a split-mouth design, each site was allocated to a treatment group: 1) SRPL, SRP and laser; 2) L, laser; 3) SRP, SRP only; and 4) C, no treatment. Clinical parameters of probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and 1, 3, 6, and 12 months after treatment. Visible plaque index, gingival bleeding index (GI), bleeding on probing (BOP), and subgingival plaque samples were also measured 12 days postoperatively, in addition to the above mentioned months. Intergroup and intragroup statistical analyses were performed (P <0.05). RESULTS: GI decreased for SRPL and increased for L, SRP, and C (P <0.05) 12 days postoperatively and decreased for SRPL and SRP (P <0.05) 3, 6, and 12 months after baseline; BOP and PD decreased for all treated groups (P <0.01) 3, 6, and 12 months after treatment. CAL gain was significant for SRPL, L, and SRP (P <0.05) 3, 6, and 12 months postoperatively. SRPL and L presented a significant reduction in the percentage of sites with bacteria 6 and 12 months after treatment (P <0.05). CONCLUSION: Non-surgical periodontal treatment with Er:YAG laser may be an alternative treatment for reduction and control of the proliferation of microorganisms in persistent periodontitis.

The effects of low level laser irradiation on gingival inflammation.

OBJECTIVE: The goal of this study was to analyze the effects of low level laser irradiation treatment and conservative treatment on gingival inflammation. BACKGROUND: It is widely accepted today that the primary etiological factor for the onset of periodontitis is dental plaque, although the exact mechanism of damage remains unknown. Inflammation is a basic response of periodontal tissue to damage and serves as a fast first line of defense against damage and infections. The treatment of gingivitis and periodontitis has gone through various stages: from the simplest, classical treatment methods, through improved radical interventions, to a new era marked by laser technology. Low level laser irradiation has an anti-inflammatory effect, both general and local. MATERIALS AND METHODS: The research was done on patients who had chronic periodontal disease (mild periodontitis) with expressed clinical symptoms of gingival inflammation. All patients in the study underwent conservative treatment. After conservative therapy, the patients from the experimental group were subjected to 10 low level laser treatment sessions. Both groups underwent regular follow-up visits 1, 3, and 6 months after treatment, which involved only clinical examination using plaque index (PI), gingival index (GI), and bleeding on probing index (BOP index). RESULTS: A considerable decrease in all three indexes after the application of both therapies was noticed. The follow-up visits revealed the difference in index values. With laser therapy, the values of indexes decreased steadily, whereas with conservative therapy they increased up to a certain point, but did not reach the pre-therapy values. CONCLUSIONS: A general conclusion can be drawn that low level laser irradiation (semiconductor, 670 nm) can be used as a successful physical adjuvant method of treatment, which, together with traditional periodontal therapy, leads to better and longer-lasting therapeutic results.

Non-surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient.

Drug-induced gingival overgrowth (DIGO) is a significant problem for periodontologists and this side effect is frequently associated with three particular drugs: phenytoin, cyclosporin A and nifedipine. A case report of gingival overgrowth induced by nifedipine in an elderly patient treated with non-surgical periodontal therapy is described. A 75-year-old male with generalised gingival overgrowth reported the problem of oral malodour and significant gingival bleeding. The medical history revealed a controlled hypertensive state and Cerebral Vascular Accident (CVA) 3 years prior to consultation. The diagnosis was gingival overgrowth associated with nifedipine, no other risk factors being identified. The patient had been taking nifedipine for 18 months, but after the consultation with the patient's doctor, nifedipine was suspended, as the hypertension was controlled. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation and prophylaxis. Six months after the first intervention, clinical parameters revealed a significant improvement with a considerable reduction in gingival overgrowth, demonstrating the effect of non-surgical periodontal therapy in severe cases of gingival overgrowth. Non-surgical treatment of DIGO is a far less invasive technique than surgical approaches and has demonstrated an impressively positive treatment response. It should therefore be considered as a first treatment option for DIGO.

Amoxicillin and metronidazole as an adjunct to full-mouth scaling and root planing of chronic periodontitis.

BACKGROUND: It has been suggested that scaling and root planing of all pockets within a few hours and chlorhexidine treatments (full-mouth disinfection) may reduce the need for supplementary therapies. The aim of this study was to evaluate the clinical benefit of amoxicillin and metronidazole administered immediately after completion of full-mouth periodontal debridement in patients with chronic periodontitis. METHODS: This was a single-center, double-masked, placebo-controlled, randomized longitudinal study of 6 months' duration. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours. Twenty-five subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days; 26 subjects received a placebo. RESULTS: Forty-seven patients could be followed up to month 6. No differences in clinical parameters were noted before treatment. The overall mean probing depth decreased from 4.3 +/- 0.4 mm to 3.0 +/- 0.2 mm in the test group and from 4.4 +/- 0.4 mm to 3.1 +/- 0.3 mm in the control group (P = 0.05, difference between groups). More importantly, test subjects had a significantly lower mean number of persisting pockets >4 mm and bleeding on probing that required further treatment (P = 0.005): 6 months after full-mouth debridement plus antibiotics, only 0.4 +/- 0.8 persisting pockets were still present, whereas 3.0 +/- 4.3 persisting pockets were still present in the control group. The protective risk of the antibiotics for having more than one pocket deeper than 4 mm and bleeding on probing per subject after 6 months was 8.85. CONCLUSION: Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.

Moxifloxacin as an adjunctive antibiotic in the treatment of severe chronic periodontitis.

BACKGROUND: The impact of moxifloxacin (MOX) was analyzed in the treatment of severe chronic periodontitis. METHODS: In a randomized, prospective, clinical multicenter trial, 92 subjects with severe chronic periodontitis were treated with scaling and root planing (SRP) alone (control group; n = 21), SRP plus adjunctive doxycycline (DOX group; n = 36), or SRP plus adjunctive MOX (MOX group; n = 35). Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline and at 3, 6, and 12 months after non-surgical periodontal treatment. The load of periodontopathogens, the level of interleukin-8, and the activities of granulocyte elastase and myeloperoxidase were also measured. RESULTS: All three procedures led to significant reductions in PD, CAL, and BOP. PD reduction was significantly greater (P <0.05) in the MOX group (2.46 +/- 1.17 mm at 6 months and 2.84 +/- 1.53 mm at 12 months) compared to the DOX group (1.85 +/- 1.24 mm and 2.19 +/- 1.13 mm at 6 and 12 months, respectively) and the controls (1.77 +/- 0.57 mm and 1.86 +/- 0.56 mm at 6 and 12 months, respectively). Only in the MOX group was the load of all investigated bacteria and all inflammatory parameters reduced at each appointment compared to baseline. CONCLUSIONS: The adjunctive application of antibiotics improved the treatment outcome in subjects with severe chronic periodontitis. MOX seemed to be more effective than DOX and might be an alternative drug in the treatment of periodontal diseases.