title: Combining host modulation and topical antimicrobial therapy in the management of moderate to severe periodontitis: a randomized multicenter trial.
abstract: BACKGROUND
  Previous studies showed that host modulation therapy (HMT) or topical antimicrobial therapy (TAT) provided significant adjunctive benefits to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The purpose of this study was to evaluate a combination therapy involving SRP, HMT, and TAT in the treatment of moderate to severe CP.
  
  
  METHODS
  A 6-month, randomized, multicenter, placebo-controlled, examiner-masked study was undertaken to evaluate the clinical usefulness of a combination treatment of systemically delivered doxycycline hyclate (HMT; 20 mg, twice a day) plus locally delivered doxycycline hyclate gel (TAT; 10%, in pockets > or =5 mm) in combination with SRP versus SRP plus placebo. Clinical outcomes included mean changes in probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI) at baseline and at 3 and 6 months.
  
  
  RESULTS
  In 171 subjects, combination therapy provided significantly greater clinical benefits than control therapy for all clinical measures at 3 and 6 months. In moderate CP (PD of 4 to 6 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P <0.01), CAL (3 months: P <0.01; 6 months: P <0.03), BOP (3 months: P <0.02; 6 months: P <0.05), and GI (3 months: P <0.01; 6 months: P <0.03). In severe CP (PD > or =7 mm), combination therapy provided significant benefits over control for PD (3 and 6 months: P <0.01), CAL (3 months: P <0.01; 6 months: P <0.02), BOP (3 months: P <0.01; 6 months: P >0.05), and GI (3 months: P <0.01; 6 months: P <0.01).
  
  
  CONCLUSIONS
  Combination therapy, including SRP, HMT, and TAT, provided significantly greater clinical benefits than SRP alone in the treatment of moderate to severe CP.
authors.affiliation: Center for Oral Health Research, University of Kentucky, Lexington, KY 40536-0305, USA. mjnova2@uky.edu
authors.forename: M John
authors.initials: MJ
authors.lastname: Novak
authors.forename: Dolphus R
authors.initials: DR
authors.lastname: Dawson
authors.forename: Ingvar
authors.initials: I
authors.lastname: Magnusson
authors.forename: Katherine
authors.initials: K
authors.lastname: Karpinia
authors.forename: Alan
authors.initials: A
authors.lastname: Polson
authors.forename: Anne
authors.initials: A
authors.lastname: Polson
authors.forename: Maria E
authors.initials: ME
authors.lastname: Ryan
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ciancio
authors.forename: Connie H
authors.initials: CH
authors.lastname: Drisko
authors.forename: Denis
authors.initials: D
authors.lastname: Kinane
authors.forename: Christopher
authors.initials: C
authors.lastname: Powala
authors.forename: Mark
authors.initials: M
authors.lastname: Bradshaw
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D012534:Dental Scaling; D004318:Doxycycline / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; 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 / Q000628:therapy*; D010919:Placebos; D016745:Root Planing; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010919:Placebos; D004318:Doxycycline