Abstract
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7–14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1β, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.
Highlights
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials showed improved clinical, microbiological and immunological results over the mechanical protocol alone
Despite the fact that SD has been shown to be successful in reducing periodontal pathogens in the subgingival area[2,3], evidence exists that major periodontal pathogens like Aggregatibacter actinomycetemcomitans or Porphyromonas gingivalis may not be completely eliminated by mechanical debridement alone and their persistence has been associated with further tissue breakdown[4,5,6]
Significantly better clinical outcomes regarding probing pocket depth (PD) reduction and clinical attachment level (CAL) g ain[11,13,22,23,24,25,26,27,28,29,30,31,32,33] as well as significant reduction of periodontal pathogens and of inflammatory cytokines were observed for the systemic use of AMX + MET adjunctive to SD compared to mechanical treatment alone[22,23,24,25,26,27,28,29,30,31,32,34,35]
Summary
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7–14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. Systemic antimicrobials had been introduced in the late 80ies as adjuncts to mechanical debridement to reinforce SD and sustain the host-defence system by reaching the pathogens not always accessible for mechanical instruments (i.e. root-concavities, furcations) or in other mouth areas (i.e. pharynx, tongue)[10] In this sense, several antimicrobials and various combinations thereof had been implemented in the nonsurgical periodontal treatment showing improved clinical, microbiological and immunological results over the mechanical protocol a lone[11,12,13,14,15]. It seems mandatory, that in various field of general medicine the antibiotic prescription and protocol should be reanalysed and clearly d efined[51], and in dentistry and especially in periodontal therapy there is an urgent need to establish the optimal antibiotic protocol and the class of patients that may really benefit from it
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