title: Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study.
abstract: OBJECTIVE
  The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis.
  
  
  METHODS
  This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement.
  
  
  RESULTS
  There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05).
  
  
  CONCLUSIONS
  Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.
authors.affiliation: Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil.
authors.forename: C C
authors.initials: CC
authors.lastname: Bergamaschi
authors.affiliation: Division of Periodontics, College of Dentistry, State University of São Paulo, São José dos Campos, Brazil.
authors.forename: M P
authors.initials: MP
authors.lastname: Santamaria
authors.affiliation: Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil.
authors.forename: L A
authors.initials: LA
authors.lastname: Berto
authors.affiliation: Department of Dentistry, University of Santo Amaro, São Paulo, Brazil.
authors.forename: K
authors.initials: K
authors.lastname: Cogo-Müller
authors.affiliation: Department of Pharmacology, Anesthesiology and Therapeutics, São Leopoldo Mandic Dental School, Campinas, Brazil.
authors.forename: R H L
authors.initials: RH
authors.lastname: Motta
authors.affiliation: Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil.
authors.forename: E A
authors.initials: EA
authors.lastname: Salum
authors.affiliation: Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil.
authors.forename: F H
authors.initials: FH
authors.lastname: Nociti Júnior
authors.affiliation: Department of Clinical Research, The Forsyth Institute, Boston, MA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Goodson
authors.affiliation: Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil.
authors.forename: F C
authors.initials: FC
authors.lastname: Groppo
mesh_terms: D055113:Chronic Periodontitis / Q000188:drug therapy*; D012534:Dental Scaling; D005500:Follow-Up Studies; D006801:Humans; D008795:Metronidazole; D017622:Periodontal Attachment Loss / Q000188:drug therapy; D057747:Periodontal Debridement; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000188:drug therapy; D010865:Pilot Projects; D012907:Smoking
chemical_list: D008795:Metronidazole
keywords: adjunctive periodontal therapy; metronidazole; periodontitis; smoking