Nonsurgical treatment of aggressive periodontitis with photodynamic therapy or systemic antibiotics.
ABSTRACT Summary The aim of this randomized, controlled clinical study was to compare the short-term effects of nonsurgical periodontal therapy with the additional administration of systemic antibiotics (AB) and the same therapy with additional photodynamic therapy (PDT) in the treatment of patients with aggressive periodontitis (AP). Thirty-six patients with AP received full-mouth nonsurgical periodontal treatment (SRP) and were then randomly divided into two groups of 18 subjects each. Group AB received amoxicillin and metronidazole three times a day for 7 days. Group PDT received two applications of PDT on the day of SRP as well as at follow-up after 7 days. The following clinical parameters were measured at baseline and 3 months after therapy: plaque index (PLI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). After 3 months, PD was significantly reduced in both groups (from 5.0 ± 0.8 mm to 3.2 ± 0.4 mm with AB, and 5.1± 0.5 mm to 4.0 ± 0.8 mm with PDT; both p < 0.001), while AB revealed significantly lower values compared to PDT (p = 0.001). In both groups, GR was not significantly changed. CAL was significantly reduced in both groups (PDT: 5.7±0.8 mm to 4.7±1.1 mm; p = 0.011; AB: 5.5 ±1.1 mm to 3.9± 1.0 mm; p < 0.001) and differed significantly between the groups (p = 0.025). The number of residual pockets (PD ≥4 mm) and positive BOP was reduced by AB from 961 to 377, and by PDT from 628 to 394. Pockets with PD ≥ 7 mm were reduced by AB from 141 to 7, and by PDT from 137 to 61. After 3 months, both treatments led to statistically significant clinical improvements. The systemic administration of antibiotics, however, resulted in significantly higher reduction of PD and a lower number of deep pockets compared to PDT.
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ABSTRACT: AIM: To investigate the indication of systemic antimicrobial agents used by dental professionals for treatment of patients affected by periodontal diseases. METHODS: Interviews by a questionnaire were held with 225 professionals of different dental specialties and who performed periodontal treatment. RESULTS: Among interviewees, 94% indicated systemic antibiotics as a form of periodontal disease treatment. Their main indication was for periodontal abscesses (80%) followed by aggressive periodontitis (62%) and necrotizing diseases (45%). The most frequently used antibiotics were amoxicillin (81%) and metronidazole (57%). The medications were indicated in association with mechanical therapy by 67% of the professionals. As regards the occasion of indication, 60% indicated systemic antibiotic therapy before and after mechanical periodontal scaling and root planing. Seventy-eight percent of the professionals indicated antibiotics associated with periodontal surgery for access to scaling, and 76% indicated it before and after the surgical procedure. Among the interviewees, 99% took into account systemic involvement for drug administration. CONCLUSIONS: It was concluded that a considerable portion of professionals indicate systemic antibiotic-therapy in an incoherent manner and in situations in which there is no indication for antibiotic use, or with ineffective protocols.Brazilian Journal of Oral Sciences 12/2013; 12(4):285-291. DOI:10.1590/S1677-32252013000400003
Article: Effect of nonsurgical periodontal treatment in conjunction with either systemic administration of amoxicillin and metronidazole or additional photodynamic therapy on the concentration of matrix metalloproteinases 8 and 9 in gingival crevicular fluid in patients with aggressive periodontitis[Show abstract] [Hide abstract]
ABSTRACT: To evaluate in patients with aggressive periodontitis (AgP) the effect of nonsurgical periodontal treatment in conjunction with either additional administration of systemic antibiotics (AB) or application of photodynamic therapy (PDT) on the gingival crevicular fluid (GCF) concentration of matrix metalloproteinases 8 and 9 (MMP-8 and -9). Thirty-six patients with AgP were included in the study. Patients were randomly assigned to treatment with either scaling and root planing (SRP) followed by systemic administration of AB (e.g. Amoxicillin + Metronidazole) or SRP + PDT. The analysis of MMP-8 and -9 GCF concentrations was performed at baseline and at 3 and 6 months after treatment. Nonparametric U-Mann-Whitney test was used for comparison between groups. Changes from baseline to 3 and 6 months were analyzed with the Friedman's ANOVA test with Kendall's index of consistency. In the AB group, patients showed a statistically significant (p = 0.01) decrease of MMP-8 GCF level at both 3 and 6 months post treatment. In the PDT group, the change of MMP-8 GCF level was not statistically significant. Both groups showed at 3 and 6 months a decrease in MMP-9 levels. However, this change did not reach statistical significance. Within the limits of the present study, it may be suggested that in patients with AgP, nonsurgical periodontal therapy in conjunction with adjunctive systemic administration of amoxicilin and metronidazole is more effective in reducing GCF MMP-8 levels compared to the adjunctive use of PDT.BMC Oral Health 05/2015; 15(1):63. DOI:10.1186/s12903-015-0048-0 · 1.15 Impact Factor