Abstract
The effectiveness of azithromycin combined with full-mouth scaling procedures was compared to quadrant-wise scaling combined with the same dosage of azithromycin when treating periodontitis patients over a 6-month period. In this randomized clinical trial study, thirty-four individuals diagnosed with generalized stage III and IV periodontitis underwent baseline, 3-month, and 6-month post-treatment examinations. The study population was randomly assigned to either full-mouth scaling (FMS) or quadrant-wise scaling and root planning (QSRP) in addition to their taking of systemic azithromycin (500 mg/day) for three consecutive days. Periodontal probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) were monitored along with the quantification of total bacterial load and red complex bacterial species (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) in subgingival samples by real time polymerase chain reaction. The volume of gingival crevicular fluid (GCF) was also monitored over time. The primary outcomes included improvements of PD and CAL. Data was statistically analyzed through a repeated-measures analysis of variance (ANOVA) test, multiple least significant difference (LSD) comparisons, Kruskal-Wallis, Friedman, and paired Student t-tests (p<0.05). FMS and QSRP provided similar PD, CAL, GI, PI, and GCF improvements. After treatment, the FMS group displayed lower mean values of total bacterial load and red complex bacterial species in comparison to the QSRP group. FMS and QSRP in conjunction with systemic azithromycin appeared to be an effective and reliable short-term therapeutic approach for the treatment of generalized stage III and IV periodontitis. However, FMD demonstrated superiority in regard to the 6-month antibacterial effects when compared to QSRP.
Highlights
Periodontitis is a mixed infection primarily caused by periodontal pathogens existing within subgingival plaque
While some studies have revealed better clinical and microbiological results for the full-mouth scaling (FMS) protocol [11,13], other studies have failed to demonstrate such results [11,12,23]. In this context and due to its dosage scheme, it was hypothesized that the addition of azithromycin in FMS would provide greater benefits in comparison to quadrant-wise scaling and root planning (QSRP)
Besides the severity of periodontal disease in the present study population, the choice of azithromycin as an adjuvant to non-surgical periodontal therapy was based on the following characteristics: its broad spectrum of action, fast leukocyte and fibroblast absorption, slow release in soft tissues, and reduced number of intake days which contributes to patient compliance [14]
Summary
Periodontitis is a mixed infection primarily caused by periodontal pathogens existing within subgingival plaque. Diverse bacteria exist in the subgingival plaque, forming an extremely complicated bacterial flora. Commensal bacterial species are key microorganisms in regard to oral homeostasis. When a decrease in the levels of advantageous symbionts occurs with a simultaneous increase of pathogenic bacteria, normal periodontal tissue function is disturbed, allowing disease to spread [2]. Periodontitis is a dysbiotic disease resulting from the broken symbiotic relationship between host and microbe [3]. Key pathogenic species, such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, are capable of disrupting periodontal homeostasis [4,5,6]
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