title: Control of periodontal infections: a randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at treated sites.
abstract: OBJECTIVE
  To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery.
  
  
  METHODS
  One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole (SMA), local tetracycline delivery (LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level (CAL) and probing pocket depth (PPD) were statistically evaluated by ancova of main effects.
  
  
  RESULTS
  Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24-month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction.
  
  
  CONCLUSIONS
  Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed.
authors.affiliation: The Forsyth Institute, Cambridge, MA, USA. MGoodson@forsyth.org
authors.forename: J Max
authors.initials: JM
authors.lastname: Goodson
authors.forename: Anne D
authors.initials: AD
authors.lastname: Haffajee
authors.forename: Sigmund S
authors.initials: SS
authors.lastname: Socransky
authors.forename: Ralph
authors.initials: R
authors.lastname: Kent
authors.forename: Ricardo
authors.initials: R
authors.lastname: Teles
authors.forename: Hatice
authors.initials: H
authors.lastname: Hasturk
authors.forename: Anna
authors.initials: A
authors.lastname: Bogren
authors.forename: Thomas
authors.initials: T
authors.lastname: Van Dyke
authors.forename: Jan
authors.initials: J
authors.lastname: Wennstrom
authors.forename: Jan
authors.initials: J
authors.lastname: Lindhe
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002482:Cellulose / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002710:Chlorhexidine / Q000627:therapeutic use; D012534:Dental Scaling; D004338:Drug Combinations; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D019647:Oral Surgical Procedures; D017622:Periodontal Attachment Loss / Q000628:therapy; D010510:Periodontal Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000628:therapy; D012907:Smoking / Q000009:adverse effects; D013752:Tetracycline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: C116585:Actisite; D000890:Anti-Infective Agents; D004338:Drug Combinations; D008795:Metronidazole; D000658:Amoxicillin; D002482:Cellulose; D013752:Tetracycline; D002710:Chlorhexidine