Non-Surgical Periodontal Therapy with Adjunctive Amoxicillin/Metronidazole or Metronidazole When No Aggregatibacter actinomycetemcomitans Is Detected-A Randomized Clinical Trial.

Holger F R Jentsch,Sigrun Eick,Martin Dietrich

doi:10.3390/antibiotics9100686

Holger F R Jentsch, Sigrun Eick + Show 1 more

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https://doi.org/10.3390/antibiotics9100686

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Abstract

Background: The aim was to compare two different systemic antibiotics regimens adjunctive to non-surgical periodontal therapy when Aggregatibacter actinomycetemcomitans was not detected in the subgingival biofilm. Methods: A total of 58 patients with periodontitis and with no A. actinomycetemcomitans in the subgingival biofilm were treated with full-mouth subgingival instrumentation and either metronidazole (MET; n = 29) or amoxicillin/metronidazole (AMX/MET; n = 29). Probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were recorded at baseline, as well as after three and six months. Subgingival biofilm and gingival crevicular fluid were collected and analyzed for major periodontopathogens and biomarkers. Results: PD, CAL and BOP improved at 3 and 6 months (each p < 0.001 vs. baseline) with no difference between the groups. Sites with initial PD ≥ 6 mm also improved in both groups after 3 and 6 months (p < 0.001) with a higher reduction of PD in the AMX/MET group (p < 0.05). T. forsythia was lower in the AMX/MET group after 3 months (p < 0.05). MMP-8 and IL-1β were without significant changes and differences between the groups. Conclusion: When A. actinomycetemcomitans was not detected in the subgingival biofilm, the adjunctive systemic use of amoxicillin/metronidazole results in better clinical and microbiological outcomes of non-surgical periodontal therapy when the application of systemic antibiotics is scheduled.

Highlights

Periodontitis is a chronic inflammatory, autodestructive disease [1,2] with high prevalence [3,4,5].The tooth-supporting tissues are progressively destructed and subsequent tooth loss can occur.Subgingival instrumentation is an efficacious part of the systematic periodontal treatment [6,7,8,9,10].Systemic antimicrobials as an adjunct to subgingival instrumentation statistically significantly improve the clinical results of the nonsurgical therapy
There exist proves of positive effects of several antibiotics regarding the reduction of probing depth (PD) and bleeding on probing (BOP) and additional attachment gain (CAL) is reported [11]
A further exclusion criterion was the detection of A. actinomycetemcomitans in the subgingival biofilm tested by analysis of the subgingival biofilm two weeks before subgingival instrumentation

Summary

Introduction

Systemic antimicrobials as an adjunct to subgingival instrumentation statistically significantly improve the clinical results of the nonsurgical therapy. The aim was to compare two different systemic antibiotics regimens adjunctive to non-surgical periodontal therapy when Aggregatibacter actinomycetemcomitans was not detected in the subgingival biofilm. Methods: A total of 58 patients with periodontitis and with no A. actinomycetemcomitans in the subgingival biofilm were treated with full-mouth subgingival instrumentation and either metronidazole (MET; n = 29) or amoxicillin/metronidazole Probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were recorded at baseline, as well as after three and six months. Results: PD, CAL and BOP improved at 3 and 6 months (each p < 0.001 vs baseline) with no difference between the groups. Sites with initial PD ≥ 6 mm improved in both groups after 3 and 6 months (p < 0.001)

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