Systemic anti-infective periodontal therapy. A systematic review

Antimicrobial photodynamic therapy against metronidazole-resistant dental plaque bactéria

The antimicrobial photodynamic therapy (aPDT) has stood out as an alternative and promising method of disinfection and has been exploited for the treatment of oral bacteria. In this study, we evaluate in vitro the action of aPDT, mediated by methylene blue, chlorin-e6, and curcumin against clinical subgingival plaques that were resistant to metronidazole. The sensitivity profile of the samples to metronidazole was analyzed by the agar dilution method. Cell viability in the planktonic and biofilm phase was assessed by CFU / mL. The composition of the biofilm was evaluated by the checkboard DNA-DNA Hibrydization technique. Photosensitizers internalization was qualitatively assessed by confocal fluorescence microscopy (CLSM). The aPDT mediated by the three photosensitizers tested was able to reduce the totality of the planktonic microbial load and partially reduce the biofilm samples. The analysis performed by CLSM showed that the photosensitizers used in the application of aPDT were able to permeate the interior of the biofilm. The aPDT has been shown to be useful in a supportive and effective approach to the treatment of periodontal disease.

Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy: A systematic review

Background

Many systematic reviews and meta-analysis have indicated beneficial effects of adjunctive systemic antibiotics in periodontal therapy in specific situations. However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase.

Material and Methods

Searches in the databases Medline, Scopus and Cochrane Library were conducted. The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all post-treatment phases.

Results

Of the 6209 records identified, two randomized clinical trials and two retrospective cohort studies were eligible according to inclusion criteria. Two studies suggested there were greater clinical benefits when systemic antibiotics were prescribed during the active phase of periodontal therapy than in the reevaluation phase while two other studies showed no significant difference in clinical outcomes at 6 months between these two different timing of administration.

Conclusions

The evidence available and evaluated in this systematic review is of heterogeneous quality and limited by the restricted number of studies and their dissimilarities in their study design and outcome reporting. Despite insufficient evidence to determine the ideal time to the adjunctive systemic antibiotic administration in the periodontal therapy, it seems that prescription of systemic antibiotic at the active phase of periodontal therapy leads to better clinical outcomes.

Key words:Active phase; periodontal therapy, periodontitis, reevaluation, systemic antibiotics, timing.

Efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen in the treatment of periodontitis in patients with diabetes: a randomized clinical trial

OBJECTIVE

To determine the efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen during nonsurgical treatment of periodontitis in patients with type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

In this double-blind, randomized clinical trial, a total of 42 patients with chronic periodontitis and type 2 diabetes were included. Patients were randomly assigned to treatment with either clindamycin or amoxicillin-metronidazole three times a day during 7 days. Clinical determinations (probing depth, bleeding on probe, and plaque index) were performed to determine the extent and severity of periodontitis before and after the pharmacological treatment.

RESULTS

After 7 days of administration of clindamycin or amoxicillin-metronidazole, no differences were observed between the clinical determinations, probing depth (0.44 vs 0.50 mm, p=0.624), plaque index (17.62 vs 15.88%, p=0.910), and bleeding on probing (16.12 vs 22.17%, p=0.163), respectively. There were no adverse events in either group.

CONCLUSION

The administration during 7 days of clindamycin or amoxicillin/metronidazole showed the same efficacy for the reduction of probing depth, plaque index, and bleeding on probing in patients with periodontitis and type 2 diabetes.

Oral mucosal irritation potential of antimicrobial chemotherapy involving hydrogen peroxide photolysis with high-power laser irradiation for the treatment of periodontitis

In the present study, we assessed the oral mucosal irritation potential of antimicrobial chemotherapy involving hydrogen peroxide (H₂O₂) photolysis with a 405-nm laser device at an output power of ≥100 mW in hamsters. Twenty-four cheek pouches from 12 male Syrian hamsters received 7-min treatment with pure water (PW), 3% H₂O₂, laser irradiation of PW at 100 mW, laser irradiation of 3% H₂O₂ at 100 mW, laser irradiation of PW at 200 mW, or laser irradiation of 3% H₂O₂ at 200 mW (n = 4 each). The diameter of the irradiation area was set at 3 mm; accordingly, the calculated irradiances (optical power densities) of the 100- and 200-mW laser lights were approximately 1400 and 2800 mW/cm², respectively. In addition, 12 cheek pouches from six animals received laser irradiation of 3% H₂O₂ at 100 mW for 1, 3, or 5 min (n = 4 each). Each treatment was repeated three times at 1-h intervals. Macroscopic and histological changes were evaluated 24 h after the last treatment. In addition, in vitro bactericidal activity of the treatment against periodontal pathogens was evaluated. We found that 405-nm laser irradiation of 3% H₂O₂ caused moderate to severe oral mucosal irritation when performed at powers of 100 and 200 mW for ≥3 min, while the same treatment performed at 100 mW for 1 min resulted in mild irritation. Moreover, 1-min H₂O₂ photolysis at 100 mW caused a >4-log decrease in viable bacterial counts. These findings suggest that 1-min H₂O₂ photolysis, which can effectively kill periodontal pathogens, may be acceptable when a 405-nm laser device is used at 100 mW. However, use of the laser at a lower power would be preferable for the prevention of unnecessary oral mucosal irritation.

Management of Acute Periodontal Abscess Mimicking Acute Apical Abscess in the Anterior Lingual Region: A Case Report

Purulent infections of periodontal tissues are known as periodontal abscesses localized to the region of the involved tooth. Due to the high prevalence rate and aggressive symptoms, it is considered a dental emergency; urgent care is mandatory to maintain the overall health and well being of the patient. This case report describes the management of a patient who presented with an acute periodontal abscess secondary to poor oral hygiene. Clinically and radiographically, the lesion was mimicking an acute apical abscess secondary to pulpal necrosis. Periodontal treatment was started after completion of antibiotic therapy. The clinical presentation of the condition and results of the recovery, along with a brief review of relevant literature are discussed.

Antibiotic prescribing practices in periodontal surgeries with and without bone grafting

BACKGROUND

The prevention of postoperative infection is often the basis for antibiotic prescription; however, the risks of unwarranted antibiotics and lack of guidelines for procedures involving bone grafts creates additional difficulty in decision making for practitioners. This study aims to evaluate practices in antibiotics prescribed for periodontal surgeries with and without bone grafting and acceptability of guidelines.

METHODS

An anonymous survey was distributed to periodontists via the California Society of Periodontists e-mail listserv. The survey questioned prescribing practices for periodontal procedures, prescribing rationale, demographic and dental practice information, and acceptability of guidelines. Results were analyzed using McNemar tests and logistic regression.

RESULTS

Practitioners were significantly less likely to prescribe antibiotics for traditional periodontal surgeries without bone grafting compared with socket preservation, guided tissue regeneration, guided bone regeneration, and sinus augmentation (P < 0.0001). Practitioners were significantly more likely to prescribe antibiotics with more complex bone grafting such as guided bone regeneration and sinus augmentation compared with socket preservation (P < 0.0001). The most common rationale for prescribing antibiotics with bone grafting was to decrease the chances of developing an infection. Seventy-five percent of practitioners reported they would follow guidelines for antibiotic prescription if they were developed by the American Academy of Periodontology.

CONCLUSIONS

Practitioners are more likely to prescribe antibiotics with bone grafting and as complexity of the bone grafting procedure increases. Based on these results, the low incidence of infection in periodontal surgery cited in the literature, and willingness of practitioners to adopt guidelines, the establishment of evidence-based guidelines would be of benefit to the periodontal practicing community.

Novel zafirlukast derivatives exhibit selective antibacterial activity against Porphyromonas gingivalis

Periodontal disease is an oral chronic immune-inflammatory disease highly prevalent worldwide that is initiated by specific oral bacterial species leading to local and systemic effects. The development of new preventive/therapeutic strategies to specifically target oral periodontopathogens without perturbing oral microbiome species normally colonizing the oral cavity is needed. The fast and affordable strategy of repositioning of already FDA-approved drugs can be an answer to the development of novel treatments against periodontal pathogens such as Porphyromonas gingivalis. Herein, we report the synthesis and antibacterial activity of novel zafirlukast derivatives, their bactericidal effect, and their cytotoxicity against oral epithelial cell lines. Many of these derivatives exhibited superior antibacterial activity against P. gingivalis compared to the parent drug zafirlukast. The most promising compounds were found to be selective against P. gingivalis and they were bactericidal in their activity. Finally, we demonstrated that these potent derivatives of zafirlukast provided a better safety profile against oral epithelial cells compared to zafirlukast.

Non-surgical therapeutic outcomes of peri-implantitis: 12-month results

OBJECTIVES

To assess the clinical and radiographic outcomes of implants treated by means of non-surgical debridement with systemic antibiotic therapy.

MATERIALS AND METHODS

A prospective case series study evaluating the 12-month clinical and radiographic outcomes of peri-implantitis lesions treated with ultrasonic scaler debridement, a glycine air abrasive, and metronidazole followed by supportive maintenance. Clinical and radiographic variables and success criteria were defined a priori.

RESULTS

Overall, 21 patients were included. One implant failed during the study period (implant survival rate 95.24%). Substantial changes occurred at 12 months in all the clinical and radiographic variables, reaching strong statistical significance in the majority of them. According to the success criteria applied, 40.90% of the peri-implantitis were arrested and resolved, while 59.1% presented with at least one probed site with bleeding on probing (BoP). Moreover, 95.45% exhibited peri-implant pocket depth (PPD) < 5 mm at the end of the study. None of the implants presented with progressive bone loss.

CONCLUSION

Non-surgical therapy of peri-implantitis is effective to arrest progressive bone loss, reduce PPD and suppuration, and achieve radiographic bone fill in the majority of cases. Nevertheless, it failed to be completely efficacious in the achievement of successful therapeutic outcomes as BoP remained frequently present.

CLINICAL RELEVANCE

Non-surgical therapy achieved significant clinical and radiological improvements.

Clinical and microbiological effects of multiple applications of antibacterial photodynamic therapy in periodontal maintenance patients. A randomized controlled clinical study

BACKGROUND

At present, very limited data are available on the clinical and microbiological outcomes obtained following repeated application of aPDT following one single mechanical debridement.

OBJECTIVE

To evaluate clinically and microbiologically the outcomes following one single session of subgingival mechanical debridement (scaling and root planing; e.g. SRP) followed by 1x immediate application of aPDT and 2 x subsequent use of aPDT without SRP.

MATERIALS AND METHODS

Forty patients diagnosed with generalized chronic periodontitis that were enrolled in periodontal maintenance (supportive periodontal therapy) program, were randomly assigned to one of the two treatments: 1. SRP by means of ultrasonic and hand instruments followed by one single session of SRP followed by 1x immediate application of aPDT and 2 x subsequent applications of aPDT without SRP (test) or 2. SRP alone (control). The following clinical parameters were recorded at baseline, at 3 and 6 months: Full-Mouth Plaque Scores (FMPS), Full-Mouth Bleeding Scores (BOP), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) and Gingival Recession (RC). Additionally, microbiological samples were evaluated at baseline and six months after treatment. The primary outcome variable was BOP.

RESULTS

Both treatments improved statistically significantly (p < 0.05) the FMPS, PPD and CAL values, while no statistically significant changes occurred in terms of RC. In the test group, BOP decreased statistically significantly (p < 0.05) after 3 and 6 months, while in the control group the respective values decreased statistically significantly only at 3 months. Both treatments reduced statistically significantly the total bacteria counts (TBC) after 6 months (p < 0.05). At 6 months, the use of SRP and aPDT resulted in a statistically significant decrease in the number of all tested bacteria except A. actinomycetemcomitans while the use of SRP alone resulted only in a statistically significant decrease in the numbers of P. gingivalis, T. denticola and T. forsythia.

CONCLUSIONS

In periodontal patients enrolled in a maintenance program one single session of SRP followed by 3x application of aPDT, enhanced the clinical and microbiological outcomes compared to SRP alone.

Structural determinants of inhibition of Porphyromonas gingivalis gingipain K by KYT-36, a potent, selective, and bioavailable peptidase inhibitor

Porphyromonas gingivalis is a member of the dysbiotic oral microbiome and a "keystone pathogen" that causes severe periodontal disease, which is among the most prevalent infectious diseases. Part of the virulence factors secreted by P. gingivalis are the essential cysteine peptidases gingipain K (Kgp) and R (RgpA and RgpB), which account for 85% of the extracellular proteolytic activity of the pathogen and are thus prime targets for inhibition. We report the high-resolution (1.20 Å) complex structure of Kgp with KYT-36, a peptide-derived, potent, bioavailable and highly selective inhibitor, which is widely used for studies in vitro, in cells and in vivo. Sub-nanomolar inhibition of Kgp is achieved by tight binding to the active-site cleft, which is covered for its sub-sites S3 through S1' under establishment of nine hydrophobic interactions, 14 hydrogen bonds and one salt bridge. In addition, an inhibitor carbonyl carbon that mimics the scissile carbonyl of substrates is pyramidalized and just 2.02 Å away from the catalytic nucleophile of Kgp, C477Sγ. Thus, the crystal structure emulates a reaction intermediate of the first nucleophilic attack during catalysis of cysteine peptidases. The present study sets the pace for the development of tailored next-generation drugs to tackle P. gingivalis.

Prescribing trends of systemic antibiotics by periodontists in Australia

BACKGROUND

Antibiotics are a common systemic pharmaceutical therapy in periodontal conditions for dental practitioners as well as specialists. However, there is limited information about prescribing patterns amongst the periodontists within Australia. The objective of this study is to examine current patterns and perceptions in prescribing systemic antibiotics for the treatment of periodontal and peri-implant diseases.

METHODS

An online questionnaire was disseminated to Australian practicing members of the Australia and New Zealand Academy of Periodontists (ANZAP) to determine their antibiotic prescribing patterns for different periodontal conditions. Indications that were analyzed included: chronic periodontitis, plaque-induced gingivitis, aggressive periodontitis, acute gingival and periodontal conditions, conditions associated with implants and implant placement, periodontal regeneration, and mucogingival surgery.

RESULTS

Out of the 50 members that participated in the study, 38 completed the questionnaire. Systemic antibiotics prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 79% reported prescription of systemic antibiotics in the treatment of chronic periodontitis whereas 52.6%, 55.3%, 18.4% of the respondents did so for periodontal regeneration procedures, implant placement surgery, and mucogingival surgery, respectively. Azithromycin, the combination of Amoxicillin and Metronidazole, and Amoxicillin were the three most commonly prescribed systemic antibiotics.

CONCLUSION

Based on the results of this survey, systemic antibiotics are widely used by the group of periodontists surveyed in this study in Australia with varying rates and patterns for different periodontal and peri-implant conditions. The current study highlights the need for recommendations and guidelines in the prescription of antibiotics for periodontal and peri-implant conditions.

A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing

Background

Several locally administered antimicrobials have been studied in the literature as adjunctive or primary treatments for periodontitis and peri-implantitis with conflicting results.

Objective

The aim of this study was twofold: (1) the formulation of a controlled-release material containing metronidazole and doxycycline; (2) an in vitro evaluation of its antibacterial properties against planktonic and biofilm species involved in periodontal and peri-implant diseases.

Methods

Doxycycline (10 mg/ml) and metronidazole (20 mg/ml) were incorporated into a hydroxyethylcellulose-polyvinylpyrrolidone-calcium polycarbophil gel. Three milliliters of gel were dialyzed against Dulbecco's phosphate-buffered saline for 13 days. Antibiotics release at 3, 7, 10, and 13 days was determined spectroscopically. The inhibitory activity of the experimental gel was tested against A. actinomycetemcomitans, S. sanguinis, P. micra, and E. corrodens with an agar diffusion test, an inactivation biofilm test, and a confocal laser scanning microscope study (CLSMS) for S. sanguinis up to 20 days.

Results

After 13 days, the released doxycycline was 9.7% (at 3 days = 1.2 mg; 7 days = 0.67 mg; 10 days = 0.76 mg; 13 days = 0.29 mg), while metronidazole was 67% (30 mg, 6.8 mg, 2.5 mg, and 0.9 mg at the same intervals). The agar diffusion test highlights that the formulated gel was active against tested microorganisms up to 312 h. Quantitative analysis of biofilm formation for all strains and CLSMS for S. sanguinis showed a high growth reduction up to 13 days.

Conclusions

The in vitro efficacy of the newly formulated gel was confirmed both on planktonic species and on bacterial biofilm over a period of 13 days. The controlled-release gel containing metronidazole and doxycycline had an optimal final viscosity and mucoadhesive properties. It can be argued that its employment could be useful for the treatment of periodontal and peri-implant diseases, where conventional therapy seems not successful.

Clinical and Biological Effects of Adjunctive Photodynamic Therapy in Refractory Periodontitis

Introduction: To date, no novel treatment approach is available for optimum outcomes regarding refractory periodontitis. The aim of the present study was to assess the efficiency of photodynamic therapy (PDT) in treating patients diagnosed with refractory periodontitis and compare the clinical and biological outcomes of conventional periodontal treatment with or without adjunctive PDT in these patients, by assessing clinical parameters (plaque index [PI], gingival recession [GR], bleeding on probing [BOP], periodontal probing depth [PPD] and clinical attachment level [CAL]) as well as biological parameters (IL-1β) in the gingival crevicular fluid (GCF). Methods: Sixteen patients within the age of 30 to 60 years, with a mean age of 40 years old, diagnosed with refractory periodontitis were included. In this split mouth design study, 2 quads (1 upper + 1 lower) from the same patient were randomly treated with (scaling and root planing [SRP]+PDT) together. The other 2 quadrants (1 upper + 1 lower) were treated by SRP only and selected to serve as controls. Clinical parameters including PI, GR, BOP, PPD and CAL and biological parameters (IL-1β) in the GCF were measured at baseline, then at, 2 and 6 months after therapy. Results: A statistically significant reduction in several clinical parameters as, BOP (P < 0.001), PI (P < 0.001), PPD (P < 0.001) and CAL (P < 0.001) in quadrant treated with SRP and adjunctive PDT when compared to control group treated with SRP alone was observed and both therapies showed non-statistically significant differences in the reduction of IL-1β level. Conclusion: The inclusion of PDT as an adjunctive measure to nonsurgical conventional periodontal treatment seems to be a useful therapeutic measure in refractory periodontitis treatment.

Administration of systemic antibiotics during non-surgical periodontal therapy-a consensus report

AIM

The aim of this meta-review was to evaluate whether there is a meaningful clinical benefit regarding the use of systemic adjunctive antibiotics in the treatment of patients with periodontitis. Additionally, a consensus regarding possible recommendations for future administration of antibiotics should be reached.

METHODS

A structured literature search was performed by two independent investigators focusing on systematic reviews (SR) covering adjunctive systemic antibiosis during non-surgical periodontal therapy. Additionally, recent randomized clinical trials (RCT, July 2015 to July 2017) were searched systematically to update the latest SR. Results were summarized and discussed in a plenary to reach a consensus.

RESULTS

Mostly, systematic reviews and RCTs showed a significant positive effect of adjunctive systematic antibiosis compared to controls. These positive effects gain clinical relevance in patients with severe periodontal disease aged 55 years and younger.

CONCLUSION

Systemic antibiotics as an adjunct to non-surgical periodontal therapy should be sensibly administered and restrictively used. Only certain groups of periodontitis patients show a significant and clinically relevant benefit after intake of systemic antibiosis during periodontal therapy.

CLINICAL RELEVANCE

Avoiding antibiotic resistance and possible side effects on the human microbiome should be a focus of dentists and physicians. Thus, a sensible administration of antibiotics is mandatory. This manuscript suggests guidelines for a reasonable use.

The Use of Amoxicillin (500 Mg) Plus Metronidazole (500 Mg) for 7 Days Adds Adjunctive Benefits for Nonsurgical Periodontal Therapy, but Limited Evidence Supports Higher/Longer Dose

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Optimal dose and duration of amoxicillin-plus-metronidazole as an adjunct to nonsurgical periodontal therapy: A systematic review and meta-analysis of randomized, placebo-controlled trials. McGowan K, McGowan T, Ivanovski S. J Clin Periodontol 2018;45:56-67.

SOURCE OF FUNDING

Information not available.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.

Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up

Objective

The aim of this double-blind, placebo-controlled and parallel- arm randomized clinical trial was to evaluate the effects of Lactobacillus rhamnosus SP1-containing probiotic sachet and azithromycin tablets as an adjunct to nonsurgical therapy in clinical parameters and in presence and levels of Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.

Material and Methods

Forty-seven systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically and microbiologically at baseline for 3, 6 and 9 months after therapy. Subgingival plaque samples were collected from four periodontal sites with clinical attachment level ≥1 mm, probing pocket depth ≥4 mm and bleeding on probing, one site in each quadrant. Samples were cultivated and processed using the PCR technique. Patients received nonsurgical therapy including scaling and root planing (SRP) and were randomly assigned to a probiotic (n=16), antibiotic (n = 16) or placebo (n = 15) group. L. rhamnosus SP1 was taken once a day for 3 months. Azithromycin 500mg was taken once a day for 5 days.

Results

All groups showed improvements in clinical and microbiological parameters at all time points evaluated. Probiotic and antibiotic groups showed greater reductions in cultivable microbiota compared with baseline. The placebo group showed greater reduction in number of subjects with P. gingivalis compared with baseline. However, there were no significant differences between groups.

Conclusions

The adjunctive use of L. rhamnosus SP1 sachets and azithromycin during initial therapy resulted in similar clinical and microbiological improvements compared with the placebo group.

Evaluating the effectiveness of clarithromycin as an adjunct to scaling and root planing: A randomized clinical trial

Background

Administration of systemic antibiotics may implement persuasive treatment effect for chronic periodontitis by intending tissue-invasive bacteria in addition to accustomed nonsurgical periodontal therapy (NSPT).

Aims

The aim of this study was to assess the ancillary effects of oral clarithromycin (CLM) along with NSPT for chronic periodontitis.

Materials and Methods

Thirty periodontitis patients were randomly divided into two equal groups in this double-blind, randomized, parallel group, and active-controlled trial: test group - scaling and root planning (SRP) plus CLM (500 mg thrice daily for 7 days, orally) was given, and control group - only SRP was done. Clinical analysis, such as gingival index (GI), probing depth (PD), and clinical attachment loss (CAL), were taken at baseline, 3 months, and 6-month intervals for both groups. Subgingival plaque samples were cultured for periodontopathic organisms. Immunological parameter C-reactive protein (CRP) levels were estimated.

Results

SPSS version 14 was used for statistical analysis. The intragroup comparison showed a significant reduction in the mean scores of all the parameters from baseline to 6 months. The intergroup comparison showed a statistically significant reduction of PD from baseline to 3 months (P < 0.001). GI, CAL, and CRP levels were also reduced but not statistically significant. The mean colony-forming units (CFU) of Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) showed a statistically significant reduction from baseline to 3 months only in the test group (P = 0.042) and (P = 0.046), respectively. There was no statistically significant reduction of Aa and Pg at 6 months.

Conclusions

CLM conceivably accepted as an addendum to NSPT for a shorter period.

Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial

BACKGROUND

There are insufficient guidelines for the use of adjunctive systemic antibiotics for patients with periodontal disease. The aim of this study was to compare clinical outcomes for patients with moderate-advanced chronic periodontitis treated with: scaling and root planing (SRP), SRP with amoxicillin and metronidazole (A+M), SRP with Azithromycin (Az).

METHODS

Thirty-seven non-smokers with generalized moderate to advanced chronic periodontitis were divided into three treatment groups: SRP, A+M and Az. Patients received the medications after the last SRP session and were reviewed three months later. Changes in clinical parameters were compared between the groups. Separate analyses were executed for: 'all sites', 'molar sites', 'sites with different PPD severities' and 'number of sites with shallow, moderate and deep PPD'.

RESULTS

The three groups exhibited improvements in most clinical parameters. At three months, A+M showed a higher reduction in PPD compared to Az in the 'all sites analysis'. Molars exhibited better reduction in BOP and PPD with A+M than SRP. Pocket depth of the 4-6 mm category reduced more in the A+M than SRP. A+M experienced a higher increase in the number of sites with PPD 1-3 mm than Az.

CONCLUSIONS

Adjunctive systemic antibiotics in the initial phase of treatment may result in improved clinical outcomes.

Adjunctive antimicrobial chemotherapy based on hydrogen peroxide photolysis for non-surgical treatment of moderate to severe periodontitis: a randomized controlled trial

Treatment of severe periodontitis with non-surgical therapy remains challenging in dentistry. The present study aimed to evaluate the clinical efficacy of hydrogen peroxide (H₂O₂) photolysis-based antimicrobial chemotherapy adjunctively performed with root debridement (RD) for moderate to severe periodontitis. A randomized controlled trial was conducted that included 53 patients with 142 test teeth. The test teeth were randomly assigned to one of three treatment groups: Group 1, RD + H₂O₂ photolysis; Group 2, RD followed by administration of a local drug delivery system (minocycline chloride gel); or Group 3, RD alone. Clinical and microbiological examination were performed for up to 12 weeks following treatment. Probing pocket depth (PPD) and bleeding on probing (BoP) were improved after each treatment session. At 12 weeks, Group 1 had achieved significantly lower PPDs than the other groups, though there were no significant differences in BoP between Group 1 and the other groups. Counts of Porphyromonas gingivalis, a known periodontal pathogen, in Group 1 were significantly lower than those in Group 3, and were comparable to those in Group 2. Therefore, it is suggested that H₂O₂ photolysis treatment can be used as a novel adjunctive antimicrobial chemotherapy for non-surgical periodontal treatment.

Modulation of periodontitis progression using pH-responsive nanosphere encapsulating metronidazole or N-phenacylthialzolium bromide

BACKGROUND AND OBJECTIVE

This study aimed to develop pH-responsive polylactide-glycolic acid co-polymer and chitosan (PLGA/chitosan) nanosphere as an inflammation-responsive vehicle and evaluate the potential of the nanosphere encapsulating metronidazole, an antibiotic, and N-phenacylthiazolium bromide (PTB), a host modulator, for treating periodontitis.

MATERIAL AND METHODS

PLGA/chitosan nanospheres were fabricated using oil-in-water emulsion method. Experimental periodontitis was induced on the rat maxillae, and the sites were randomly allocated to four treatment categories, including periodontitis alone (PR), periodontitis with nanospheres alone, nanospheres encapsulating metronidazole (MT) and nanospheres encapsulating PTB (PB). The ligature was retained until the animals were killed, and the treatment outcome was evaluated by the progression of periodontal bone loss (PPBL), inflammatory cell infiltration and collagen deposition.

RESULTS

The encapsulated drug was released rapidly from the nanospheres without significant initial burst release at pH 5.5. Compared with group PR, PPBL was significantly reduced in groups MT and PB on day 4 (P<.05). On day 21, PPBL was significantly lower in group PB (P<.05). In groups MT and PB, inflammation was significantly reduced in groups MT and PB relative to groups PR and periodontitis with nanospheres alone (P<.05), and collagen deposition was significantly greater relative to group PR (P<.05).

CONCLUSION

PLGA/chitosan nanospheres encapsulating metronidazole or PTB showed potential for modulating periodontitis progression.

One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole

BACKGROUND

To evaluate the clinical outcomes 12 months after systemic administration of amoxicillin (AMX) and metronidazole (MET) adjunctive to subgingival debridement (SD) in patients with severe chronic periodontitis (sChP).

MATERIAL AND METHODS

102 patients with sChP were treated randomly as follows: SD within 2 consecutive days and placebo for 7 days (group A), SD+AMX+MET (both 500mg x3 times daily TID) for 3 days (group B), SD+AMX+MET (both 500mg x 3 TID) for 7 days (group C). At baseline, at 3-, 6-, and 12-months post-treatment probing pocket depth (PD), clinical attachment level (CAL), furcation involvement, bleeding on probing (BOP), full-mouth plaque score (FMPS) were determined. The reduction in the number of sites with PD≥6mm was defined as main outcome variable.

RESULTS

75 patients completed the study. At 12 months, all three treatment groups showed statistically significant improvements (p<0.001) of mean PD, CAL, BOP and number of sites with PD≥6mm compared to baseline. Mean residual PD were statistically significantly lower and CAL gain statistically significantly greater in the two antibiotic groups as compared to placebo. While PD reductions (p = 0.012) and CAL gain (p = 0.017) were statistically significantly higher in group C compared to group A, only the 3-day AB group showed statistically significantly fewer sites with PD≥6mm at 12 m (p = 0.003). The reduction in the number of sites with PD≥6 mm (primary outcome) showed no statistical significant differences between the 3 treatment groups. However, in both antibiotic groups significantly more patients compared to the placebo group reached a low risk for disease progression at 12 months (≤4 sites with PD≥5mm).

CONCLUSION

At 12 months, both adjunctive antibiotic protocols resulted in statistically significantly greater clinical improvements compared to placebo.

Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis

This review gives an update of the current scientific evidence on the efficacy of the adjunctive use of systemic and local antibiotics/antimicrobials in the treatment of periodontitis. In particular, it addresses whether their use can improve the results of nonsurgical mechanical therapy in mild-to-moderate forms of the disease. Large numbers of randomized clinical trials and systematic reviews with meta-analyses have clearly established that adjunctive systemic antibiotics, combined with mechanical debridement, offer clinical improvements additional to those obtained with scaling and root planing alone. These effects are more pronounced in aggressive periodontitis and in initially deep pockets, whereas more limited additional improvements, of 0.3 mm for additional pocket reduction and 0.2 mm for additional clinical attachment gain, have been documented for moderately deep sites (4-6 mm) in patients with chronic periodontitis. The marginal clinical benefit in patients with moderate disease has to be balanced against possible side effects. Notably, it has to be realized that an increasing number of warnings have been articulated against the unrestricted use of antibiotics in treating periodontal diseases because of the emerging global public health issue of bacterial resistance. The effects of the adjunctive local administration of antimicrobials have also been very well documented in several systematic reviews. Overall, in persistent or recurrent localized deep sites, the application of antimicrobials by sustained-delivery devices may offer a benefit of an additional 0.4 mm in pocket depth reduction and 0.3 mm in clinical attachment level gain. In conclusion, the slight additional benefits of adjunctive antimicrobials, which were shown for moderate forms of periodontitis, have to be balanced against their side effects and therefore their prescription should be limited as much as possible.

Systemic antibiotics in the treatment of periodontitis

Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.

Structural insights unravel the zymogenic mechanism of the virulence factor gingipain K from Porphyromonas gingivalis, a causative agent of gum disease from the human oral microbiome

Skewing of the human oral microbiome causes dysbiosis and preponderance of bacteria such as Porphyromonas gingivalis, the main etiological agent of periodontitis. P. gingivalis secretes proteolytic gingipains (Kgp and RgpA/B) as zymogens inhibited by a pro-domain that is removed during extracellular activation. Unraveling the molecular mechanism of Kgp zymogenicity is essential to design inhibitors blocking its activity. Here, we found that the isolated 209-residue Kgp pro-domain is a boomerang-shaped all-β protein similar to the RgpB pro-domain. Using composite structural information of Kgp and RgpB, we derived a plausible homology model and mechanism of Kgp-regulating zymogenicity. Accordingly, the pro-domain would laterally attach to the catalytic moiety in Kgp and block the active site through an exposed inhibitory loop. This loop features a lysine (Lys¹²⁹) likely occupying the S₁ specificity pocket and exerting latency. Lys¹²⁹ mutation to glutamate or arginine led to misfolded protein that was degraded in vivo Mutation to alanine gave milder effects but still strongly diminished proteolytic activity, without affecting the subcellular location of the enzyme. Accordingly, the interactions of Lys¹²⁹ within the S₁ pocket are also essential for correct folding. Uniquely for gingipains, the isolated Kgp pro-domain dimerized through an interface, which partially overlapped with that between the catalytic moiety and the pro-domain within the zymogen, i.e. both complexes are mutually exclusive. Thus, pro-domain dimerization, together with partial rearrangement of the active site upon activation, explains the lack of inhibition of the pro-domain in trans. Our results reveal that the specific latency mechanism of Kgp differs from those of Rgps.

The use of bacteriophages to biocontrol oral biofilms

Infections induced by oral biofilms include caries, as well as periodontal, and peri-implant disease, and may influence quality of life, systemic health, and expenditure. As bacterial biofilms are highly resistant and resilient to conventional antibacterial therapy, it has been difficult to combat these infections. An innovative alternative to the biocontrol of oral biofilms could be to use bacteriophages or phages, the viruses of bacteria, which are specific, non-toxic, self-proliferating, and can penetrate into biofilms. Phages for Actinomyces naeslundii, Aggregatibacter actinomycetemcomitans, Enterococcus faecalis, Fusobacterium nucleatum, Lactobacillus spp., Neisseria spp., Streptococcus spp., and Veillonella spp. have been isolated and characterised. Recombinant phage enzymes (lysins) have been shown to lyse A. naeslundii and Streptococcus spp. However, only a tiny fraction of available phages and their lysins have been explored so far. The unique properties of phages and their lysins make them promising but challenging antimicrobials. The genetics and biology of phages have to be further explored in order to determine the most effective way of applying them. Studying the effect of phages and lysins on multispecies biofilms should pave the way for microbiota engineering and microbiota-based therapy.

Long-term clinical response to treatment and maintenance of localized aggressive periodontitis: a cohort study

AIM

To evaluate long-term clinical response to periodontal therapy and maintenance in localized aggressive periodontitis (LAP).

MATERIALS AND METHODS

One hundred forty-one African Americans diagnosed with LAP, aged 5-25 years, were enrolled. Patients underwent periodontal mechanical debridement plus 1 week of amoxicillin/metronidazole. Mechanical therapy was repeated as needed and clinical parameters were recorded at baseline, 3, 6, 12, 18 and 24 months, and two additional annual follow-up visits after treatment. Radiographs from primary dentition of patients with LAP in permanent dentition, and additional healthy siblings (HS) were analysed retrospectively.

RESULTS

Periodontal therapy significantly improved probing depth and clinical attachment level up to 4 years (mean reductions: 2.18 ± 1.03 and 2.80 ± 1.43 mm, respectively). Percentage of affected sites was reduced at all time points and maintained up to 4 years. Non-compliance with antibiotics/appointments negatively affected the treatment response. Ninety per cent of LAP patients in permanent dentition and 32% of HS presented radiographic bone loss in primary dentition.

CONCLUSIONS

Mechanical debridement with 1 week of systemic antibiotics along with proper periodontal maintenance was effective in the treatment and successful maintenance of LAP for up to 4 years. LAP in permanent dentition may be preceded in the primary dentition. Clinicaltrials.gov #NCT01330719.

Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review

BACKGROUND

The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP).

METHODS

The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects).

RESULTS

After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP.

CONCLUSION

Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP.

PRACTICAL IMPLICATIONS

Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient.

Clinical Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis

INTRODUCTION

Over the years, numerous trials have sufficiently documented benefits of adjuvant administration of antibiotics in combination to Scaling and Root Planing (SRP) in treatment of periodontitis. Nevertheless there are justified doubts in respect to antibiotics administration with regard to increasing development of resistances.

AIM

The aim of this review study and meta-analysis was to verify a possible benefit of Azithromycin (AZM) as an alternative adjuvant antibiotic in combination with SRP.

MATERIALS AND METHODS

Electronic databases (Pubmed) were searched from the earliest point of record until May 2015. A hand search was also conducted. The variables considered in this respect were Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and SRP. A meta-analysis containing trials comparing SRP as a sole therapy with SRP and administration of AZM was produced once all of the data obtained had been reviewed.

RESULTS

Six randomised clinical trials were accepted into the review and the meta-analysis following the process of trial selection. Meta-analysis revealed larger overall effects by the systemic administration of AZM compared with SRP on their own in terms of PD, CAL, BOP, Plaque-Index and total bacterial load reduction after three and six months.

CONCLUSION

The data used in this study revealed that the systemic administration of AZM is beneficial compared with SRP on its own for the treatment of chronic periodontitis.

Clinical Therapeutic Effects of the Application of Doxycycline in the Treatment of Periodontal Disease

OBJECTIVE

To compare the therapeutic effects of the application of doxycycline-full dose (100 mg) and sub-dose (20 mg) in the treatment of periodontal disease.

MATERIAL AND METHODS

A total of 60 patients with periodontal disease were examined. Patients are divided into two groups: A) treated with antimicrobial dose of 100 mg doxycycline once daily for 30 days, and B) treated with 2 x 20 mg/day. doxycycline, during 75 days. Among all patients a conservative treatment was carried out and ordinated the proper dose doxycycline in total dose during treatment from 3 gr. Index of dental plaque by Löe-Sillness, index of gingival inflammation and gingival bleeding by Cowell were followed.

RESULTS

Values of dental plaque in relation first examination, 10th, 20th day, 1 month and 2.5 months, showed that after 2.5 months, average value (x = 0.83) of dental plaque in second group is slightly less than the value (x = 0.93) of dental plaque in the first group. The average value (x = 0.17) of gingival inflammation in second group is significantly less than the value (x = 0.50) of gingival inflammation in the first group. The average value (x = 0.97) of gingival bleeding in patients from the first group was significantly higher than value(x = 0.37) of gingival bleeding in the second group.

CONCLUSION

Patients whose therapy was helped by a sub-dose doxycycline demonstrated positive therapeutic effects on gingival inflammation and bleeding.

Systemic antibiotics and the risk of superinfection in peri-implantitis

Peri-implantitis has emerged in the last few years as a complication difficult to resolve. The etiopathogenesis consensus is mainly attributed to bacteria. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, a PubMed/Medline literature search was performed using the US National Library of Medicine database up to 2015 to analyze available scientific data on the rationale and risk of superinfection associated to systemic antimicrobials in human peri-implant disease. A hand search was also conducted on relevant medical and microbiology journals. The methodological index for non-randomized studies (MINORS) was independently assessed for quality on the selected papers. Proposed combined therapies use broad-spectrum antibiotics to halt the disease progression. A major associated risk, particularly when prescribed empirically without microbiological follow-up, is the undetected development of superinfections and overgrowth of opportunistic pathogens difficult to eradicate. Peri-implant superinfections with opportunistic bacteria, yeast and viruses, are plausible risks associated to the use of systemic antibiotics in immunocompetent individuals. Lack of microbiological follow-up and antibiotic susceptibility testing may lead to ongoing microbial challenges that exacerbate the disease progression. The increased proliferation of antimicrobial resistance, modern implant surface topography and indiscriminative empiric antibiotic regimens may promote the escalation of peri-implant disease in years to come. A personalized 3-month supportive therapy may help prevent risks by sustaining a normal ecological balance, decreasing specific pathogen proportions and maintaining ideal plaque control.

The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review

Objective

The aim of this systematic review was to compare the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase.

Material and Methods

An electronic search was performed in the databases EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A manual search of the reference list of selected studies and of review articles was also performed up to November 2013. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded.

Results

The initial search identified 1,039 articles, of which seven were selected, and only one met the inclusion criteria. This study showed that subjects taking metronidazole and amoxicillin at the initial phase of treatment exhibited statistically significantly greater reduction in pocket depth and gain in clinical attachment level in initially deep sites (PD≥7 mm) than subjects taking antibiotics after healing (p<0.05). This comparison was conducted 2 months after antibiotic intake, at the healing phase.

Conclusion

To date, only one short-term RCT has directly compared different moments of systemic antibiotics administration, as adjuncts to SRP, in the treatment of periodontitis. Although the results of this study suggested some benefits for antibiotics intake during the active phase of therapy, these findings need to be confirmed by larger placebo-controlled randomized clinical trials with longer follow-up periods.

Localized aggressive periodontitis treatment response in primary and permanent dentitions

BACKGROUND

The comparative treatment response of children and young adults with localized aggressive periodontitis treatment (LAgP) affecting primary and permanent dentition is unknown. The objective of this study is to evaluate the influence of non-surgical periodontal therapy with adjunctive systemic antibiotics on the clinical outcome of children and young adults with primary versus permanent dentition affected by LAgP.

METHODS

A cohort of 97 African American participants aged 5 to 21 years (30 males and 67 females; 22 primary and 75 permanent dentitions affected) diagnosed with LAgP were included. Patients presented with no significant medical history. All patients underwent periodontal therapy, which consisted of full-mouth mechanical debridement at baseline and the 3-, 6-, and 12-month appointments. Additionally, all patients were prescribed a 1-week regimen of systemic antibiotics at the initial appointment. Clinical parameters were analyzed, including probing depth, clinical attachment level (CAL), bleeding on probing, and percentage of visible plaque.

RESULTS

Overall, periodontal therapy was found to be effective in improving the clinical outcomes of both primary and permanent dentitions. Although baseline CALs were similar between the groups, the reduction in mean CAL at 3, 6, and 12 months and reduction in percentage plaque at 3 months were significantly greater in primary dentition compared with permanent dentition.

CONCLUSIONS

Non-surgical therapy with systemic antibiotics is effective for LAgP in both primary and permanent dentitions. A greater reduction in CAL in LAgP of primary dentition may suggest that younger children may carry a greater propensity for positive treatment outcomes and healing potential compared with children/young adults with permanent dentition.

Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial

AIM

We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear.

MATERIAL & METHODS

This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals.

RESULTS

From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively).

CONCLUSIONS

Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription.

Effect of gallium aluminium arsenide diode laser therapy on Porphyromonas gingivalis in chronic periodontitis: a randomized controlled trial

OBJECTIVES

The aim of this randomized, controlled trial was to evaluate the effects of 685-nm gallium aluminium arsenide (GaAlAs) diode laser therapy (1.6 J cm^-2 ) as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

METHODS

Thirty-two patients aged 35-60 years old who had chronic periodontitis met the eligibility criteria. They were randomly assigned to two equal groups: scaling and root planing were performed in the SRP group, while scaling, root planing and laser irradiation of periodontal pockets were performed in the SRP + DL group. Subgingival plaque samples were subjected to polymerase chain reaction (PCR) to detect P. gingivalis-colonized sites, and common clinical indices were evaluated before and 2 months after treatment. Clinical examination included gingival index (GI), plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival bleeding index (GBI), all of which were recorded.

RESULTS

Data from 30 patients [19 women and 11 men; mean age, 48.4 (5.4) years old] were analysed. There were statistically significant improvements in GI, PD, CAL and GBI for the SRP + DL group compared to SRP group but no significant difference in PI between the groups. Additionally, the percentage of P. gingivalis-positive sites in the SRP + DL group decreased from 80% (12/15) to 20% (3/15) after laser irradiation (P < 0.05). No significant changes were noted in the SRP group.

CONCLUSION

GaAlAs diode laser irradiation of diseased periodontal pockets at 685 nm and 1.6 J cm^-2 seemed to be an effective adjuvant to mechanical instrumentation to treat chronic periodontitis.