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Effects of azithromycin, metronidazole, amoxicillin, and metronidazole plus amoxicillin on an in vitro polymicrobial subgingival biofilm model. Antimicrob Agents Chemother 2015; 59:2791-8. [PMID: 25733510 DOI: 10.1128/aac.04974-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/24/2015] [Indexed: 01/30/2023] Open
Abstract
Chronic periodontitis is one of the most prevalent human diseases and is caused by dysbiosis of the subgingival microbiota. Treatment involves primarily mechanical disruption of subgingival biofilms and, in certain cases, adjunctive use of systemic antibiotic therapy. In vitro biofilm models have been developed to study antimicrobial agents targeting subgingival species. However, these models accommodate a limited number of taxa, lack reproducibility, and have low throughput. We aimed to develop an in vitro multispecies biofilm model that mimics subgingival plaque, to test antimicrobial agents. Biofilms were cultivated using the Calgary Biofilm Device and were exposed to amoxicillin (AMX), metronidazole (MTZ), azithromycin (AZM), and AMX-MTZ at four different concentrations for 12, 24, or 36 h. Chlorhexidine (CHX) (0.12%) was used as the positive control. The compositions of the biofilms were analyzed by checkerboard DNA-DNA hybridization, and the percent reduction in biofilm metabolic activity was determined using 2,3,5-triphenyltetrazolium chloride and spectrophotometry. Thirty-five of the 40 species used in the inoculum were consistently recovered from the resulting in vitro biofilms. After 36 h of exposure at the 1:27 dilution, AMX-MTZ reduced metabolic activity 11% less than CHX (q = 0.0207) but 54% more than AMX (q = 0.0031), 72% more than MTZ (q = 0.0031), and 67% more than AZM (q = 0.0008). Preliminary evidence of a synergistic interaction between AMX and MTZ was also observed. In summary, we developed reproducible biofilms with 35 subgingival bacterial species, and our results suggested that the combination of AMX and MTZ had greater antimicrobial effects on these in vitro multispecies biofilms than expected on the basis of the independent effects of the drugs.
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Barca E, Cifcibasi E, Cintan S. Adjunctive use of antibiotics in periodontal therapy. J Istanb Univ Fac Dent 2015; 49:55-62. [PMID: 28955547 PMCID: PMC5573506 DOI: 10.17096/jiufd.90144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Periodontal diseases are infectious diseases with a
mixed microbial aetiology and marked inflammatory
response leading to destruction of underlying tissue.
Periodontal therapy aims to eliminate pathogens
associated with the disease and attain periodontal
health. Periodontitis is generally treated by nonsurgical
mechanical debridement and regular
periodontal maintenance care. Periodontal surgery
may be indicated for some patients to improve access
to the root surface; however, mechanical debridement
alone may not be helpful in all cases. In such cases,
adjunctive systemic antibiotic therapy remains the
treatment of choice. It can reach microorganisms
at the base of the deep periodontal pockets and
furcation areas via serum, and also affects organisms
residing within gingival epithelium and connective
tissue. This review aims to provide an update on
clinical issues regarding when and how to prescribe
systemic antibiotics in periodontal therapy. The
points discussed are the mode of antibiotic action,
susceptible periodontal pathogens, antibiotic dosage,
antibiotic use in treatment of periodontal disease, and
mechanism of bacterial resistance to each antibiotic.
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Affiliation(s)
- Ece Barca
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Emine Cifcibasi
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Serdar Cintan
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:689-706. [DOI: 10.1111/jre.12252] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 12/24/2022]
Affiliation(s)
- J. A. J. Keestra
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - I. Grosjean
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Coucke
- Department of Clinical Biology; Scientific Institute of Public Health; Brussels Belgium
| | - M. Quirynen
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Teughels
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
- Fund for Scientific Research Flanders (FWO), Egermontstraat; Brussels Belgium
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Queiroz AC, Suaid FA, de Andrade PF, Novaes AB, Taba M, Palioto DB, Grisi MF, Souza SL. Antimicrobial photodynamic therapy associated to nonsurgical periodontal treatment in smokers: Microbiological results. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2014; 141:170-5. [DOI: 10.1016/j.jphotobiol.2014.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 09/16/2014] [Accepted: 10/30/2014] [Indexed: 11/25/2022]
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Vanić Ž, Planinšek O, Škalko-Basnet N, Tho I. Tablets of pre-liposomes govern in situ formation of liposomes: Concept and potential of the novel drug delivery system. Eur J Pharm Biopharm 2014; 88:443-54. [DOI: 10.1016/j.ejpb.2014.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 01/09/2023]
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Soares GMS, Mendes JAV, Silva MP, Faveri M, Teles R, Socransky SS, Wang X, Figueiredo LC, Feres M. Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial. J Clin Periodontol 2014; 41:366-76. [PMID: 24834504 DOI: 10.1111/jcpe.12217] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies. METHODS One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy. RESULTS At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites. CONCLUSION The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone.
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:294-314. [PMID: 25142259 DOI: 10.1111/jre.12221] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. BACKGROUND Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. MATERIAL AND METHODS The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent. CONCLUSION Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).
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Affiliation(s)
- J A J Keestra
- Department of Oral Health Sciences, Periodontology, KU Leuven & University of Leuven, Leuven, Belgium; Department of Periodontology, University Hospitals Leuven, Leuven, Belgium
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Miranda TS, Feres M, Perez-Chaparro PJ, Faveri M, Figueiredo LC, Tamashiro NS, Bastos MF, Duarte PM. Metronidazole and amoxicillin as adjuncts to scaling and root planing for the treatment of type 2 diabetic subjects with periodontitis: 1-year outcomes of a randomized placebo-controlled clinical trial. J Clin Periodontol 2014; 41:890-9. [PMID: 24930639 DOI: 10.1111/jcpe.12282] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the clinical and microbiological effects of the use of metronidazole (MTZ) + amoxicillin (AMX) as adjuncts to scaling and root planing (SRP) for the treatment of chronic periodontitis (ChP) in type 2 diabetic subjects. MATERIAL AND METHODS Fifty-eight type 2 diabetic subjects (n = 29/group) with generalized ChP were randomly assigned to receive SRP alone or with MTZ [400 mg/thrice a day (TID)]+AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by qPCR for the presence of seven periodontal pathogens. Subjects were monitored at baseline, 3, 6 and 12 months post-therapies. RESULTS The group receiving SRP+MTZ+AMX presented greater mean probing depth (PD) reduction and clinical attachment gain, a lower number of sites with PD ≥5 mm (primary outcome variable) and a reduced number of subjects with ≥9 of these residual pockets than the control group at 1-year post-therapy (p < 0.05). The antibiotic-treated group also presented reduced levels and greater decreases of the three red complex species, Eubacterium nodatum and Prevotella intermedia, compared to the control group at 1 year (p < 0.05). CONCLUSIONS The adjunctive use of MTZ+AMX significantly improved the clinical and microbiological outcomes of SRP in the treatment of type 2 diabetic subjects with ChP.
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Gomes SC, Romagna R, Rossi V, Corvello PC, Angst PDM. Supragingival treatment as an aid to reduce subgingival needs: a 450-day investigation. Braz Oral Res 2014; 28. [PMID: 25000595 DOI: 10.1590/s1806-83242014.50000004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the clinical effects of using a supragingival biofilm control regimen (SUPRA) as a step prior to scaling and root planing (SRP). A split-mouth clinical trial was performed in which 25 subjects with periodontitis (47.2 ± 6.5 years) underwent treatment (days 0–60) and monitoring (days 90–450) phases. At Day 0 (baseline) treatments were randomly assigned per quadrant: SUPRA, SRP and S30SRP (SUPRA 30 days before SRP). The full-mouth visible plaque index (VPI), gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) were examined on days 0, 30, 60, 90, 120, 270, and 450. Baseline data were similar among all groups. From days 0 to 60, the groups showed similar significant decreases in VPI and GBI. Reductions in PPD for the SRP (3.39 ± 0.17 to2.42 ± 0.16 mm) and S30SRP (3.31 ± 0.11 to 2.40 ± 0.07 mm) groups were greater (p < 0.05) than those for the SUPRA group. This pattern was also observed for BOP. Attachment gain was similar and greater for the SRP (3.34 ± 0.28 to 2.58 ± 0.26 mm) and S30SRP (3.25 ± 0.21 to 2.54 ± 0.19 mm) groups compared to the SUPRA group. Results were maintained from day 90 forward. Overall, the S30SRP treatment reduced the subgingival treatment needs in 48.16%. Performance of a SUPRA step before SRP decreased subgingival treatment needs and maintained the periodontal stability over time.
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60
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Faveri M, Figueiredo LC, Feres M. Treatment of Chronic Periodontitis May Be Improved by the Adjunctive Use of Systemic Metronidazole. J Evid Based Dent Pract 2014; 14:70-2. [DOI: 10.1016/j.jebdp.2014.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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61
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Longoni S, Sartori M, Proserpio N, Marino S, Dusi L, Carini F, Baldoni M. Posizionamento di impianti immediati o differiti in siti postestrattivi o in aree edentule in pazienti trattati con bifosfonati orali. DENTAL CADMOS 2014. [DOI: 10.1016/s0011-8524(14)70162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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62
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Teles R, Teles F, Frias-Lopez J, Paster B, Haffajee A. Lessons learned and unlearned in periodontal microbiology. Periodontol 2000 2014; 62:95-162. [PMID: 23574465 PMCID: PMC3912758 DOI: 10.1111/prd.12010] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Periodontal diseases are initiated by bacterial species living in polymicrobial biofilms at or below the gingival margin and progress largely as a result of the inflammation elicited by specific subgingival species. In the past few decades, efforts to understand the periodontal microbiota have led to an exponential increase in information about biofilms associated with periodontal health and disease. In fact, the oral microbiota is one of the best-characterized microbiomes that colonize the human body. Despite this increased knowledge, one has to ask if our fundamental concepts of the etiology and pathogenesis of periodontal diseases have really changed. In this article we will review how our comprehension of the structure and function of the subgingival microbiota has evolved over the years in search of lessons learned and unlearned in periodontal microbiology. More specifically, this review focuses on: (i) how the data obtained through molecular techniques have impacted our knowledge of the etiology of periodontal infections; (ii) the potential role of viruses in the etiopathogenesis of periodontal diseases; (iii) how concepts of microbial ecology have expanded our understanding of host-microbe interactions that might lead to periodontal diseases; (iv) the role of inflammation in the pathogenesis of periodontal diseases; and (v) the impact of these evolving concepts on therapeutic and preventive strategies to periodontal infections. We will conclude by reviewing how novel systems-biology approaches promise to unravel new details of the pathogenesis of periodontal diseases and hopefully lead to a better understanding of their mechanisms.
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63
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Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000 2014; 62:218-31. [PMID: 23574468 DOI: 10.1111/prd.12008] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine-driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial-delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full-mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long-term treatment outcomes, surgical therapy results in greater probing-depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.
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64
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Preus HR, Scheie AA, Baelum V. Letter to the Editor: Re: The Clinical Effect of Scaling and Root Planing and the Concomitant Administration of Systemic Amoxicillin and Metronidazole: A Systematic Review; Re: Effectiveness of Systemic Amoxicillin/Metronidazole as Adjunctive Therapy to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review and Meta-Analysis; Re: Effectiveness of Systemic Amoxicillin/Metronidazole as an Adjunctive Therapy to Full-Mouth Scaling and Root Planing in the Treatment of Aggressive Periodontitis: A Systematic Review and Meta-Analysis. J Periodontol 2014; 85:374-84. [DOI: 10.1902/jop.2014.130379] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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65
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Preus HR, Gunleiksrud TM, Sandvik L, Gjermo P, Baelum V. A Randomized, Double-Masked Clinical Trial Comparing Four Periodontitis Treatment Strategies: 1-Year Clinical Results. J Periodontol 2013; 84:1075-86. [DOI: 10.1902/jop.2012.120400] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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66
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Faveri M, Rebello A, de Oliveira Dias R, Borges-Junior I, Duarte PM, Figueiredo LC, Feres M. Clinical and microbiologic effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized chronic periodontitis: smokers versus non-smokers. J Periodontol 2013; 85:581-91. [PMID: 23826648 DOI: 10.1902/jop.2013.130278] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate the clinical and microbiologic effects of the adjunctive use of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of smokers and non-smokers with generalized chronic periodontitis (CP). METHODS Thirty-two smokers and 32 non-smokers were selected and received scaling and root planing (SRP) combined with MTZ (400 mg three times daily) and AMX (500 mg three times daily) for 14 days. Clinical and microbiologic examinations were performed at baseline and 3 months after SRP. Nine subgingival plaque samples per patient were analyzed using checkerboard DNA-DNA hybridization. RESULTS Both groups presented a significant improvement in all clinical parameters at 3 months after therapy (P <0.05). Non-smokers showed lower mean number of sites with probing depth (PD) ≥5 mm after therapy. Fewer non-smokers exhibited at least nine of these sites at 3 months after treatment. Non-smokers also presented the greatest reductions in mean PD and gain in clinical attachment between baseline and 3 months after therapy at initially deep (PD ≥7 mm) sites (P <0.01). The most beneficial changes in the microbial profile were also observed in the non-smoker group, which showed the lowest proportions of the orange complex at 3 months, as well as a significant increase in the proportions of Actinomyces species after treatment. CONCLUSION Smokers with CP benefit less than non-smokers from treatment by the combination of SRP, MTZ, and AMX.
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Affiliation(s)
- Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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67
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Mombelli A, Cionca N, Almaghlouth A, Décaillet F, Courvoisier DS, Giannopoulou C. Are There Specific Benefits of Amoxicillin Plus Metronidazole inAggregatibacter actinomycetemcomitans-Associated Periodontitis? Double-Masked, Randomized Clinical Trial of Efficacy and Safety. J Periodontol 2013; 84:715-24. [DOI: 10.1902/jop.2012.120281] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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68
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Socransky SS, Haffajee AD, Teles R, Wennstrom JL, Lindhe J, Bogren A, Hasturk H, van Dyke T, Wang X, Goodson JM. Effect of periodontal therapy on the subgingival microbiota over a 2-year monitoring period. I. Overall effect and kinetics of change. J Clin Periodontol 2013; 40:771-80. [PMID: 23710672 DOI: 10.1111/jcpe.12117] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/30/2022]
Abstract
AIM To examine the 2-year post-therapy kinetics of change in the composition of subgingival biofilms. MATERIAL AND METHODS In this study, 178 chronic periodontitis subjects were recruited and clinically monitored at baseline, 3, 6, 12, 18 and 24 months after therapy. All subjects received scaling and root planing and 156 one or more of periodontal surgery, systemically administered amoxicillin + metronidazole or local tetracycline at pockets ≥5 mm. Subgingival biofilm samples taken from each subject at each time point were analysed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization. The significance of changes in median species counts over time was sought using the Wilcoxon or Friedman tests and adjusted for multiple comparisons. RESULTS Mean counts were significantly reduced from baseline to 2 years for 30 of the 40 taxa. Marked reductions were observed for periodontal pathogens including Tannerella forsythia, Treponema denticola and Eubacterium nodatum. The kinetics of change differed from species to species. When data were subset according to baseline PD, patterns of change in the microbial profiles were generally similar. CONCLUSION Periodontal therapy leads to a rapid reduction in periodontal pathogens, followed by a slower reduction in other taxa that can be sustained for at least 2 years.
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Affiliation(s)
- Sigmund S Socransky
- Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA, USA
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69
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Sgolastra F, Severino M, Petrucci A, Gatto R, Monaco A. Effectiveness of metronidazole as an adjunct to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2013; 49:10-9. [DOI: 10.1111/jre.12089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 12/01/2022]
Affiliation(s)
- F. Sgolastra
- Department of Health Sciences; School of Dentistry; University of L'Aquila; L'Aquila Italy
| | - M. Severino
- Department of Health Sciences; School of Dentistry; University of L'Aquila; L'Aquila Italy
| | - A. Petrucci
- Department of Health Sciences; School of Dentistry; University of L'Aquila; L'Aquila Italy
| | - R. Gatto
- Department of Health Sciences; School of Dentistry; University of L'Aquila; L'Aquila Italy
| | - A. Monaco
- Department of Health Sciences; School of Dentistry; University of L'Aquila; L'Aquila Italy
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70
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Soares GMS, Figueiredo LC, Faveri M, Cortelli SC, Duarte PM, Feres M. Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs. J Appl Oral Sci 2013; 20:295-309. [PMID: 22858695 PMCID: PMC3881775 DOI: 10.1590/s1678-77572012000300002] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 09/20/2011] [Indexed: 11/22/2022] Open
Abstract
Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.
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Affiliation(s)
- Geisla Mary Silva Soares
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
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71
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Nguyen-Hieu T. Microbial sampling process can change results of microbiological analysis in periodontitis diagnosis. A minireview. ACTA ACUST UNITED AC 2012. [PMID: 23188761 DOI: 10.1111/jicd.12010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This minireview aims to verify the supposition that the microbial sampling process can change results of microbiological analysis in periodontitis diagnosis. The literature search via Pubmed yielded 52 appropriate articles for analysis. Of which 38% (20/52) described that the sampling sites were isolated from saliva, whereas 62% (32/52) did not. Also, 29% (15/52) declared that the microbial sampling was performed before probing pocket depth (PPD), whereas 71% (37/52) did not. Comparison of the results of microbiological analysis in these studies showed that the bacteria most frequently detected in periodontal pockets was variable. Therefore, a sampling process that includes both the microbial sample being taken before PPD and saliva isolation of the sampling sites is needed to ensure the accuracy of microbiological analysis in periodontitis diagnosis.
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Affiliation(s)
- Tung Nguyen-Hieu
- Aix-Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.
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72
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Nguyen-Hieu T, Khelaifia S, Aboudharam G, Drancourt M. Methanogenic archaea in subgingival sites: a review. APMIS 2012; 121:467-77. [PMID: 23078250 DOI: 10.1111/apm.12015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 09/20/2012] [Indexed: 02/06/2023]
Abstract
Archaea are non-bacterial prokaryotes associated with oral microbiota in humans, but their roles in oral pathologies remain controversial. Several studies reported the molecular detection of methanogenic archaea from periodontitis, but the significance of this association has not been confirmed yet. An electronic search was therefore conducted in MEDLINE-Pubmed to identify all papers published in English connecting archaea and periodontal infections. Data analysis of the selected studies showed that five genera of methanogenic archaea have been detected in the subgingival microbiota, Methanobrevibacter oralis being the most frequently detected species in 41% of periodontitis patients and 55% of periodontal pockets compared to 6% of healthy subjects and 5% of periodontally-healthy sites (p < 10(-5) , Chi-squared test). Based on the five determination-criteria proposed by Socransky (association with disease, elimination of the organism, host response, animal pathogenicity and mechanisms of pathogenicity), M. oralis is a periodontal pathogen. The methanogenic archaea load correlating with periodontitis severity further supports the pathogenic role of methanogenic archaea in periodontitis. Therefore, detection and quantification of M. oralis in periodontal pockets could help the laboratory diagnosis and follow-up of periodontitis. Determining the origin, diversity and pathogenesis of archaea in periodontal infections warrants further investigations.
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Affiliation(s)
- Tung Nguyen-Hieu
- URMITE, UMR63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, Marseille, France
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73
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Clinical and microbiological changes after minimally invasive therapeutic approaches in intrabony defects: a 12-month follow-up. Clin Oral Investig 2012; 17:1635-44. [PMID: 23053707 DOI: 10.1007/s00784-012-0855-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/25/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This 12-month randomized, controlled trial evaluated the clinical effects and microbiological changes of minimally invasive nonsurgical and surgical approaches for the therapy of intrabony defects. MATERIALS AND METHODS Twenty-nine subjects with intrabony defects in single-rooted tooth were randomly assigned to; (1) minimally invasive nonsurgical technique (MINST) or (2) minimally invasive surgical technique (MIST). Quantities of Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis, determined by using real-time PCR, were evaluated at baseline, 3, 6, and 12 months after the treatments. Clinical recordings--probing depth (PD), position of the gingival margin (PGM), and relative clinical attachment level (RCAL)--were obtained at baseline and 12 months post-therapy. The primary outcome variable of the study was RCAL. RESULTS Both treatment modalities resulted in an improvement in all clinical recordings, with significant PD reductions (p < 0.05), RCAL gains (p < 0.05), and no change in the PGM (p > 0.05) after 12 months in both MINST and MIST groups. No clinical differences were observed between groups (p > 0.05). Regarding the microbiological outcomes, at the re-examinations, a significant decrease was observed for T. forsythia and P. gingivalis when compared with baseline (p < 0.05) for both treatments. The amount of A. actinomycetemcomitans did not reduced decrease throughout the study (p > 0.05). Intergroup differences in the microbiological assay were not found at any time point (p > 0.05). CONCLUSIONS Both MINST and MIST provided comparable clinical results and microbiological changes in the treatment of intrabony defects over 12 months follow-up. CLINICAL RELEVANCE This randomized, controlled, parallel trial revealed that both therapeutic modalities may promote clinical and microbiological benefits at 12 months post-therapy.
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74
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Feres M, Soares GMS, Mendes JAV, Silva MP, Faveri M, Teles R, Socransky SS, Figueiredo LC. Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol 2012; 39:1149-58. [DOI: 10.1111/jcpe.12004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Magda Feres
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | - Geisla Mary Silva Soares
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | | | - Maike Paulino Silva
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | - Marcelo Faveri
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos São Paulo Brazil
| | - Ricardo Teles
- The Forsyth Institute; Cambridge MA USA
- Department of Oral Medicine, Infection, and Immunity; Harvard School of Dental Medicine; Boston MA USA
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75
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Herrera D, Matesanz P, Bascones-Martínez A, Sanz M. Local and Systemic Antimicrobial Therapy in Periodontics. J Evid Based Dent Pract 2012; 12:50-60. [DOI: 10.1016/s1532-3382(12)70013-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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76
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Mestnik MJ, Feres M, Figueiredo LC, Soares G, Teles RP, Fermiano D, Duarte PM, Faveri M. The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol 2012; 39:955-61. [DOI: 10.1111/j.1600-051x.2012.01932.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Maria J. Mestnik
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Magda Feres
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Luciene C. Figueiredo
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Geisla Soares
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Ricardo P. Teles
- Department of Periodontology; The Forsyth Institute; Cambridge; MA; USA
| | - Daiane Fermiano
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Poliana M. Duarte
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
| | - Marcelo Faveri
- Department of Periodontology; Dental Research Division; Guarulhos University; Guarulhos; São Paulo; Brazil
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77
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Matarazzo F, Ribeiro AC, Faveri M, Taddei C, Martinez MB, Mayer MPA. The domain Archaea in human mucosal surfaces. Clin Microbiol Infect 2012; 18:834-40. [PMID: 22827611 DOI: 10.1111/j.1469-0691.2012.03958.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Archaea present distinct features from bacteria and eukaryotes, and thus constitute one of the branches of the phylogenetic tree of life. Members of this domain colonize distinct niches in the human body, arranged in complex communities, especially in the intestines and the oral cavity. The diversity of archaea within these niches is limited to a few phylotypes, constituted in particular by methane-producing archaeal organisms. Although they are possibly symbionts, methanogens may play a role in the establishment of mucosal diseases by favouring the growth of certain bacterial groups.
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Affiliation(s)
- F Matarazzo
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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78
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Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of Systemic Amoxicillin/Metronidazole as an Adjunctive Therapy to Full-Mouth Scaling and Root Planing in the Treatment of Aggressive Periodontitis: A Systematic Review and Meta-Analysis. J Periodontol 2012; 83:731-43. [DOI: 10.1902/jop.2011.110432] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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79
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Zandbergen D, Slot DE, Cobb CM, Van der Weijden FA. The clinical effect of scaling and root planing and the concomitant administration of systemic amoxicillin and metronidazole: a systematic review. J Periodontol 2012; 84:332-51. [PMID: 22612369 DOI: 10.1902/jop.2012.120040] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The treatment of periodontitis frequently begins with a non-surgical phase that includes scaling and root planing (SRP) and, on occasion, the use of systemic antibiotics. The goal of this review is to systematically evaluate the data concerning the effect of the concomitant administration of amoxicillin and metronidazole adjunctive to SRP in adults who are otherwise healthy. METHODS The PubMed-MEDLINE, Cochrane-Central, and EMBASE databases were searched to April 1, 2012, to identify appropriate studies. Probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were selected as outcome variables. Based on the extracted mean values and number of individuals, changes in weighted means were calculated and a meta-analysis conducted. RESULTS The search yielded 526 unique titles and abstracts. Ultimately, 35 studies were selected, describing 28 clinical trials meeting the eligibility criteria. The full-mouth weighted mean change for PD showed an improvement of 1.41 mm. The full-mouth weighted mean change for CAL showed a gain of 0.94 mm. CONCLUSION Systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in adults who are otherwise healthy.
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Affiliation(s)
- Dina Zandbergen
- Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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80
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Mendonça AC, Santos VR, Ribeiro FV, Lima JA, Miranda TS, Feres M, Duarte PM. Surgical and non-surgical therapy with systemic antimicrobials for residual pockets in type 2 diabetics with chronic periodontitis: a pilot study. J Clin Periodontol 2012; 39:368-76. [DOI: 10.1111/j.1600-051x.2012.01860.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Adriana Cutrim Mendonça
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Vanessa Renata Santos
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Fernanda Vieira Ribeiro
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Jadson Almeida Lima
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Tamires Szeremeske Miranda
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Magda Feres
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
| | - Poliana Mendes Duarte
- Dental Research Division; Department of Periodontology; Guarulhos University; São Paulo; São Paulo; Brazil
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81
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Reise M, Wyrwa R, Müller U, Zylinski M, Völpel A, Schnabelrauch M, Berg A, Jandt KD, Watts DC, Sigusch BW. Release of metronidazole from electrospun poly(L-lactide-co-D/L-lactide) fibers for local periodontitis treatment. Dent Mater 2012; 28:179-88. [PMID: 22226009 DOI: 10.1016/j.dental.2011.12.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 12/10/2011] [Accepted: 12/11/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to achieve detailed biomaterials characterization of a drug delivery system for local periodontitis treatment based on electrospun metronidazole-loaded resorbable polylactide (PLA) fibers. METHODS PLA fibers loaded with 0.1-40% (w/w) MNA were electrospun and were characterized by SEM and DSC. HPLC techniques were used to analyze the release profiles of metronidazole (MNA) from these fibers. The antibacterial efficacy was determined by measuring inhibition zones of drug-containing aliquots from the same electrospun fiber mats in an agar diffusion test. Three pathogenic periodontal bacterial strains: Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were studied. Cytotoxicity testing was performed with human gingival fibroblasts by: (i) counting viable cells via live/dead staining methods and (ii) by exposing cells directly onto the surface of MNA-loaded fibers. RESULTS MNA concentration influenced fiber diameters and thus w/w surface areas: diameter being minimal and area maximal at 20% MNA. HPLC showed that these 20% MNA fibers had the fastest initial MNA release. From the third day, MNA release was slower and nearly linear with time. All fiber mats released 32-48% of their total drug content within the first 7 days. Aliquots of media taken from the fiber mats inhibited the growth of all three bacterial strains. MNA released up to the 28th day from fiber mats containing 40% MNA significantly decreased the viability of F. nucleatum and P. gingivalis and up to the 2nd day also for the resistant A. actinomycetemcomitans. All of the investigated fibers and aliquots showed excellent cytocompatibility. SIGNIFICANCE This study shows that MNA-loaded electrospun fiber mats represent an interesting class of resorbable drug delivery systems. Sustained drug release properties and cytocompatibility suggest their potential clinical applicability for the treatment of periodontal diseases.
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Affiliation(s)
- Markus Reise
- Department of Conservative Dentistry, Jena University Hospital, Friedrich-Schiller-Universität Jena, Germany.
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Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. J Periodontol 2011; 83:1257-69. [PMID: 22050545 DOI: 10.1902/jop.2012.110625] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The systemic use of combined amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to full-mouth scaling and root planing (FMSRP) has been proposed for the treatment of generalized aggressive periodontitis; however, its effectiveness and clinical safety remain to be defined. The purpose of the present meta-analysis is to assess the effectiveness of FMSRP + AMX/MET compared to FMSRP alone. METHODS An electronic search of eight databases and a hand-search of 10 international dental journals were conducted through September 11, 2011. Gain in clinical attachment level (CAL), reduction in probing depth (PD), secondary outcomes, and adverse events were analyzed. A random-effect model was used to pool the extracted data. The weighted mean difference (MD) with 95% confidence interval (CI) was calculated for continuous outcomes, whereas risk difference (RD) with 95% CI was used for dichotomous data; heterogeneity was assessed with the χ(2)-based Cochran Q test and I(2) statistic. The level of significance was set at P <0.05. RESULTS After the selection process, six randomized clinical trials were included. Results of the meta-analysis showed significant CAL gain (MD, 0.42; 95% CI, 0.23 to 0.61; P <0.05) and PD reduction (MD, 0.58; 95% CI, 0.39 to 0.77; P <0.05) in favor of FMSRP + AMX/MET; moreover, no significant RD was found in the occurrence of adverse events (RD, 0.01; 95% CI, -0.02 to 0.04; P >0.05). CONCLUSION The findings of the meta-analysis seem to support the effectiveness and the clinical safety of FMSRP + AMX/MET; however, future studies are needed to confirm these results.
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Affiliation(s)
- Fabrizio Sgolastra
- Department of Health Sciences, School of Dentistry, University of L'Aquila, San Salvatore 1, L'Aquila, Italy.
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