title: Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial.
abstract: OBJECTIVE
  To compare the 1-year clinical and microbiological outcomes of an enhanced anti-infective therapy with versus without systemic antimicrobials in patients with generalized aggressive periodontitis (GAP).
  
  
  METHODS
  In this 12-month randomized, double-blinded, placebo-controlled trial, 35 individuals assigned to a control (n = 17) or test group (n = 18) received full-mouth supra and subgingival ultrasonic debridement followed by scaling and root planing with chlorhexidine rinsing, brushing, and irrigation. Subjects received either amoxicillin (AMX, 500 mg) + metronidazole (MET, 250 mg) or placebos, TID for 10 days. Subgingival samples were obtained and analysed for their composition by checkerboard. Data were subjected to non-parametric tests.
  
  
  RESULTS
  Both therapeutic protocols resulted in similar significant clinical improvement for most parameters at 1 year (p < 0.01). The AMX + MET group exhibited shallower residual pockets than the placebo (p = 0.05). Most periodontal pathogens decreased, whereas beneficial bacteria increased in counts in both groups over time (p < 0.0012). High levels of some periodontal and other microbial pathogens were associated with disease persistence regardless treatment.
  
  
  CONCLUSIONS
  The enhanced anti-infective mechanical therapy is comparable with its combination with systemic AMX+MET for most clinical parameters and for maintaining low levels of periodontal pathogens for up to 1 year after treatment of GAP.
authors.affiliation: Division of Graduate Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Mayra Xavier E
authors.initials: MX
authors.lastname: Silva-Senem
authors.forename: Débora
authors.initials: D
authors.lastname: Heller
authors.forename: Victor Macedo
authors.initials: VM
authors.lastname: Varela
authors.forename: Maria Cynesia Barros
authors.initials: MC
authors.lastname: Torres
authors.forename: Eduardo Jorge
authors.initials: EJ
authors.lastname: Feres-Filho
authors.forename: Ana Paula Vieira
authors.initials: AP
authors.lastname: Colombo
mesh_terms: D010520:Aggressive Periodontitis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D058491:Bacterial Load / Q000187:drug effects; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D012534:Dental Scaling / Q000379:methods; D004311:Double-Blind Method; D004338:Drug Combinations; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D009067:Mouthwashes / Q000008:administration & dosage / Q000627:therapeutic use; D057747:Periodontal Debridement / Q000379:methods*; D010514:Periodontal Pocket / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D010919:Placebos; D016745:Root Planing / Q000379:methods; D007507:Therapeutic Irrigation; D014099:Toothbrushing / Q000379:methods; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D009067:Mouthwashes; D010919:Placebos; D008795:Metronidazole; D000658:Amoxicillin; D002710:Chlorhexidine