Locally delivered doxycycline as an adjunct to mechanical debridement at retreatment of periodontal pockets: outcome at furcation sites.
BACKGROUND
The goal was to evaluate the clinical outcome of non-surgical retreatment at molar furcation sites by ultrasonic debridement with or without adjunctive application of locally delivered doxycycline, and to explore factors affecting the healing results.


METHODS
This study involves 32 patients with chronic periodontitis, who received initial pocket/root debridement by ultrasonic instrumentation, followed by random assignment to retreatment of remaining pathologic sites at 3 months by ultrasonic instrumentation with or without adjunctive local application of an 8.8% doxycycline gel. Clinical examinations of plaque, probing depth (PD), relative attachment level, furcation involvement, and bleeding after furcation probing were performed initially, before retreatment at 3 months (baseline), and 3 and 9 months after retreatment. The primary efficacy variable was reduction in the degree of furcation involvement. A multilevel logistic model was used to evaluate the impact of patient and tooth site related factors on the main outcome variable.


RESULTS
The retreatment including locally delivered doxycycline resulted in closure of 50% of degree I furcation sites, compared to 29% for sites treated with mechanical debridement only (P >0.05). Of the degree II furcation sites, 17% in the test and 11% in the control group were reduced in depth (P >0.05). The logistic multilevel model with "furcation improvement" as the dichotomous outcome variable revealed that local application of doxycycline had no statistically significant effect. The odds ratio for ?furcation improvement? was 0.80 (95% confidence interval [CI], 0.65 to 0.99) for 1-mm increase of initial vertical PD, 0.36 (95% CI, 0.17 to 0.80) for initial furcation involvement degree II compared to degree I, and 0.24 (95% CI, 0.08 to 0.72) for smokers compared to non-smokers.


CONCLUSIONS
Improvement in molar furcation involvement after non-surgical periodontal therapy was not enhanced by adjunctive locally applied doxycycline and negatively affected by increased vertical PD and tobacco smoking.
Tomasi
Cristiano
C
Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. cristiano.tomasi@odontologi.gu.se
Wennström
Jan L
JL
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004318:Doxycycline / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005782:Gels; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008963:Molar; D057747:Periodontal Debridement / Q000295:instrumentation / Q000379:methods*; D010514:Periodontal Pocket / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019233:Retreatment; D016037:Single-Blind Method; D012907:Smoking / Q000009:adverse effects; D014092:Tooth Root / Q000473:pathology; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
D000891:Anti-Infective Agents, Local; D005782:Gels; D004318:Doxycycline