Non-surgical periodontal therapy with adjunctive topical doxycycline: a double-masked, randomized, controlled multicenter study. II. Microbiological results.
BACKGROUND
Topical application of active substances offers an additional option in periodontal therapy. The aim of this study was to examine the influence of the administration of a novel, biodegradable 14% doxycycline gel on microbiological findings, in connection with scaling and root planing.


METHODS
One hundred ten patients in three centers (Frankfurt and Heidelberg, Germany; Nijmegen, The Netherlands) with moderate to advanced periodontitis were evaluated in this randomized, double-masked, split-mouth clinical trial. In each patient, three test teeth were randomly assigned to one of three treatment modalities: 1) scaling and root planing (SRP) alone; 2) SRP with subgingival placebo gel (VEH); or 3) SRP and 14% doxycycline gel (DOX). Subgingival plaque samples were analyzed at baseline and 3 and 6 months after therapy for Actinobacillus actinomycetemcomitans (A.a.), Tannerella forsythensis (T.f.), Porphyromonas gingivalis (P.g.), and Treponema denticola (T.d.) using a RNA probe. Samples from 10 patients were tested for resistance against doxycycline, amoxicillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole using agar diffusion testing.


RESULTS
The largest decrease in pathogens was found after 3 months, with the most pronounced differences between DOX and SRP (P <0.05). At 6 months, pathogens were still reduced markedly in all groups. Treatment results were consolidated for VEH and DOX, with a slight deterioration for SRP (DOX versus SRP: P <0.001). Resistance was observed to amoxycillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole (four isolates) but not to doxycycline.


CONCLUSIONS
The addition of subgingival instillation of a 14% doxycycline gel resulted in pronounced reduction of periodontal pathogens after 3 months and stabilizing results up to 6 months after therapy. Resistance to doxycycline was not induced.
Ratka-Krüger
Petra
P
Department of Operative Dentistry and Periodontology, School of Dental Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany. ratka@zmk2.ukl.uni-freiburg.de
Schacher
Beate
B
Bürklin
Thomas
T
Böddinghaus
Boris
B
Holle
Rolf
R
Renggli
Heinz H
HH
Eickholz
Peter
P
Kim
Ti-Sun
TS
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003773:Dental Plaque / Q000382:microbiology; D012534:Dental Scaling; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D005782:Gels; D006801:Humans; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000188:drug therapy* / Q000382:microbiology; D016745:Root Planing
D000900:Anti-Bacterial Agents; D005782:Gels; D004318:Doxycycline