title: Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel.
abstract: OBJECTIVE
  Conventional treatment of chronic periodontitis involves mechanical debridement of periodontal pockets. Recently, subgingival antimicrobials have been used adjunctively following such debridement. This 2-centre study compared the clinical effects of subgingival scaling (SRP) with SRP plus subgingival application of 25% metronidazole gel, Elyzol (SRP+gel), in patients with chronic adult periodontitis.
  
  
  METHODS
  Voluntary informed written consent was obtained from 45 subjects at the Eastman (mean age 46, range 34-63) and 43 subjects at RAF Halton (mean age 47, range 34-71) who participated in this blind, randomised split-mouth design study. All had at least 2 sites in each quadrant with probing pocket depth (PPD) > or = 5 mm. PPD, bleeding on probing (BOP), and clinical probing attachment levels (CAL) measured using a stent, were recorded at baseline and at 1, 3, 6 and 9 months post-therapy. After subgingival scaling of all quadrants, 2 quadrants were randomly selected to be treated with metronidazole gel.
  
  
  RESULTS
  A paired t-test on baseline values showed no bias between groups. Both treatments effectively reduced the signs of periodontitis. At each follow-up visit, reduction in PPD, CAL and BOP after the combined treatment was greater than for SRP alone. Paired t-tests showed that the improvement in the SRP+gel group was statistically significantly better (p<0.001) than for SRP alone (mean 0.5 +/- 0.6 mm. 95% CI 0.4-0.6 mm.) Similarly, the % of sites which improved to a final pocket depth of < or = 3 mm and the % of sites which improved over the 9 months of the study by as much as > or = 2 mm were greater for SRP+gel than for SRP alone.
  
  
  CONCLUSIONS
  At the end of the study, the mean reductions for PPD were 1.0 mm (SRP) compared to 1.5 mm (SRP+gel), and for CAL they were 0.4 mm (SRP) compared to 0.8 mm (SRP+gel), with mean difference for CAL between treatments of 0.4 +/- 0.6 mm (95% confidence intervals of 0.3-0.6 mm). The combination therapy of SRP+gel was superior to the conventional treatment of SRP alone, and these differences were maintained for 9 months.
authors.affiliation: Department of Periodontology, Eastman Dental Institute and Hospital for Oral Health Care Sciences, University College London, UK. g.griffiths@eastman.ucl.ac.uk
authors.forename: G S
authors.initials: GS
authors.lastname: Griffiths
authors.forename: G J
authors.initials: GJ
authors.lastname: Smart
authors.forename: J S
authors.initials: JS
authors.lastname: Bulman
authors.forename: G
authors.initials: G
authors.lastname: Weiss
authors.forename: J
authors.initials: J
authors.lastname: Shrowder
authors.forename: H N
authors.initials: HN
authors.lastname: Newman
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002908:Chronic Disease; D012534:Dental Scaling; D004311:Double-Blind Method; D005260:Female; D005989:Glycerides / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008875:Middle Aged; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000628:therapy; D010518:Periodontitis / Q000188:drug therapy*; D012715:Sesame Oil / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; C094288:Elyzol Dentalgel; D005989:Glycerides; D008795:Metronidazole; D012715:Sesame Oil