title: Systemic Biomarkers in 2-Phase Antibiotic Periodontal Treatment: A Randomized Clinical Trial.
abstract: Accumulating evidence suggests that periodontal infections may have an impact on systemic health. In patients with untreated periodontitis, very high values for several inflammatory markers in serum are expressed simultaneously. We investigated to what extent these peak values change after nonsurgical and surgical periodontal treatment, with adjunctive antibiotics administered during the first or the second treatment phase. In a single-center, randomized, placebo-controlled, and double-masked clinical trial, 80 patients with chronic or aggressive periodontitis were randomized into 2 treatment groups: group A, receiving systemic amoxicillin and metronidazole during the first, nonsurgical phase of periodontal therapy (phase 1), and group B, receiving the antibiotics during the second, surgical phase (phase 2). Serum samples were obtained at baseline (BL), 3 mo after phase 1 (M3), and 6 and 12 mo after phase 2 (M6, M12). Samples were evaluated for 15 cytokines and 9 acute-phase proteins using the Bio-Plex bead array multianalyte detection system. For each analyte, peak values were defined as greater than mean +2 SD of measurements found in 40 periodontally healthy persons. Sixty-six patients showed a peak value of at least 1 analyte at BL. At M12, the number of these patients was only 36 (P = 0.0002). This decrease was stronger in group A (BL: 35, M12: 19, P = 0.0009) than in group B (BL: 31, M12: 17, P = 0.14). Twenty patients displayed peak values of at least 4 biomarkers at BL. The nonsurgical therapy delivered in the first phase reduced most of these peaks (group A, BL: 9, M3: 4, P = 0.17; group B, BL: 11, M3: 2, P = 0.01), irrespective of adjunctive antibiotics. The reductions obtained at M3 were maintained until M12 in both groups. Initial, nonsurgical periodontal therapy reduced the incidence of peak levels of inflammatory markers. Antibiotics and further surgical therapy did not enhance the effect (Clinicaltrials.gov NCT02197260).
authors.affiliation: Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland ekaterini.giannopoulou@unige.ch.
authors.forename: C
authors.initials: C
authors.lastname: Giannopoulou
authors.affiliation: Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Cionca
authors.affiliation: Department of Dentistry, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Almaghlouth
authors.affiliation: Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Cancela
authors.affiliation: Center for Clinical Research and Division of Clinical Epidemiology, University of Geneva, Geneva, Switzerland.
authors.forename: D S
authors.initials: DS
authors.lastname: Courvoisier
authors.affiliation: Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Mombelli
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000368:Aged; D010520:Aggressive Periodontitis / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D055113:Chronic Periodontitis / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006242:Haptoglobins / Q000032:analysis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D057747:Periodontal Debridement / Q000379:methods; D010919:Placebos; D011498:Protein Precursors / Q000097:blood; D000683:Serum Amyloid P-Component / Q000032:analysis
chemical_list: D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016207:Cytokines; D006242:Haptoglobins; C508609:IL10 protein, human; C507763:IL1RN protein, human; D018836:Inflammation Mediators; D053590:Interleukin 1 Receptor Antagonist Protein; D010919:Placebos; D011498:Protein Precursors; D000683:Serum Amyloid P-Component; D016753:Interleukin-10; D008795:Metronidazole; D000658:Amoxicillin; D002116:Calcitonin; D005293:Ferritins
keywords: acute phase proteins; antimicrobials; clinical research; cytokines; periodontal therapy; serum