Adjunctive benefits of subantimicrobial dose doxycycline in the management of severe, generalized, chronic periodontitis.
BACKGROUND
Severe, generalized periodontitis is a form of chronic periodontitis that appears to be associated with an exaggerated host response. Little information is available on the benefits of using adjunctive host modulation in the management of this form of periodontal disease.


METHODS
Thirty subjects < or = 45 years of age with severe, generalized periodontitis received subgingival debridement and oral hygiene instructions each week for 4 weeks, plus 6 months of adjunctive subantimicrobial doxycycline (SDD) or placebo. Periodontal status was monitored at baseline, and at 1, 3, 5.25, and 8.25 months following completion of the hygiene sessions. Maintenance therapy was performed at 3, 5.25, and 8.25 months for both groups.


RESULTS
Ten subjects in each group completed all phases of the study. Subgingival debridement plus adjunctive SDD reduced deep pockets (> or =7 mm at baseline) by an average of 3.02 mm after 9 months versus 1.42 mm for the placebo group. A significant clinical response was seen in both groups as soon as 1 month, but the response was always clinically and statistically greater in the SDD group. In the SDD group, nearly 40% of 237 pockets > or =7 mm were reduced by > or =4 mm, and 55% were reduced by > or =3 mm. In addition, only 2 pockets deepened by > or =4 mm in the SDD group versus 10 in the placebo group.


CONCLUSIONS
The supplementation of hygienist-delivered full mouth subgingival and supragingival debridement with a host-modulating agent, SDD, provides clinically and statistically significant benefits in the reduction of deep pockets in patients with severe, generalized periodontitis. In addition, adjunctive SDD is more effective than a placebo in preventing further increases in probing depth.
Novak
M John
MJ
Center for Oral Health Research, University of Kentucky, Lexington 40536-0297, USA. mjnova2@pop.uky.edu
Johns
Lee P
LP
Miller
Renee C
RC
Bradshaw
Mark H
MH
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002908:Chronic Disease; D004311:Double-Blind Method; D004318:Doxycycline / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors; D008875:Middle Aged; D010512:Periodontal Index; D010518:Periodontitis / Q000188:drug therapy* / Q000201:enzymology / Q000628:therapy; D011480:Protease Inhibitors / Q000008:administration & dosage*; D013357:Subgingival Curettage; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D061965:Matrix Metalloproteinase Inhibitors; D011480:Protease Inhibitors; D004318:Doxycycline