The use of 2 antibiotic regimens in aggressive periodontitis: comparison of changes in clinical parameters and gingival crevicular fluid biomarkers.
OBJECTIVE
To evaluate and compare the effect of nonsurgical periodontal therapy in conjunction with 2 different antibacterial agents on clinical and immunological parameters in aggressive periodontitis (AgP) patients.


METHODS
Thirty-one AgP patients underwent clinical examination that included plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). GCF (gingival crevicular fluid) samples were collected and assayed for PGE(2), IL-1beta, and TNFalpha. Nonsurgical periodontal therapy was performed. The patients received doxycycline (doxy group) or metronidazole plus amoxicillin (am-met group). After completion of the mechanical phase of therapy, patients were seen biweekly for oral hygiene reinforcement. After 12 weeks, clinical measurements and GCF sampling were repeated.


RESULTS
The combined mechanical and antimicrobial therapy resulted in overall improvement in all clinical parameters; mean PPD reduction of 0.74 +/- 0.1 mm and mean CAL gain 0.86 +/- 0.1 mm were both statistically significant (P = .0001). Marked reduction was observed for PGE2 and IL-1beta, but not TNFalpha. There was no significant difference between the 2 groups at baseline or final examination, except for PGE(2) at final examination: It was significantly lower for the doxy group (83.61 +/- 5.8 ng) than for the am-met group (124.08 +/- 15.8 ng), P = .0202.


CONCLUSIONS
Both treatment protocols resulted in significant improvements in the clinical and immunological parameters. When combined mechanical and antimicrobial protocol is desired and microbial cultures are not available, the use of both antibiotic regimens is recommended; the treatment of choice should be based on compliance, allergies, and potential side effects.
Machtei
Eli E
EE
Department of Periodontology, Oral, and Dental Medicine, Rambam Medical Center, Haifa, Israel. machtei@rambam.health.gov.il
Younis
Mahmoud N
MN
D000293:Adolescent; D000328:Adult; D010520:Aggressive Periodontitis / Q000188:drug therapy* / Q000276:immunology* / Q000628:therapy; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D003774:Dental Plaque Index; D012534:Dental Scaling; D015232:Dinoprostone / Q000032:analysis; D004318:Doxycycline / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005883:Gingival Crevicular Fluid / Q000737:chemistry*; D006801:Humans; D053583:Interleukin-1beta / Q000032:analysis; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D009910:Oral Hygiene; D010512:Periodontal Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D055815:Young Adult
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D004338:Drug Combinations; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D008795:Metronidazole; D000658:Amoxicillin; D015232:Dinoprostone; D004318:Doxycycline