A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis.
BACKGROUND
In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts.


METHODS
The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2-step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full-mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty-eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP.


RESULTS
After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step.


CONCLUSIONS
The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2-step nonsurgical procedure of scaling and root planing in RPP patients.
Sigusch
B
B
Department of Periodontology, Conservative Dentistry, Friedrich Schiller University of Jena, Germany.
Beier
M
M
Klinger
G
G
Pfister
W
W
Glockmann
E
E
D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects / Q000254:growth & development; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use; D002985:Clinical Protocols; D003774:Dental Plaque Index; D003777:Dental Prophylaxis; D012534:Dental Scaling; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D009504:Neutrophils / Q000187:drug effects / Q000502:physiology; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000628:therapy; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000188:drug therapy / Q000628:therapy; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D010587:Phagocytosis / Q000187:drug effects; D016966:Porphyromonas gingivalis / Q000187:drug effects / Q000254:growth & development; D016745:Root Planing; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002981:Clindamycin; D004318:Doxycycline