A case of early-onset periodontitis with vitamin D deficiency: A case report and literature review.

RATIONALE: Periodontitis is an inflammatory disease with multifactorial etiology. Vitamin D, a fat-soluble vitamin, has protective effects on inflammatory response in various systemic conditions. The clinical features of vitamin D deficiency include growth failure, hypotonia, pathologic fractures, rachitic rosary, tetany and so on. Here we present a case of 12-year-old girl affected by early-onset periodontitis accompanied with vitamin D deficiency. PATIENT CONCERNS: A 12-year-old girl with gingival redness, bleeding associated with tooth brushing, and mandibular anterior teeth movement, with difficulty in mastication for the past 2 months. There is no relevant family history or special systemic disease history. The serological microelement test showed vitamin D levels were significantly lower than normal range. Immunological test showed abnormal CD4+/CD8+(CD3+CD4+/CD3+CD8+) ratio as well. DIAGNOSES: Based on the clinical and serological findings, this patient was ultimately diagnosed with early-onset periodontitis accompanied with vitamin D deficiency. INTERVENTIONS: The main treatments for this patient were 3-fold: periodontal therapy, vitamin D supplement and oral hygiene instructions. OUTCOMES: Following 1-year therapy, periodontal conditions recovered and became stable. And serological vitamin D levels returned to normal range. LESSONS: The case of interest serves as an important reminder to clinicians, that the early-onset periodontitis may be associated with micronutrients abnormalities, and early-diagnosis and treatment could avoid the body heathy disorders.

Moxifloxacin versus amoxicillin plus metronidazole as adjunctive therapy for generalized aggressive periodontitis: a pilot randomized controlled clinical trial.

OBJECTIVE: Adjunctive antimicrobials improve probing depth and clinical attachment loss compared with subgingival debridement (SD) alone in patients with aggressive periodontitis. The microbiologic and clinical effectiveness of moxifloxacin (MOX) and amoxicillin plus metronidazole (AMOX+ME) as adjunctive therapies for generalized aggressive periodontitis were compared. METHOD AND MATERIALS: This pilot randomized controlled clinical trial included 36 patients who were assigned to one of three therapy groups: SD plus systemic MOX (400 mg QD for 7 days), SD plus systemic AMOX+ME (500 mg TID each for 7 days), or SD plus placebo. Probing depth, clinical attachment loss, bleeding on probing, and plaque were recorded at baseline and 3 and 6 months after treatment. Subgingival plaque samples were analyzed. RESULTS: All treatments resulted in significant probing depth and clinical attachment loss reduction compared with the baseline values (P < .0001 for all), with the effects still present at 6 months posttreatment, but the patients taking antibiotic protocols presented the most significant gains (P < .0001). There was a significant reduction in the occurrence of gingival pockets ≥ 6 mm at 6 months in all treatment groups (P < .0001), favoring the MOX and AMOX+ME groups. Adjunctive MOX diminished subgingival Aggregatibacter actinomycetemcomitans to unnoticeable stages, after the follow-up period. Adverse events were noted only in some patients of the AMOX+ME group. CONCLUSIONS: This pilot clinical trial proposes that using MOX and AMOX+ME as adjuncts to SD improves the clinical and microbiologic parameters in comparison to mechanical therapy alone; however, the MOX protocol did not cause adverse events and decreased subgingival A actinomycetemcomitans to imperceptible levels.

Antibacterial activity of salvia officinalis L. against periodontopathogens: An in vitro study.

Being aware of the remarkable antimicrobial potential of S. officinalis L., we aimed to evaluate the antimicrobial activity of the S. officinalis dichloromethane crude extract (SOD), dichloromethane-soluble fractions (SODH and SODD), SODD subfractions (SODD1 and SODD2), and pure substances (manool, salvigenin, and viridiflorol) against periodontopathogens. This bioassay-guided study comprises five antimicrobial tests-determination of the Minimum Inhibitory Concentration (MIC), determination of the Minimum Bactericidal Concentration (MBC), determination of the antibiofilm activity, construction of the Time-kill curve (determination of Bactericidal Kinetics), and determination of the Fractional Inhibitory Concentration Index-on six clinical bacterial isolates and three standard bacterial strains involved in periodontal disease. SOD has moderate activity against most of the tested bacteria, whereas SODD1, SODH1, SODH3, and manool afford the lowest results. The Porphyromonas gingivalis (ATTC and clinical isolate) biofilm is considerably resistant to all the samples. In association with chlorhexidine gluconate, only SODH1 exerts additive action against P. gingivalis (clinical isolate). Therefore, SODH1 and manool are promising antibacterial agents and may provide therapeutic solutions for periodontal infections.

Avaliação da suplementação diária de ácidos graxos poli-insaturados de ômega-3 e aspirina em baixa dosagem no tratamento de periodontite agressiva generalizada: estudos clínicos controlados randomizados / Evaluation of omega-3 polyunsaturated fatty acids daily supplementation plus low-dose aspirin to treat generalized aggressive periodontitis: randomized controlled clinical trials

A destruição periodontal resulta principalmente da resposta inflamatória exacerbada do hospedeiro frente ao desafio bacteriano. Por isso, pesquisas envolvendo a modulação da resposta do hospedeiro têm sido desenvolvidas com o objetivo de facilitar a resolução da inflamação, bem como promover reparação tecidual e estabilidade periodontal. Recentemente, o uso de ácidos graxos poli-insaturados de ômega-3 (AGP Ω-3) e ácido acetilsalicílico (AAS) foi relacionado à produção de mediadores lipídicos mais bioativos e à melhores resultados clínicos no tratamento de periodontite crônica. Desse modo, pesquisas envolvendo modulação das respostas inflamatórias de portadores de periodontite agressiva (PAg) podem ser de grande valia. Assim, o objetivo dos presentes estudos clínicos controlados randomizados foi avaliar a utilização da suplementação de 900 mg AGP Ω-3 e 100 mg de AAS por 180 dias como adjuvantes ao tratamento de PAg generalizada (PAgG). (1) Selecionou-se 38 pacientes com PAgG os quais receberam debridamento subgengival associado a AGP Ω-3 e AAS (n=19) ou placebo (n=19). Ambos os grupos apresentaram diminuição (p<0,05) em todos os parâmetros clínicos avaliados, bem como em IL-1ß, sem diferença entre os tratamentos (p>0,05). O nível de TIMP-2 diminuiu significantemente no grupo controle, porém se manteve estável no grupo teste. Concluiu-se que a nova terapia proposta não trouxe benefícios clínicos no tratamento não-cirúrgico de PAgG. (2) Selecionou-se 34 pacientes com PAgG previamente submetidos à terapia básica que apresentavam bolsas residuais e foram submetidos à cirurgia de acesso para raspagem e alisamento radicular associado a AGP Ω-3 e AAS (n=17) ou placebo (n=17). Após 6 meses, ambos os grupos obtiveram diminuição na PS (p<0,05), porém somente o grupo teste obteve ganho no NIC na comparação intergrupo (p=0,02), assim como apresentou menor recessão gengival (p=0,03), diminuição da hipersensibilidade dentinária (p=0,01), menor consumo de analgésicos (p=0,02) e diminuição intragrupo de IL-10 (p<0,05). Concluiu-se que a nova terapia proposta trouxe benefícios clínicos no tratamento de bolsas residuais de pacientes com PAgG(AU)

Periodontal destruction results mainly from the exacerbated host inflammatory response to the bacterial challenge. For this reason, research involving the modulation of host response has been developed aiming to facilitate the resolution of inflammation, as well as to promote tissue repair and periodontal stability. Recently, the use of omega-3 polyunsaturated fatty acids (Ω-3 PUFA) and low-dose acetylsalicylic acid (ASA) was related to the production of enhanced lipidic mediators and to better clinical outcomes in the treatment of chronic periodontitis. Thus, the aim of the present randomized controlled clinical trials was to evaluate the use of 900 mg Ω-3PUFA and 100 mg ASA for 180 days as adjuvants to the treatment of generalized aggressive periodontitis (GAgP). (1) Thirty-eight GAgP patients were submitted to subgingival debridement associated with Ω-3 PUFA and ASA (n=19) or placebo (n=19). Both groups showed a statistically significant decrease (p<0.05) in all clinical parameters, as well as a decrease in IL-1ß, with no difference between treatments (p>0.05). The TIMP-2 level significantly decreased in the control group and remained stable in the test group. It was concluded that the proposed new therapy did not bring clinical benefits in the non-surgical treatment (NST) of GAgP. (2) Thirty-four GAgP patients previously submitted to NST with residual pockets were selected and underwent open flap debridement associated with Ω-3 PUFA 3 and ASA (n=17) or placebo (n=17). After 6 months, both therapies led to decreased PD (p>0.05), but only the test group had CAL gain in the intergroup comparison (p=0,02), as well as presented less gingival recession (p=0,03), decreased dentin hypersensitivity (p=0,01), lower consumption of analgesics (p=0,02) and significant intragroup reduction of IL-10 (p<0.05). It was concluded that the proposed new therapy brought clinical benefits in the surgical treatment of GAgP patient(AU)

No evidence to support benefit of 14-day courses of amoxicillin-plus-metronidazole as adjunct to non-surgical periodontal treatment at three months.

Data sources Databases including Embase, MEDLINE, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trial Register Platform were screened by two reviewers. A manual search has been performed in references from included articles and relevant reviews.Study selection Blinded, placebo-controlled, randomised clinical trials (RCTs) with a minimum follow-up of three months were included. Primary outcomes were periodontal pocket depth (PD) and clinical attachment level (CAL) changes after non-surgical periodontal treatment with adjunctive use of amoxicillin/metronidazole vs placebo in periodontitis patients. Secondary outcomes were adverse events and compliance.Data extraction and synthesis Data were extracted and compiled in a spreadsheet. Studies were grouped according to duration (seven days or fourteen days) and dose of amoxicillin/metronidazole regimen (lower dose (mg): 250/200, 375/250, 375/500, 500/250 and higher dose (mg): 500/400, 500/500). Meta-analyses were performed using inverse-variance method. Random-effect models were applied and weighted mean differences were estimated for PD reduction and CAL changes at three months. Risk of bias was assessed using the Cochrane Collaboration tool.Results Eighteen studies were identified and included in the systematic review. Among them, 15 were pooled for meta-analysis. The use of a wide range of antibiotics concentrations (amoxicillin (from 250 to 500 mg) and metronidazole (from 200 to 500 mg)) was reported and the duration of antibiotic administration ranged from three to 14 days. Eleven studies were performed in chronic periodontitis patients and six in aggressive periodontitis patients. No significant differences were found regarding mean PD and mean CAL changes according to the duration or dose of administered antibiotics (Table 1). Risk differences for adverse events in the higher dose and longer duration groups were minimally greater (0.04 and 0.05 respectively).Conclusions Longer courses (14 days) of antibiotics adjuvant to non-surgical therapy do not appear to provide better results in terms of PD reduction or CAL gain at three months. No differences were found between high and low dose groups. In this context, 400/500 mg or 500/500 mg of amoxicillin/metronidazole three times per day should be recommended for seven days.

Efficacy of adjunctive low-level laser therapy in the treatment of aggressive periodontitis: A systematic review.

The aim of the present study was to systematically review the efficacy of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) vs SRP alone in the treatment of aggressive periodontitis (AgP). The addressed PICO (Population, Interventions, Comparisons and Outcomes) question was: Is LLLT as an adjunct to SRP effective in the treatment of AgP? Electronic databases, including MEDLINE via PubMed, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials, and EMBASE, were searched until March 2018. Four clinical studies were included. Three studies showed significant improvement in periodontal outcomes among LLLT group compared to SRP alone, whereas only one study showed comparable periodontal outcomes between the adjunctive LLLT and SRP groups at follow up. The overall mean difference for clinical attachment level gain (weighted mean difference [WMD] = -1.69, 95% confidence interval [CI] = -3.46 to 0.07, P < 0.061) was not significant. However, significant difference for probing depth reduction (WMD = -0.95, 95% CI = -1.66 to 0.23, P = 0.009) was noticed between groups at follow up. Whether LLLT as an adjunct to SRP is more effective than SRP alone in the treatment of AgP remains debatable. Further randomized, clinical trials are required with long follow-up periods and standard laser parameters to reach a strong conclusion.

Adjunctive Effect of Autologous Platelet-Rich Fibrin in the Treatment of Intrabony Defects in Localized Aggressive Periodontitis Patients: A Randomized Controlled Split-Mouth Clinical Trial.

The aim of this study was to investigate the clinical and radiologic efficacy of autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects associated with localized aggressive periodontitis (LAP). A total of 30 sites, 2 sites per individual in 15 LAP patients, were treated with modified flap operation (MFO; Kirkland flap) alone or combined with autologous PRF. The study variables included plaque index, sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level at baseline and 12 months postoperatively. The radiographic bone fill (RBF) on standardized radiographs was assessed after a year using image analysis software. The improvements in PD, CAL, and RBF in test sites compared to control sites were statistically significant (P < .05). Mean CAL gain and bone fill in the test sites were 4.0 ± 0.63 mm and 3.09 mm, respectively. Almost 80% of the PRF-treated sites showed ≥ 50% bone fill with minimal marginal tissue recession. Use of PRF significantly enhances the clinical and radiographic outcomes of open flap debridement in the treatment of periodontal intraosseous defects in patients affected by LAP.

The Effects of Diode Laser Therapy as an Adjunct to Scaling and Root Planing in the Treatment of Aggressive Periodontitis: A 1-Year Randomized Controlled Clinical Trial.

OBJECTIVE: The aim of this study was to investigate and compare the clinical, microbial, and inflammatory effects of a diode laser as an adjunct to scaling and root planing (SRP) versus SRP alone for the treatment of generalized aggressive periodontitis (GAgP). METHODS: Using a split-mouth design, 31 patients with GAgP were enrolled in the study. The maxillary right and left quadrants were randomly assigned to SRP+diode laser or SRP alone. Patients were examined on a regular basis for clinical, microbiological, and inflammatory mediator changes over a 1-year period. Clinical attachment level (CAL) was the primary outcome variable chosen. In addition, subgingival biofilm samples and gingival crevicular fluid (GCF) inflammatory mediators were analyzed at each follow-up session. RESULTS: Compared to baseline, both treatments demonstrated an improvement in periodontal parameters at 1 year. However, SRP+diode laser produced a significant improvement in probing depth (PD; 2.56 ± 0.44 vs. 3.36 ± 0.51 mm, p < 0.05) and CAL (3.47 ± 0.25 vs. 4.11 ± 0.26 mm, p < 0.05) values compared to SRP alone. Similarly, in the SRP+diode laser group, the bacteria of orange complex group were significantly reduced at 30 and 60 days compared to SRP alone. Moreover, SRP+diode laser determined a reduction in mean GCF level of interleukin (IL)-1ß and IL-1ß/IL-10 ratio at 15 and 30 days compared to SRP alone (p < 0.05). CONCLUSIONS: At 1 year, SRP+diode laser yielded a significant reduction in some clinical parameters, while microbial and inflammatory mediator changes were not significantly reduced compared to SRP alone.

Microbiologic Response to Periodontal Therapy and Multivariable Prediction of Clinical Outcome.

BACKGROUND: This study assesses the microbiologic effects of a two-phase antimicrobial periodontal therapy and tested microbiologic, clinical, and biologic markers as prognostic indicators for clinical success. METHODS: Eighty patients with chronic or aggressive periodontitis received periodontal treatment supplemented with 375 mg amoxicillin plus 500 mg metronidazole, three times daily for 7 days. In group A, antibiotics were given during the first non-surgical phase (T1); in group B, antibiotics were given during the second surgical phase (T2). Six microorganisms, group assignment, demographic and clinical variables, peak values of 15 cytokines, and nine acute-phase proteins in serum were evaluated as potential predictors of at least one site with probing depth (PD) >4 mm and bleeding on probing (BOP) at 12 months post-therapy. RESULTS: T1 decreased the counts of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia (Pi), and Treponema denticola significantly more in group A than group B. Aggregatibacter actinomycetemcomitans and Parvimonas micra (Pm) showed a significant decrease only if the treatment was supplemented with antibiotics, i.e., T1 in group A, or T2 in group B. After T2, differences between groups were no longer significant. A multivariable model including four parameters revealed a predictive value of Pm (odds ratio [OR] = 4.38, P = 0.02) and Pi (OR = 3.44, P = 0.049) and yielded moderate accuracy for predicting the treatment outcome (area under the curve = 0.72). Host-derived factors and treatment sequence were not significantly associated with the outcome. CONCLUSIONS: Long-term microbiologic outcomes of periodontal therapy with adjunctive antibiotics either in T1 or T2 were similar. Detection of Pm before therapy was a predictor for persistence of sites with PD >4 mm and BOP at 12 months post-treatment.

Benefits of adjunctive moxifloxacin in generalized aggressive periodontitis: a subgroup analyses in Aggregatibacter actinomycetemcomitans-positive/negative patients from a clinical trial.

AIM: The aim of the present study was to evaluate the influence of the baseline detection of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) on the clinical outcomes of moxifloxacin (MOX) as an adjunct to full-mouth scaling and root planing (SRP) in generalized aggressive periodontitis (GAgP). METHODS: Forty patients were randomly distributed to two therapy protocols: SRP + placebo or SRP combined with MOX. A. actinomycetemcomitans was detected using culture methods. The significance of the treatment option (MOX or SRP + placebo) on the dependent variables (probing depth [PD] and clinical attachment level [CAL]), considering the interaction with the baseline detection of A. actinomycetemcomitans, was estimated. RESULTS: MOX therapy led to a higher significant PD reduction and CAL gain in A. actinomycetemcomitans-positive patients at baseline. In A. actinomycetemcomitans-positive patients, the reduction of sites ≥5 mm was higher in the MOX group. A. actinomycetemcomitans was not present in sites with PD ≥6 mm in the MOX group. The interactions of A. actinomycetemcomitans and MOX were significantly associated with CAL gain and PD reduction at 6 months. CONCLUSIONS: Adjunctive MOX trended toward better clinical responses in A. actinomycetemcomitans-positive patients at baseline. These results suggest that A. actinomycetemcomitans at baseline might modify the effect of adjunctive MOX in GAgP.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Photodynamic therapy in the treatment of aggressive periodontitis: A systematic review

BACKGROUND: Aggressive periodontitis (AgP) is a severe form of periodontal diseases with rapid destruction of the supporting bone around teeth. The efficacy of PDT in suppressing periodontal pathogens may be crucial in adopting new protocols for the treatment of AgP. Thus, the aim of this systematic review was to investigate the possible role of PDT in the treatment of AgP as an adjunctive therapy or monotherapy. MATERIAL AND METHODS: A systematic search of the literature was performed. Additionally, the references from all the selected full-text studies were searched for relevant articles. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. RESULTS: Initial screening of electronic databases yielded 418 potentially relevant publications. After screening of the titles and full-text examination, five studies were included in the systematic review. Four publications evaluated the effects of PDT adjunctive to SRP in patients with AgP: two of them compared the clinical outcomes of SRP and PDT with a control group that received therapy with SRP and antibiotics (metronidazole and amoxicillin); two publications included SRP and PDT in the test group, and SRP alone in the control group. In one study, PDT was tested as a monotherapy compared with SRP alone. CONCLUSIONS: Within the limitations of this review, PDT may exhibit a beneficial role in the therapy of aggressive periodontitis after repeated applications. In the future, more methodologically sound, long-term randomized clinical trials are needed to be conducted

Generalized aggressive periodontitis: microbiological composition and clinical parameters in non-surgical therapy / Periodontitis agresiva generalizada: composición microbiológica y parámetros clínicos en la terapia no quirúrgica

The aim of this study was to determine the variations in periodontal parameters and microbiological composition in periodontal pockets at the baseline and 3 and 6 months posttreatment in patients with Generalized Aggressive Periodontitis (GAP) undergoing nonsurgical periodontal treatment combined with chlorhexidine and systemic antibiotics. Medical and dental history was taken from 10 subjects, average age 30.62.7 years, diagnosed with GAP. A nonsurgical periodontal treatment combined with 0.12% chlorhexidine, 875 mg amoxicillin and 500 mg metronidazole every 12 hours for ten days was conducted. At each visit, the following measurements were recorded: bacterial plaque (BP), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), hypermobility, and furcation lesions, and a sample of subgingival plaque was taken from the site of the deepest probing depth of each sextant to identify Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using molecular biology techniques. After 6 months, the Wilcoxon test showed an increase of 0.97 mm in CAL (p=0.0047) and 2.54 mm in PD (p=0.009). A healthy site was defined as having a PD <5 mm, negative BOP and no pathogenic bacteria detected at 6 months, indicating significant improvement (p=0.008), with OR (95% CI) =4.7 (1.102220.11). With the treatment protocol used in this study, 6 months after treatment, patients had an approximately 4fold higher possibility of presenting PD <5 mm and periodontal pockets without periodontal pathogenic bacteria.

En este trabajo, nos propusimos determinar las variaciones de los parámetros periodontales y la composición microbiológica de las bolsas periodontales al inicio, a los 3 y 6 meses después del tratamiento en pacientes con periodontitis agresiva generalizada (GAP), sometidos a tratamiento periodontal no quirúrgico combinado con clorhexidina y antibióticos sistémicos. Se elaboró historia médica y dental en 10 sujetos, con una edad media de 30,6 2,7 años, con diagnóstico de GAP. Se les practicó tratamiento periodontal no quirúrgico combinado con clorhexidina al 0,12%, 875 mg de amoxicilina y 500 mg de metronidazol. Los antibióticos se prescribieron cada 12 horas durante diez días. Se registraron: la placa bacteriana (BP), sangrado al sondaje (BOP), la profundidad de sondaje (PD), el nivel de inserción clínica (NIC), hipermovilidad y lesiones de furcación. En cada visita, se tomaron las mediciones, y se tomó una muestra de la placa subgingival en sitio de la mayor profundidad al sondaje en cada sextante para identificar mediante técnica de biología molecular: Porphyromonas gingivalis, Treponema denticola, forsythia Tannerella, Prevotella intermedia, y Aggregatibacter actinomycetemcomitans. Después de 6 meses, el análisis de la prueba de Wilcoxon mostró un aumento de 0,97 mm de CAL (p = 0,0047) y 2,54 mm en la PB (p = 0,009). Se definió sitio sano, cuando se determinó un PD <5 mm, BOP negativo, y no se detectaron bacterias patógenas a los 6 meses, lo que indicó una mejora significativa (p = 0,008), con (IC 95%) = 4,7 (1,1022 a 20,11). Con el protocolo de tratamiento presentado, es posible especular que a los 6 meses después del tratamiento, un paciente puede tener aproximadamente 4 veces más posibilidades de presentar una PD<5 mm y bolsillos periodontales sin bacterias patógenas.

Clinical Factors Influencing the Efficacy of Systemic Moxifloxacin in the Therapy of Patients With Generalized Aggressive Periodontitis: A Multilevel Analysis From a Clinical Trial.

BACKGROUND: It has been reported that clinical results of mechanical periodontal treatment could differ between subjects and among different sites of the tooth in the patient. The objective of this multilevel analysis is to investigate clinical factors at subject and sites of the tooth that influence variations in clinical attachment (CAL) increase and probing depth (PD) diminution of adjunctive moxifloxacin (MOX) at six months post-treatment in generalized aggressive periodontitis. METHODS: This clinical trial included 40 patients randomly distributed to two therapy protocols: scaling and root planing alone or combined with MOX. Multilevel linear models for continuous variables were formulated to evaluate the clinical impact of the hierarchical configuration of periodontal data. RESULTS: Six months following therapy, the divergences between both protocols were statistically significant in PD diminution and CAL increase, favouring the MOX therapy (p<0.001). Besides, the multilevel analysis revealed that adjunctive MOX at the subject level, non-molar and the interaction non-molar x MOX at the tooth level, interproximal sites and the interaction interproximal sites x MOX at the site level, were statistically significant factors in determining CAL increase and PD diminution. CONCLUSIONS: The main cause of variability in CAL gain and PD reduction following adjunctive MOX was attributable to the tooth level. Adjunctive MOX and their interactions with non-molar and interproximal sites showed higher clinical benefits at the tooth and site levels which could be essential for PD reduction and CAL gain in generalized aggressive periodontitis subjects.

Systemic moxifloxacin vs amoxicillin/metronidazole adjunct to non-surgical treatment in generalized aggressive periodontitis.

BACKGROUND: The objective of this randomized clinical study was to evaluate the effect of systemic administration of moxifloxacin compared to amoxicillin and metronidazole, combined with non-surgical treatment in patients with generalized aggressive periodontitis (GAgP) in a 6-month follow-up. MATERIAL AND METHODS: A total of 39 systemically healthy patients with GAgP were evaluated in this randomized clinical trial. Periodontal parameters were recorded at the baseline during the 1st, 3rd and 6th month. Patients received either 400 mg of moxifloxacin per os once daily or 500 mg of metronidazole and 500 mg amoxicillin per os three times daily for 7 days consecutively. RESULTS: No significant differences between groups were found in any parameters at the baseline. Both groups led to a statistically significant decrease in all clinical periodontal parameters compared to the baseline (PI; p<0.001 and GI, PD, BOP, CAL, p<0.01). There were no differences between the 1st and 3rd months or the 3rd and 6th months for clinical parameters in the groups. Also, no intergroup difference was observed in any parameters at any time, except the gingival index at 6th months. CONCLUSIONS: Systemic administration of moxifloxacin as an adjunct to non-surgical treatment significantly improves clinical outcomes and provides comparable clinical improvement with less adverse events to that of combination of amoxicillin and metronidazole in the treatment of GAgP.

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.

Prescribing for periodontal disease.

With concerns about the ever-increasing development of antimicrobial resistance, it is imperative that antimicrobials are prescribed responsibly and used appropriately. This article provides an overview and simple guidelines for antimicrobial prescribing in the management of periodontal diseases.

Effects of cranberry components on human aggressive periodontitis gingival fibroblasts.

BACKGROUND AND OBJECTIVE: Aggressive periodontitis (AgP) causes rapid periodontal breakdown involving AgP gingival fibroblast production of cytokines [i.e. interleukin (IL)-6, a bone metabolism regulator], and matrix metalloproteinase (MMP)-3. Lipopolysaccharide upregulates fibroblast IL-6 and MMP-3, via transcription factors (i.e. NF-κB). Cranberry (Vaccinium macrocarpon) inhibits lipopolysaccharide-stimulated macrophage and normal gingival fibroblast activities, but little is known of its effects on AgP fibroblasts. Objectives of this study are to use AgP fibroblasts, to determine cytotoxicity of cranberry components or periodontopathogen (Fusobacterium nucleatum, Porphyromonas gingivalis) lipopolysaccharide ± cranberry components, and effects of cranberry components on lipopolysaccharide-stimulated NF-κB activation and IL-6 and MMP-3 production. MATERIAL AND METHODS: AgP fibroblasts were incubated ≤ 6 d with high molecular weight non-dialyzable material (NDM) (derived from cranberry juice (1-500 µg/mL) or lipopolysaccharide (1 µg/mL) ± NDM. Membrane damage and viability were assessed by enzyme activity released into cell supernatants and activity of a mitochondrial enzyme, respectively. Secreted IL-6 and MMP-3 were measured by ELISA. NF-κB p65 was measured via binding to an oligonucleotide containing the NF-κB consensus site. Data were analyzed using analysis of variance and Scheffe's F procedure for post hoc comparisons. RESULTS: Short-term exposure to NDM, or lipopolysaccharide ± NDM caused no membrane damage. NDM (≤ 100 µg/mL) or lipopolysaccharide ± NDM had no effect on viability ≤ 7 d exposure. NDM (50 µg/mL) inhibited lipopolysaccharide-stimulated p65 (P ≤ 0.003) and constitutive or lipopolysaccharide-stimulated MMP-3 (P ≤ 0.02). NDM increased AgP fibroblast constitutive or lipopolysaccharide-stimulated IL-6 (P ≤ 0.0001), but inhibited normal human gingival fibroblast IL-6 (P ≤ 0.01). CONCLUSION: Lack of toxicity of low NDM concentrations, and its inhibition of NF-κB and MMP-3, suggest that cranberry components may regulate AgP fibroblast inflammatory responses. Distinct effects of NDM on AgP and gingival fibroblast production of IL-6 (which can have both positive and negative effects on bone metabolism) may reflect phenotypic differences in IL-6 regulation in the two cell types.

Azithromycin as an adjunctive treatment of aggressive periodontitis: radiographic findings of a 12-month randomized clinical trial.

PURPOSE: To compare the 12-month radiographic outcomes following the use of azithromycin or placebo as adjuncts to non-surgical periodontal treatment of AgP. METHODS: 17 aggressive periodontitis (AgP) subjects 13-26 years old were randomly assigned to receive scaling and root planing (SRP) with systemic azithromycin or placebo. Standardized radiographs were taken at baseline and 12 months postoperatively. Recall visits consisting of oral prophylaxis and oral hygiene instructions were performed during the 12 months. Digital image subtraction analysis and linear bone measurements were conducted by a blinded and calibrated examiner. Student t-tests were used for within and between-groups comparisons. ANCOVA was applied for between-group comparisons of changes in linear bone level adjusting for baseline values. RESULTS: There were significant gains in linear bone levels in the azithromycin (0.55 +/- 0.10 mm) and placebo (0.42 +/- 0.07 mm) groups between the baseline and 12-month postoperative visits. There were also significant gains in bone density in the two treatment groups. No significant differences were observed between the two treatments in the amount of linear bone gain or bone density during the follow-up period. The use of azithromycin as an adjunct to SRP in the treatment of AgP did not result in significant radiographic bone level changes compared to placebo.