title: Full-mouth ultrasonic debridement associated with amoxicillin and metronidazole in the treatment of severe chronic periodontitis.
abstract: BACKGROUND
  The purpose of this study was to evaluate the adjunctive clinical, microbiologic, and immunologic effects of the systemic administration of amoxicillin and metronidazole in the full-mouth ultrasonic debridement of patients with severe chronic periodontitis.
  
  
  METHODS
  Twenty-five patients presenting at least eight teeth with probing depth (PD) > or =5 mm and bleeding on probing (BOP) were selected and randomly assigned to full-mouth ultrasonic debridement + placebo (control group) or full-mouth ultrasonic debridement + amoxicillin and metronidazole (test group). The clinical outcomes evaluated were visible plaque index, BOP, position of the gingival margin, relative attachment level (RAL), and PD. Real-time polymerase chain reaction (PCR) was used for quantitative analysis of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis). The enzyme-linked immunosorbent assay (ELISA) technique permitted the detection of prostaglandin E(2,) interleukin-1beta, and interferon-gamma levels in gingival crevicular fluid. All parameters were evaluated at baseline and at 3 and 6 months post-treatment.
  
  
  RESULTS
  At 6 months, the test treatment resulted in lower BOP and an additional reduction (0.83 mm) in PD (P <0.05). Data also showed RAL gain > or =2 mm at 43.52% of sites in control patients compared to 58.03% of sites in test patients (P <0.05). However, both groups had similar mean RAL gain (1.68 and 1.88 mm for the control and test groups, respectively). Real-time PCR and ELISA failed to identify significant differences between the groups.
  
  
  CONCLUSIONS
  Both treatments resulted in significant clinical improvements; however, there was a slight, but significantly greater, improvement in BOP and the percentage of sites with PD > or =5 mm exhibiting RAL gain > or =2 mm in the test group. Nevertheless, no improvement in the microbiologic or immunologic outcome was observed with the adjunctive use of systemic amoxicillin and metronidazole.
authors: Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil.
authors: Erica Del Peloso
authors: Edel P
authors: Ribeiro
authors: Sandro
authors: S
authors: Bittencourt
authors: Iriana Carla Junqueira
authors: IC
authors: Zanin
authors: Glaucia Maria
authors: GM
authors: Bovi Ambrosano
authors: Enilson A
authors: EA
authors: Sallum
authors: Francisco H
authors: FH
authors: Nociti
authors: Reginaldo Bruno
authors: RB
authors: Gonçalves
authors: Márcio Zaffalon
authors: MZ
authors: Casati
mesh_terms: D000328:Adult; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001439:Bacteroides / Q000187:drug effects; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D003774:Dental Plaque Index; D012534:Dental Scaling / Q000295:instrumentation / Q000379:methods*; D015232:Dinoprostone / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D005884:Gingival Hemorrhage / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis; D053583:Interleukin-1beta / Q000032:analysis; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000628:therapy; D010919:Placebos; D016966:Porphyromonas gingivalis / Q000187:drug effects; D013357:Subgingival Curettage / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D053583:Interleukin-1beta; D010919:Placebos; D008795:Metronidazole; D000658:Amoxicillin; D007371:Interferon-gamma; D015232:Dinoprostone