1
|
Isola G, Polizzi A, Santonocito S, Alibrandi A, Pesce P, Kocher T. Effect of quadrantwise versus full-mouth subgingival instrumentation on clinical and microbiological parameters in periodontitis patients: A randomized clinical trial. J Periodontal Res 2024; 59:647-656. [PMID: 38666373 DOI: 10.1111/jre.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 07/16/2024]
Abstract
AIM This study evaluated the efficacy of quadrantwise subgingival instrumentation (Q-SI) versus one-stage full-mouth subgingival instrumentation (FM-SI) on probing depth and periodontal pathogen reduction over a 6-month follow-up period, as well as whether baseline periodontal pathogens influenced the impact of periodontal treatment protocols on outcomes. METHODS Patients with periodontitis were randomized to receive Q-SI (n = 43) or FM-SI (n = 45). Patients were instructed and motivated to maintain optimal oral hygiene during the treatment sessions. Clinical (probing pocket depth [PPD], clinical attachment loss [CAL], and bleeding on probing [BOP]) and periodontal pathogens were assessed at baseline and after 30, 90, and 180 days. Total bacterial load and periodontal pathogens were analysed via real-time PCR. RESULTS At the 6-month follow-up, the median PPD decreased from 4.8 mm (interquartile range [IQR]: 4.3-5.2) to 2.6 mm (IQR: 2.3-2.9) in FM-SI patients and from 4.7 mm (IQR: 4.1-5.2) to 3.2 mm (IQR: 2.4-3.5) in Q-SI patients (p < .001). At 6 months, FM-SI was more effective at reducing the median proportions of Porphyromonas gingivalis (Pg), Aggregatibacter actinocomyctemcomitans, and Tannerella forsythia (Tf) (p < .001 for each value). Multilevel linear regression analysis demonstrated that high baseline PPD (p = .029), Pg (p = .014), and Tf (p < .001) levels and the FM-SI protocol (p < .001) were statistically significant predictors of PPD reduction at 6 months. Furthermore, PPD reduction was significantly greater in the FM-SI group when lower baseline Pg levels were detected. CONCLUSION The FM-SI was more effective than the Q-SI in reducing the mean PPD and number of periodontal pathogens in periodontitis patients over a 6-month follow-up period. Higher baseline PPD and Pg levels had a negative impact on PPD reduction at 6 months after FM-SI.
Collapse
Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, Unit of Periodontology, School of Dentistry, University of Catania, Catania, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Paediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
2
|
Walker A, Czyz DM. Oh my gut! Is the microbial origin of neurodegenerative diseases real? Infect Immun 2023; 91:e0043722. [PMID: 37750713 PMCID: PMC10580905 DOI: 10.1128/iai.00437-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
There is no cure or effective treatment for neurodegenerative protein conformational diseases (PCDs), such as Alzheimer's or Parkinson's diseases, mainly because the etiology of these diseases remains elusive. Recent data suggest that unique changes in the gut microbial composition are associated with these ailments; however, our current understanding of the bacterial role in the pathogenesis of PCDs is hindered by the complexity of the microbial communities associated with specific microbiomes, such as the gut, oral, or vaginal microbiota. The composition of these specific microbiomes is regarded as a unique fingerprint affected by factors such as infections, diet, lifestyle, and antibiotics. All of these factors also affect the severity of neurodegenerative diseases. The majority of studies that reveal microbial contribution are correlational, and various models, including worm, fly, and mouse, are being utilized to decipher the role of individual microbes that may affect disease onset and progression. Recent evidence from across model organisms and humans shows a positive correlation between the presence of gram-negative enteropathogenic bacteria and the pathogenesis of PCDs. While these correlational studies do not provide a mechanistic explanation, they do reveal contributing bacterial species and provide an important basis for further investigation. One of the lurking concerns related to the microbial contribution to PCDs is the increasing prevalence of antibiotic resistance and poor antibiotic stewardship, which ultimately select for proteotoxic bacteria, especially the gram-negative species that are known for intrinsic resistance. In this review, we summarize what is known about individual microbial contribution to PCDs and the potential impact of increasing antimicrobial resistance.
Collapse
Affiliation(s)
- Alyssa Walker
- Department of Microbiology and Cell Science, University of Florida, Gainesville, Florida, USA
| | - Daniel M. Czyz
- Department of Microbiology and Cell Science, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
3
|
Herrera D, van Winkelhoff AJ, Matesanz P, Lauwens K, Teughels W. Europe's contribution to the evaluation of the use of systemic antimicrobials in the treatment of periodontitis. Periodontol 2000 2023. [PMID: 37314038 DOI: 10.1111/prd.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
This narrative review celebrates Europe's contribution to the current knowledge on systemically administered antimicrobials in periodontal treatment. Periodontitis is the most frequent chronic noncommunicable human disease. It is caused by dysbiotic bacterial biofilms and is commonly treated with subgingival instrumentation. However, some sites/patients do not respond adequately, and its limitations and shortcomings have been recognized. This has led to the development of alternative or adjunctive therapies. One is the use of antimicrobials to target bacteria in subgingival biofilms in the periodontal pocket, which can be targeted directly through the pocket entrance with a locally delivered antibiotic or systemically by oral, intravenous, or intramuscular methods. Since the early 20th century, several studies on systemic antibiotics have been undertaken and published, especially between 1990 and 2010. Europe's latest contribution to this topic is the first European Federation of Periodontology, S3-level Clinical Practice Guideline, which incorporates recommendations related to the use of adjuncts to treat stage I-III periodontitis. Understanding the etiopathogenesis of periodontal diseases, specifically periodontitis, has influenced the use of systemic periodontal antibiotic therapy. Randomized clinical trials and systematic reviews with meta-analyses have demonstrated the clinical advantages of adjunctive systemic antimicrobials. However, current recommendations are restrictive due to concerns about antibiotic misuse and the increase in microbial antibiotic resistance. European researchers have contributed to the use of systemic antimicrobials in the treatment of periodontitis through clinical trials and by providing rational guidelines. Nowadays, European researchers are exploring alternatives and directing clinical practice by providing evidence-based guidelines to limit the use of systemic antimicrobials.
Collapse
Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Arie Jan van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Katalina Lauwens
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Skalerič E, Petelin M, Gašpirc B. Antimicrobial photodynamic therapy in treatment of aggressive periodontitis (stage III, grade C periodontitis): A comparison between photodynamic therapy and antibiotic therapy as an adjunct to non-surgical periodontal treatment. Photodiagnosis Photodyn Ther 2022; 41:103251. [PMID: 36587861 DOI: 10.1016/j.pdpdt.2022.103251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment of aggressive periodontitis (stage III, grade C periodontitis) represents a challenge. The aim of the study was to compare the long-term results of antimicrobial photodynamic therapy (aPDT) and antibiotic therapy as an adjunct to conventional non-surgical therapy in patients with aggressive periodontitis. MATERIALS AND METHODS Twenty subjects with untreated aggressive periodontitis (stage III, grade C periodontitis) were divided into two groups: the test group (TG) received non-surgical therapy and two sessions of aPDT using a laser (HELBO TheraLite laser) with a wavelength of 670 nm associated with HELBO Blue photosensitizer, and the control group (CG) received non-surgical therapy and antibiotics (amoxicillin 500 mg and metronidazole 400 mg, 7 days). Clinical parameters of probing depth, clinical attachment level and bleeding on probing (BOP) were assessed at baseline, 3, 6, 9 and 12 months after treatment. RESULTS The mean probing pocket depths at baseline were 3.68 mm in TG and 3.51 mm in CG. These values decreased to 2.77 mm (p < 0.05) and 2.54 mm (p < 0.05) 3 months after treatment and stayed decreased after 12 months. Clinical attachment levels at baseline were 3.88 mm in TG and 3.70 mm in CG. These values decreased to 3.06 mm (p < 0.05) and 2.80 mm (p < 0.05) after 3 months and stayed decreased after 12 months. We also found a decrease in BOP after 3, 6, 9 and 12 months in TG and in CG. CONCLUSIONS aPDT and antibiotics as an adjunct to non-surgical periodontal treatment lead to a comparable improvement in long term periodontal parameters.
Collapse
Affiliation(s)
- Eva Skalerič
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
| | - Milan Petelin
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
| | - Boris Gašpirc
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
| |
Collapse
|
5
|
Sabbagh MN, Decourt B. COR388 (atuzaginstat): an investigational gingipain inhibitor for the treatment of Alzheimer disease. Expert Opin Investig Drugs 2022; 31:987-993. [PMID: 36003033 PMCID: PMC10275298 DOI: 10.1080/13543784.2022.2117605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/23/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Evidence from in vitro and in vivo studies demonstrates that amyloid beta (Aβ) oligomers have potent, broad-spectrum antimicrobial properties created by fibrils that entrap pathogens and disrupt their membranes. Data suggest that Aβ may play a protective role in the innate immune response to microbial infections and that Aβ in the brain plays a damaging role when the inflammatory response is not well controlled. AREAS COVERED This paper describes the relationship between periodontal disease and Alzheimer disease (AD), the role of Porphyromonas gingivalis and its secreted gingipains in AD, and the potential of the gingipain inhibitor atuzaginstat (COR388) to modulate AD neuropathologies. EXPERT OPINION P. gingivalis is opsonized by Aβ42, is capable of entering the brain, and is an accelerant of neuropathologies in rodent models of AD. Thus, in our opinion, this bacteria is highly likely to be a pathogen capable of initiating or precipitating the progression of AD, which agrees with the pathogen hypothesis of clinical AD development.
Collapse
Affiliation(s)
- Marwan N. Sabbagh
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix Arizona, USA
| | - Boris Decourt
- Translational Neuroscience Lab, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| |
Collapse
|
6
|
Collins JR, Ogando G, González R, Figuero E, Marín MJ, Sanz M, Herrera D. Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial. Clin Oral Investig 2022; 26:4195-4207. [PMID: 35122549 DOI: 10.1007/s00784-022-04392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.
Collapse
Affiliation(s)
- James Rudolph Collins
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic.
| | - Gabriel Ogando
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic
| | - Rolando González
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - María José Marín
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| |
Collapse
|
7
|
Retamal-Valdes B, Teughels W, Oliveira LM, da Silva RN, Fritoli A, Gomes P, Soares GMS, Temporão N, Furquim CP, Duarte PM, Doyle H, Faveri M, Figueiredo LC, Feres M. Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial. Trials 2021; 22:283. [PMID: 33858486 PMCID: PMC8048221 DOI: 10.1186/s13063-021-05246-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis. METHODS Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines. STATISTICAL ANALYSES The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%. TRIAL REGISTRATION ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.
Collapse
Affiliation(s)
- Belen Retamal-Valdes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium
| | - Laryssa Macedo Oliveira
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Rebeca Nascimento da Silva
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Aretuza Fritoli
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Patricia Gomes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | | | - Natalie Temporão
- Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Camila Pinheiro Furquim
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Helio Doyle
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Marcelo Faveri
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Luciene Cristina Figueiredo
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| |
Collapse
|
8
|
Wadhawan A, Reynolds MA, Makkar H, Scott AJ, Potocki E, Hoisington AJ, Brenner LA, Dagdag A, Lowry CA, Dwivedi Y, Postolache TT. Periodontal Pathogens and Neuropsychiatric Health. Curr Top Med Chem 2021; 20:1353-1397. [PMID: 31924157 DOI: 10.2174/1568026620666200110161105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023]
Abstract
Increasing evidence incriminates low-grade inflammation in cardiovascular, metabolic diseases, and neuropsychiatric clinical conditions, all important causes of morbidity and mortality. One of the upstream and modifiable precipitants and perpetrators of inflammation is chronic periodontitis, a polymicrobial infection with Porphyromonas gingivalis (P. gingivalis) playing a central role in the disease pathogenesis. We review the association between P. gingivalis and cardiovascular, metabolic, and neuropsychiatric illness, and the molecular mechanisms potentially implicated in immune upregulation as well as downregulation induced by the pathogen. In addition to inflammation, translocation of the pathogens to the coronary and peripheral arteries, including brain vasculature, and gut and liver vasculature has important pathophysiological consequences. Distant effects via translocation rely on virulence factors of P. gingivalis such as gingipains, on its synergistic interactions with other pathogens, and on its capability to manipulate the immune system via several mechanisms, including its capacity to induce production of immune-downregulating micro-RNAs. Possible targets for intervention and drug development to manage distal consequences of infection with P. gingivalis are also reviewed.
Collapse
Affiliation(s)
- Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States.,Department of Psychiatry, Saint Elizabeths Hospital, Washington, D.C. 20032, United States
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore 21201, United States
| | - Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States
| | - Alison J Scott
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, United States
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, United States
| | - Andrew J Hoisington
- Air Force Institute of Technology, Wright-Patterson Air Force Base, United States
| | - Lisa A Brenner
- Departments of Psychiatry, Neurology, and Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States
| | - Christopher A Lowry
- Departments of Psychiatry, Neurology, and Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States.,Department of Integrative Physiology, Center for Neuroscience and Center for Microbial Exploration, University of Colorado Boulder, Boulder, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, United States
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Alabama, United States
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States.,Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, United States
| |
Collapse
|
9
|
Khattri S, Kumbargere Nagraj S, Arora A, Eachempati P, Kusum CK, Bhat KG, Johnson TM, Lodi G. Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis. Cochrane Database Syst Rev 2020; 11:CD012568. [PMID: 33197289 PMCID: PMC9166531 DOI: 10.1002/14651858.cd012568.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Systemic antimicrobials can be used as an adjunct to mechanical debridement (scaling and root planing (SRP)) as a non-surgical treatment approach to manage periodontitis. A range of antibiotics with different dosage and combinations are documented in the literature. The review follows the previous classification of periodontitis as all included studies used this classification. OBJECTIVES To assess the effects of systemic antimicrobials as an adjunct to SRP for the non-surgical treatment of patients with periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases to 9 March 2020: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, and Embase. The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) which involved individuals with clinically diagnosed untreated periodontitis. Trials compared SRP with systemic antibiotics versus SRP alone/placebo, or with other systemic antibiotics. DATA COLLECTION AND ANALYSIS We selected trials, extracted data, and assessed risk of bias in duplicate. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 45 trials conducted worldwide involving 2664 adult participants. 14 studies were at low, 8 at high, and the remaining 23 at unclear overall risk of bias. Seven trials did not contribute data to the analysis. We assessed the certainty of the evidence for the 10 comparisons which reported long-term follow-up (≥ 1 year). None of the studies reported data on antimicrobial resistance and patient-reported quality of life changes. Amoxicillin + metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -16.20%, 95% CI -25.87 to -6.53; 1 study, 44 participants); clinical attachment level (CAL) (MD -0.47 mm, 95% CI -0.90 to -0.05; 2 studies, 389 participants); probing pocket depth (PD) (MD -0.30 mm, 95% CI -0.42 to -0.18; 2 studies, 389 participants); and percentage of bleeding on probing (BOP) (MD -8.06%, 95% CI -14.26 to -1.85; 2 studies, 389 participants) was of very low certainty. Only the results for closed pockets and BOP showed a minimally important clinical difference (MICD) favouring amoxicillin + metronidazole + SRP. Metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -12.20%, 95% CI -29.23 to 4.83; 1 study, 22 participants); CAL (MD -1.12 mm, 95% CI -2.24 to 0; 3 studies, 71 participants); PD (MD -1.11 mm, 95% CI -2.84 to 0.61; 2 studies, 47 participants); and percentage of BOP (MD -6.90%, 95% CI -22.10 to 8.30; 1 study, 22 participants) was of very low certainty. Only the results for CAL and PD showed an MICD favouring the MTZ + SRP group. Azithromycin + SRP versus SRP for chronic/aggressive periodontitis: we found no evidence of a difference in percentage of closed pockets (MD 2.50%, 95% CI -10.19 to 15.19; 1 study, 40 participants); CAL (MD -0.59 mm, 95% CI -1.27 to 0.08; 2 studies, 110 participants); PD (MD -0.77 mm, 95% CI -2.33 to 0.79; 2 studies, 110 participants); and percentage of BOP (MD -1.28%, 95% CI -4.32 to 1.76; 2 studies, 110 participants) (very low-certainty evidence for all outcomes). Amoxicillin + clavulanate + SRP versus SRP for chronic periodontitis: the evidence from 1 study, 21 participants for CAL (MD 0.10 mm, 95% CI -0.51 to 0.71); PD (MD 0.10 mm, 95% CI -0.17 to 0.37); and BOP (MD 0%, 95% CI -0.09 to 0.09) was of very low certainty and did not show a difference between the groups. Doxycycline + SRP versus SRP in aggressive periodontitis: the evidence from 1 study, 22 participants for CAL (MD -0.80 mm, 95% CI -1.49 to -0.11); and PD (MD -1.00 mm, 95% CI -1.78 to -0.22) was of very low certainty, with the doxycycline + SRP group showing an MICD in PD only. Tetracycline + SRP versus SRP for aggressive periodontitis: we found very low-certainty evidence of a difference in long-term improvement in CAL for the tetracycline group (MD -2.30 mm, 95% CI -2.50 to -2.10; 1 study, 26 participants). Clindamycin + SRP versus SRP in aggressive periodontitis: we found very low-certainty evidence from 1 study, 21 participants of a difference in long-term improvement in CAL (MD -1.70 mm, 95% CI -2.40 to -1.00); and PD (MD -1.80 mm, 95% CI -2.47 to -1.13) favouring clindamycin + SRP. Doxycycline + SRP versus metronidazole + SRP for aggressive periodontitis: there was very low-certainty evidence from 1 study, 27 participants of a difference in long-term CAL (MD 1.10 mm, 95% CI 0.36 to 1.84); and PD (MD 1.00 mm, 95% CI 0.30 to 1.70) favouring metronidazole + SRP. Clindamycin + SRP versus metronidazole + SRP for aggressive periodontitis: the evidence from 1 study, 26 participants for CAL (MD 0.20 mm, 95% CI -0.55 to 0.95); and PD (MD 0.20 mm, 95% CI -0.38 to 0.78) was of very low certainty and did not show a difference between the groups. Clindamycin + SRP versus doxycycline + SRP for aggressive periodontitis: the evidence from 1 study, 23 participants for CAL (MD -0.90 mm, 95% CI -1.62 to -0.18); and PD (MD -0.80 mm, 95% CI -1.58 to -0.02) was of very low certainty and did not show a difference between the groups. Most trials testing amoxicillin, metronidazole, and azithromycin reported adverse events such as nausea, vomiting, diarrhoea, mild gastrointestinal disturbances, and metallic taste. No serious adverse events were reported. AUTHORS' CONCLUSIONS There is very low-certainty evidence (for long-term follow-up) to inform clinicians and patients if adjunctive systemic antimicrobials are of any help for the non-surgical treatment of periodontitis. There is insufficient evidence to decide whether some antibiotics are better than others when used alongside SRP. None of the trials reported serious adverse events but patients should be made aware of the common adverse events related to these drugs. Well-planned RCTs need to be conducted clearly defining the minimally important clinical difference for the outcomes closed pockets, CAL, PD, and BOP.
Collapse
Affiliation(s)
- Shivi Khattri
- Department of Periodontics, Subharti Dental College and Hospital, Meerut, India
| | - Sumanth Kumbargere Nagraj
- Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Ankita Arora
- Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Melaka-Manipal Medical College, Melaka, Malaysia
| | - Prashanti Eachempati
- Department of Prosthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Chandan Kumar Kusum
- Department of Prosthodontics, Subharti Dental College and Hospital, Meerut, India
| | - Kishore G Bhat
- Department of Molecular Biology and Immunology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, India
| | - Trevor M Johnson
- Faculty of General Dental Practice (UK), RCS England, London, UK
| | - Giovanni Lodi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Cosgarea R, Eick S, Jepsen S, Arweiler NB, Juncar R, Tristiu R, Salvi GE, Heumann C, Sculean A. Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT. Sci Rep 2020; 10:16322. [PMID: 33004857 PMCID: PMC7530673 DOI: 10.1038/s41598-020-73054-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7-14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1β, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.
Collapse
Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany.
- Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania.
- Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany.
| | - S Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany
| | - N B Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany
| | - R Juncar
- Department of Dental Medicine, University of Oradea, Oradea, Romania
| | - R Tristiu
- Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - G E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - C Heumann
- Department for Statistics, Ludwig-Maximilians University, Munich, Germany
| | - A Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Zhang M, Liu X, Xie Y, Zhang Q, Zhang W, Jiang X, Lin J. Biological Safe Gold Nanoparticle-Modified Dental Aligner Prevents the Porphyromonas gingivalis Biofilm Formation. ACS OMEGA 2020; 5:18685-18692. [PMID: 32775870 PMCID: PMC7407536 DOI: 10.1021/acsomega.0c01532] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/29/2020] [Indexed: 05/13/2023]
Abstract
Oral microbiology could directly influence overall health. Porphyromonas gingivalis (P. gingivalis) is a highly pathogenic bacterium that causes periodontitis and other related systematic diseases, including Alzheimer's disease. Orthodontic devices (e.g., invisalign aligner) is commonly used in populations with periodontitis who are also at a high risk of systematic diseases. In this study, newly explored antibacterial 4,6-diamino-2-pyrimidinethiol-modified gold nanoparticles (AuDAPT) were coated onto aligners. The coated aligners showed favorable antibacterial activity against P. gingivalis. In the presence of the coated aligner, the number of planktonic cells was decreased, and biofilm formation was prevented. This material also showed favorable biocompatibility in vivo and in vitro. This study reveals a new method for treating oral P. gingivalis by coating aligners with AuDAPT, which has typical advantages compared to other treatments for both periodontitis and related systematic diseases.
Collapse
Affiliation(s)
- Mengqi Zhang
- Department
of Orthodontics, Peking University School and Hospital of Stomatology, No. 22, Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| | - Xiaomo Liu
- Department
of Orthodontics, Peking University School and Hospital of Stomatology, No. 22, Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| | - Yangzhouyun Xie
- Department
of Biomedical Engineering, Southern University
of Science and Technology, No. 1088 Xueyuan Rd, Nanshan District, Shenzhen, Guangdong 518055, P. R. China
| | - Qian Zhang
- Central
Laboratory, Peking University School and
Hospital of Stomatology, No. 22, Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R.
China
| | - Wei Zhang
- Beijing
Engineering Research Center for BioNanotechnology and CAS Key Laboratory
for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center
for Excellence in Nanoscience, National
Center for NanoScience and Technology, No. 11 Zhongguancun Beiyitiao, Beijing 100190, P. R.
China
| | - Xingyu Jiang
- Department
of Biomedical Engineering, Southern University
of Science and Technology, No. 1088 Xueyuan Rd, Nanshan District, Shenzhen, Guangdong 518055, P. R. China
| | - Jiuxiang Lin
- Department
of Orthodontics, Peking University School and Hospital of Stomatology, No. 22, Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| |
Collapse
|
12
|
Boia S, Boariu M, Baderca F, Rusu D, Muntean D, Horhat F, Boia ER, Borza C, Anghel A, Stratul ŞI. Clinical, microbiological and oxidative stress evaluation of periodontitis patients treated with two regimens of systemic antibiotics, adjunctive to non-surgical therapy: A placebo-controlled randomized clinical trial. Exp Ther Med 2019; 18:5001-5015. [PMID: 31819766 PMCID: PMC6895779 DOI: 10.3892/etm.2019.7856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Aim of research was to evaluate and compare the clinical and microbiological effects of two different regimens of amoxicillin (AMX) and metronidazole (MTZ) combined with non-surgical periodontal therapy in patients with chronic periodontitis (CP), and identify antibiotic-resistant bacteria and changes in oxidative stress (OS). Forty-six patients with generalized CP were randomly assigned to group A [scaling and root planing within 24 h (SRP) + placebo for 7 days), group B [SRP + AMX + MTZ, both 500 mg three times daily (TID), 3 days), and group C [SRP + AMX + MTZ, both 500 mg TID, 7 days). Periodontal pocket depth (PPD-primary outcome), clinical attachment level (CAL), full-mouth bleeding scores (FMBS), plaque scores (FMPS), blood and subgingival plaque were assessed at baseline and after three months. OS was evaluated via derivatives of reactive oxygen metabolites (d-ROMs) and assessments of biological antioxidant potential (BAP). Bacterial profiling was performed by PCR. Antibiotic resistance was evaluated in cultures. PPD, CAL, number of sites with PPD ≥6 mm, their PPD, CAL and FMBS decreased (P<0.05) in all groups, as well as FMPS in groups A and B, and d-ROMs in group C. There were significant differences among groups regarding decreases in the frequency of detection for Aa and Tf. For Aa, there were differences between groups A and C (P=0.048) and between groups B and C (P=0.048), but not between groups A and B; whereas for Tf, groups A and B were different from group C (P<0.001), but not from each other (P=0.920). No resistance to AMX was identified prior to treatment; two strains were resistant after treatment. Before treatment, 13 strains were resistant to MTZ, and 2 were resistant after. One strain in the same patient was sensitive prior to treatment, and later became resistant to both antibiotics. SRP with a 7-day course of antibiotic therapy was more effective for improving clinical parameters, in decrease of detection of several periopathogens, and in improvement of OS when compared to a 3-day regimen. Resistance was found in fewer strains after treatment than before.
Collapse
Affiliation(s)
- Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Flavia Baderca
- Department of Histology, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Delia Muntean
- Department of Microbiology, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Florin Horhat
- Department of Microbiology, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Eugen-Radu Boia
- Department of ENT, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Claudia Borza
- Department of Pathophysiology, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Andrei Anghel
- Department of Biochemistry, Faculty of Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Ştefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timişoara, Romania
| |
Collapse
|
13
|
Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, Nguyen M, Haditsch U, Raha D, Griffin C, Holsinger LJ, Arastu-Kapur S, Kaba S, Lee A, Ryder MI, Potempa B, Mydel P, Hellvard A, Adamowicz K, Hasturk H, Walker GD, Reynolds EC, Faull RLM, Curtis MA, Dragunow M, Potempa J. Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. SCIENCE ADVANCES 2019; 5:eaau3333. [PMID: 30746447 PMCID: PMC6357742 DOI: 10.1126/sciadv.aau3333] [Citation(s) in RCA: 1012] [Impact Index Per Article: 202.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/11/2018] [Indexed: 05/19/2023]
Abstract
Porphyromonas gingivalis, the keystone pathogen in chronic periodontitis, was identified in the brain of Alzheimer's disease patients. Toxic proteases from the bacterium called gingipains were also identified in the brain of Alzheimer's patients, and levels correlated with tau and ubiquitin pathology. Oral P. gingivalis infection in mice resulted in brain colonization and increased production of Aβ1-42, a component of amyloid plaques. Further, gingipains were neurotoxic in vivo and in vitro, exerting detrimental effects on tau, a protein needed for normal neuronal function. To block this neurotoxicity, we designed and synthesized small-molecule inhibitors targeting gingipains. Gingipain inhibition reduced the bacterial load of an established P. gingivalis brain infection, blocked Aβ1-42 production, reduced neuroinflammation, and rescued neurons in the hippocampus. These data suggest that gingipain inhibitors could be valuable for treating P. gingivalis brain colonization and neurodegeneration in Alzheimer's disease.
Collapse
Affiliation(s)
- Stephen S. Dominy
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
- Corresponding author.
| | - Casey Lynch
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Florian Ermini
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Malgorzata Benedyk
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Agata Marczyk
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Andrei Konradi
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Mai Nguyen
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Ursula Haditsch
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Debasish Raha
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | | | | | | | - Samer Kaba
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Alexander Lee
- Cortexyme, Inc., 269 East Grand Ave., South San Francisco, CA, USA
| | - Mark I. Ryder
- Division of Periodontology, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Potempa
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| | - Piotr Mydel
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Broegelman Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Annelie Hellvard
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
- Broegelman Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Karina Adamowicz
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Hatice Hasturk
- The Forsyth Institute, Cambridge, MA, USA
- Harvard University School of Dental Medicine, Boston, MA, USA
| | - Glenn D. Walker
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School and the Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric C. Reynolds
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School and the Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard L. M. Faull
- Department of Anatomy with Radiology, Centre for Brain Research and NeuroValida, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Maurice A. Curtis
- Centre for Brain Research and NeuroValida, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mike Dragunow
- Centre for Brain Research and NeuroValida, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Pharmacology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| |
Collapse
|
14
|
Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000 2018; 75:152-188. [PMID: 28758300 DOI: 10.1111/prd.12201] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
Collapse
|
15
|
Saleh A, Rincon J, Tan A, Firth M. Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial. Aust Dent J 2017; 61:469-481. [PMID: 26836781 DOI: 10.1111/adj.12415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 01/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- A Saleh
- Oral Health Centre of Western Australia, Nedlands, Western Australia, Australia
| | - J Rincon
- Oral Health Centre of Western Australia, Australia
| | - A Tan
- Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - M Firth
- Centre for Applied Statistics, School of Mathematics and Statistics, The University of Western Australia, Western Australia, Australia
| |
Collapse
|
16
|
Comparison of repeated applications of aPDT with amoxicillin and metronidazole in the treatment of chronic periodontitis: A short-term study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 174:364-369. [DOI: 10.1016/j.jphotobiol.2017.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 01/11/2023]
|
17
|
Cosgarea R, Heumann C, Juncar R, Tristiu R, Lascu L, Salvi GE, Arweiler NB, Sculean A. 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. PLoS One 2017; 12:e0179592. [PMID: 28662049 PMCID: PMC5491014 DOI: 10.1371/journal.pone.0179592] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/18/2017] [Indexed: 12/29/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Raluca Cosgarea
- Clinic of Periodontology, Philipps University, Marburg, Germany
- Clinic of Prosthodontics, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Christian Heumann
- Department for Statistics, Ludwig-Maximilians University, Munich, Germany
| | - Raluca Juncar
- Clinic of Prosthodontics, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Roxana Tristiu
- Clinic of Prosthodontics, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Liana Lascu
- Clinic of Prosthodontics, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | | | | | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
18
|
Jepsen K, Jepsen S. Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000 2017; 71:82-112. [PMID: 27045432 DOI: 10.1111/prd.12121] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
Abstract
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.
Collapse
|
19
|
Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 2017; 146:508-24.e5. [PMID: 26113099 DOI: 10.1016/j.adaj.2015.01.028] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. RESULTS The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). CONCLUSIONS AND PRACTICAL IMPLICATIONS With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.
Collapse
|
20
|
Gartenmann SJ, Dörig I, Sahrmann P, Held U, Walter C, Schmidlin PR. Influence of different post-interventional maintenance concepts on periodontal outcomes: an evaluation of three systematic reviews. BMC Oral Health 2016; 17:19. [PMID: 27431672 PMCID: PMC4949770 DOI: 10.1186/s12903-016-0244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To selectively review the existing literature on post-interventional maintenance protocols in patients with periodontal disease receiving either non-surgical or surgical periodontal treatment. METHODS Three systematic reviews with different periodontal interventions, i.e. scaling and root planing (SRP), SRP with adjunctive antibiotics or regenerative periodontal surgery were evaluated focusing on their post-interventional maintenance care. Due to the early publication of one review an additional literature search update was undertaken. The search was executed for studies published from January 2001 till March 2015 through an electronic database to ensure the inclusion of resent studies on SRP. Two reviewers guided the study selection and assessed the validity of the three reviews found. RESULTS Within the group of scaling and root planing alone there have been nine studies with more than three appointments for maintenance care and five studies with more than two appointments in the first 2 months after the intervention. Chlorhexidine was the most frequently used antiseptic agent used for 2 weeks after non-surgical intervention. Scaling and root planing with adjunctive antibiotics showed a similar number of visits with professional biofilm debridement, whereas regenerative studies displayed more studies with more than three visits in the intervention group. In addition, the use of antiseptics was longer and lasted 4 to 8 weeks after the regenerative intervention. The latter studies also showed more stringent maintenance protocols. CONCLUSIONS With increased interventional effort there was a greater tendency to increase frequency and duration of the maintenance care program and antiseptic agents.
Collapse
Affiliation(s)
- Stefanie J Gartenmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Iris Dörig
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre for Patient-Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology University Center for Dental Medicine (UZB), Basel, Switzerland
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
| |
Collapse
|
21
|
Cosgarea R, Juncar R, Heumann C, Tristiu R, Lascu L, Arweiler N, Stavropoulos A, Sculean A. Non-surgical periodontal treatment in conjunction with 3 or 7 days systemic administration of amoxicillin and metronidazole in severe chronic periodontitis patients. A placebo-controlled randomized clinical study. J Clin Periodontol 2016; 43:767-77. [DOI: 10.1111/jcpe.12559] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology; Philipps University Marburg; Marburg Germany
- Clinic for Prosthetic Dentistry; University Iuliu Hatieganu; Cluj-Napoca Romania
| | - Raluca Juncar
- Clinic for Prosthetic Dentistry; University Iuliu Hatieganu; Cluj-Napoca Romania
| | - Christian Heumann
- Department for Statistics; Ludwig-Maximilians University; Munich Germany
| | - Roxana Tristiu
- Clinic for Prosthetic Dentistry; University Iuliu Hatieganu; Cluj-Napoca Romania
| | - Liana Lascu
- Clinic for Prosthetic Dentistry; University Iuliu Hatieganu; Cluj-Napoca Romania
| | - Nicole Arweiler
- Department of Periodontology; Philipps University Marburg; Marburg Germany
| | - Andreas Stavropoulos
- Department of Periodontology; Faculty of dentistry; Malmö University; Malmö Sweden
| | - Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| |
Collapse
|
22
|
Bizzarro S, Van der Velden U, Loos BG. Local disinfection with sodium hypochlorite as adjunct to basic periodontal therapy: a randomized controlled trial. J Clin Periodontol 2016; 43:778-88. [PMID: 27169789 DOI: 10.1111/jcpe.12578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
AIM To investigate the clinical and microbiological effects of local disinfection with 0.5% sodium hypochlorite (NaOCl) with or without systemic antimicrobials (amoxicillin and metronidazole, AM) during basic periodontal therapy (BPT). MATERIAL AND METHODS In a randomized clinical trial (four groups), 110 chronic periodontitis patients received BPT plus local irrigation with saline (BPT + S), local disinfection with NaOCl (BPT + DIS), BPT + DIS + AM or BPT + S + AM. The outcome was analysed at baseline, 3, 6 and 12 months. RESULTS There was no difference in clinical attachment level gain at 12 months between the four groups. BPT + DIS showed no additional improvement compared to BPT + S; BPT + DIS + AM showed fewer sites with probing pocket depth (PPD) ≥7 mm versus BPT + S only up to 6 months (p = 0.037). In factorial analyses, additional clinical reduction for PPD (p = 0.023) and number of sites with PPD ≥5 (p = 0.007), ≥6 (p = 0.002) and ≥7 mm (p < 0.001) were found when AM was added to BPT, but not when DIS was applied. In all groups, a comparable decrease in targeted bacteria was found. AM caused adverse events in 22% of the patients. CONCLUSION Local disinfection with NaOCl, also in combination with AM, showed, after 1-year follow-up, no additional clinical and microbiological effects compared to BPT alone.
Collapse
Affiliation(s)
- Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
| | - Ubele Van der Velden
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
23
|
The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=. BMC Oral Health 2016; 16:27. [PMID: 26928597 PMCID: PMC4770674 DOI: 10.1186/s12903-015-0123-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/19/2015] [Indexed: 11/22/2022] Open
Abstract
Background The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone. Methods The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted. Results A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm, p = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001). Conclusion Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care. Electronic supplementary material The online version of this article (doi:10.1186/s12903-015-0123-6) contains supplementary material, which is available to authorized users.
Collapse
|
24
|
Harks I, Koch R, Eickholz P, Hoffmann T, Kim T, Kocher T, Meyle J, Kaner D, Schlagenhauf U, Doering S, Holtfreter B, Gravemeier M, Harmsen D, Ehmke B. Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial. J Clin Periodontol 2015; 42:832-842. [PMID: 26250060 PMCID: PMC5054899 DOI: 10.1111/jcpe.12441] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 01/21/2023]
Abstract
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.
Collapse
Affiliation(s)
- Inga Harks
- Department of PeriodontologyUniversity Hospital MünsterMünsterGermany
| | - Raphael Koch
- Institute of Biostatistics and Clinical ResearchUniversity of MünsterMünsterGermany
| | - Peter Eickholz
- Department of PeriodontologyJohann Wolfgang Goethe‐University FrankfurtFrankfurtGermany
| | | | - Ti‐Sun Kim
- Section of PeriodontologyDepartment of Conservative DentistryUniversity Hospital HeidelbergHeidelbergGermany
| | - Thomas Kocher
- Unit of PeriodontologyUniversity Medicine GreifswaldGreifswaldGermany
| | - Joerg Meyle
- Department of PeriodontologyUniversity of GiessenGiessenGermany
| | - Doğan Kaner
- Departments of Periodontology and Synoptic DentistryCharité Centrum 3Charité‐Universitätsmedizin BerlinBerlinGermany
- Department of PeriodontologyDental SchoolFaculty of HealthUniversity of Witten/HerdeckeWittenGermany
| | | | - Stephan Doering
- Department of Psychoanalysis and PsychotherapyMedical University of ViennaViennaAustria
| | - Birte Holtfreter
- Unit of PeriodontologyUniversity Medicine GreifswaldGreifswaldGermany
| | | | - Dag Harmsen
- Department of PeriodontologyUniversity Hospital MünsterMünsterGermany
| | - Benjamin Ehmke
- Department of PeriodontologyUniversity Hospital MünsterMünsterGermany
| |
Collapse
|
25
|
Abstract
Although scaling and root planing is a cost-effective approach for initial treatment of chronic periodontitis, it fails to eliminate subgingival pathogens and halt progressive attachment loss in some patients. Adjunctive use of systemic antibiotics immediately after completion of scaling and root planing can enhance the degree of clinical attachment gain and probing depth reduction provided by nonsurgical periodontal treatment. This article discusses the rationale for prescribing adjunctive antibiotics, reviews the evidence for their effectiveness, and outlines practical issues that should be considered before prescribing antibiotics to treat chronic periodontitis.
Collapse
Affiliation(s)
- John Walters
- Division of Periodontology, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA.
| | - Pin-Chuang Lai
- Division of Periodontology, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA; Division of Biosciences, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
26
|
Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 2015; 146:525-35. [DOI: 10.1016/j.adaj.2015.01.026] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
|
27
|
Kolakovic M, Held U, Schmidlin PR, Sahrmann P. An estimate of pocket closure and avoided needs of surgery after scaling and root planing with systemic antibiotics: a systematic review. BMC Oral Health 2014; 14:159. [PMID: 25529408 PMCID: PMC4531502 DOI: 10.1186/1472-6831-14-159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/09/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown. However, means and standard deviations of enhanced reductions are difficult to translate into clinical relevant treatment outcomes such as pocket resolution or avoidance of additional surgical interventions. Accordingly, the aim of this systematic review was to calculate odds ratios for relevant cut-off values of PD after mechanical periodontal treatment with and without antibiotics, specifically the combination of amoxicilline and metronidazol, from published studies. As clinical relevant cut-off values "pocket closure" for PD ≤ 3mm and "avoidance of surgical intervention" for PD ≤ 5 mm were determined. METHODS The databases PubMed, Embase and Central were searched for randomized clinical studies assessing the beneficial effect of the combination of amoxicillin and metronidazole after non-surgical mechanical debridement. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. From published means and standard deviations for PD after therapy, odds ratios for the clinically relevant cut-off values were calculated using a specific statistical approach. RESULTS Meta-analyses were performed for the time points 3 and 6 month after mechanical therapy. Generally, a pronounced chance for pocket closure from 3 to 6 months of healing was shown. The administration of antibiotics resulted in a 3.55 and 4.43 fold higher probability of pocket closure after 3 and 6 months as compared to mechanical therapy alone. However, as the estimated risk for residual pockets > 5 mm was 0 for both groups, no odds ratio could be calculated for persistent needs for surgery. Generally, studies showed a moderate to high quality and large heterogeneity regarding treatment protocol, dose of antibiotic medication and maintenance. CONCLUSION With the performed statistical approach, a clear benefit in terms of an enhanced chance for pocket closure by co-administration of the combination of amoxicillin and metronidazole as an adjunct to non-surgical mechanical periodontal therapy has been shown. However, data calculation failed to show a benefit regarding the possible avoidance of surgical interventions.
Collapse
Affiliation(s)
- Mirela Kolakovic
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Ulrike Held
- Horten Center, University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| |
Collapse
|
28
|
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
| |
Collapse
|
29
|
Rajan P, Baramappa R, Rao NM, Pavaluri AK, P I, Rahaman SMU. Hyaluronic Acid as an adjunct to scaling and root planing in chronic periodontitis. A randomized clinical trail. J Clin Diagn Res 2014; 8:ZC11-4. [PMID: 25654021 DOI: 10.7860/jcdr/2014/8848.5237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022]
Abstract
AIM AIM of the present study was to evaluate the adjunctive effect of local application of hyaluronon gel following scaling and root planing (SRP) in chronic periodontitis patients. MATERIALS AND METHODS In this randomized split mouth study 33 subjects with chronic periodontitis were evaluated after full mouth SRP. In the test sites hyaluronon gel was applied immediately after SRP and one week post therapy, the control sites were treated with SRP alone. Bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 4 wk and 12 wk. RESULTS Significant reduction in BOP scores was observed in both the groups at 12weeks (p<0.001). The hyaluronon group showed a greater reduction in BOP (p<0.001). In the hyaluronon group the mean PPD at baseline was 6.33±0.09 which reduced to 2.49±0.51 at 12 weeks which was statistically significant (p<0.001). In the control group the mean PPD at baseline was 6.09±1.26 which reduced to 4.36±1.29 at 12 weeks which was statistically significant (p<0.001). The CAL measurements showed a significant difference between the groups (p<0.001) at 12 wk post therapy. CONCLUSION Hyaluronic Acid (HA) has a beneficial effect on periodontal health in patients with chronic Periodontitis. HA appears to be a suitable candidate as an adjunct to SRP in chronic periodontitis patients.
Collapse
Affiliation(s)
- Padma Rajan
- Professor & Head of Department, Department of Periodontics, Coorg Institute of Dental Sciences , Virajpet, Karnataka, India
| | - Radhika Baramappa
- Senior Lecturer, Department of Periodontics, Coorg Institute of Dental Sciences , Virajpet, Karnataka, India
| | - Nagashree Medanda Rao
- Professor, Department of Periodontics, St. Joseph Dental college , Eluru, Andhra Pradesh, India
| | - Arvind Kumar Pavaluri
- Reader, Department of Periodontics, St. Joseph Dental college , Eluru, Andhra Pradesh, India
| | - Indeevar P
- Senior Lecturer, Department of Periodontics, Eluru, Andhra Pradesh, India
| | - Syed Mouaz Ur Rahaman
- Post Graduate Student, Coorg Institute of Dental Sciences , Virajpet, Karnataka, India
| |
Collapse
|
30
|
Guerrero A, Nibali L, Lambertenghi R, Ready D, Suvan J, Griffiths GS, Wilson M, Tonetti MS. Impact of baseline microbiological status on clinical outcomes in generalized aggressive periodontitis patients treated with or without adjunctive amoxicillin and metronidazole: an exploratory analysis from a randomized controlled clinical trial. J Clin Periodontol 2014; 41:1080-9. [DOI: 10.1111/jcpe.12299] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Adrián Guerrero
- Graduate Periodontology; University of Granada and Private Periodontal Practice; Málaga Spain
| | - Luigi Nibali
- University College London (UCL) Eastman Dental Institute; London UK
| | | | - Derren Ready
- PHL London; Public Health England; London UK
- Department of Microbial Diseases; Eastman Dental Institute and Hospital; University College London; London UK
| | - Jean Suvan
- University College London (UCL) Eastman Dental Institute; London UK
| | - Gareth S. Griffiths
- Academic Unit of Restorative Dentistry; University of Sheffield; Sheffield UK
| | - Michael Wilson
- Department of Microbial Diseases; Eastman Dental Institute and Hospital; University College London; London UK
| | | |
Collapse
|
31
|
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).
Collapse
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
| | | | | | | | | |
Collapse
|
32
|
Martande SS, Pradeep AR, Singh SP, Kumari M, Naik SB, Suke DK, Singh P. Clinical and microbiological effects of systemic azithromycin in adjunct to nonsurgical periodontal therapy in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis: a randomized placebo-controlled clinical trial. ACTA ACUST UNITED AC 2014; 7:72-80. [PMID: 25044531 DOI: 10.1111/jicd.12115] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate clinical and microbiological effects of systemic azithromycin (AZM) in adjunct to nonsurgical periodontal therapy (NSPT; or scaling root planing - SRP) in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis (AAAP). METHODS AND MATERIALS Seventy individuals with moderate to severe periodontitis and subgingival detection of A. actinomycetemcomitans were randomly allocated to two groups. Thirty-five individuals were allocated to full mouth SRP+AZM (500 mg oral delivery (OD) × 3 days) while 35 individuals were allocated to SRP+Placebo (OD × 3 days) group. The clinical variables evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and percent bleeding on probing sites (%BOP), while microbiologic variables included percentage of subjects positive for A. actinomycetemcomitans at baseline, 3, 6, and 12 months. RESULTS The AZM group showed statistically significant reduction in mean PD (2.91 ± 0.88 mm) as compared to placebo (1.51 ± 0.98 mm) (P < 0.001), while CAL gain was significant in the AZM group (2.71 ± 1.15 mm) as compared to the placebo group (1.71 ± 1.29 mm) (P < 0.001). There was also a statistically significant reduction in the number of subjects positive for A. actinomycetemcomitans in the AZM group (P < 0.0001). CONCLUSION Azithromycin was found to significantly improve the clinical and microbiological parameters in AAAP individuals.
Collapse
Affiliation(s)
- Santosh S Martande
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
| | - Avani R Pradeep
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
| | - Sonender P Singh
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
| | - Minal Kumari
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
| | - Savitha B Naik
- Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bangalore, India
| | - Deepak Kumar Suke
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, India
| | - Priyanka Singh
- Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India
| |
Collapse
|
33
|
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.
Collapse
|
34
|
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]
|
35
|
Abstract
Periodontal diseases (gingivitis and periodontitis) are chronic bacterial infections with a remarkably high prevalence and morbidity. Periodontitis, in contrast to gingivitis, is not reversible, is associated with certain bacterial species and affects all of the soft tissue and bone that support teeth. Among the periodontal pathogens, species, such as Aggregatibacter (Actinobacillus) actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and several forms of uncultivable spirochetes play the major role in the pathogenesis. In severe chronic, recurrent and especially aggressive forms of periodontitis, diagnosis of the species involved and, whenever possible, an optimized evidence-based antimicrobial treatment is indicated. In order to monitor alarming bacterial changes in the periodontal pocket, several techniques, namely microscopy, culture, immunoassays, enzyme tests and DNA-based techniques, have been established and the methods are described in the first part of this review. In the second part, the selection and use of locally delivered (topical) and systemic antibiotics used adjunctively in periodontal therapy are discussed.
Collapse
Affiliation(s)
- Hans-Peter Horz
- Division of Oral Microbiology and Immunology, Department of Operative and Preventive Dentistry and Periodontology, University Hospital RWTH Aachen, Aachen, Germany.
| | | |
Collapse
|
36
|
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]
|
37
|
Patil V, Mali R, Mali A. Systemic anti-microbial agents used in periodontal therapy. J Indian Soc Periodontol 2013; 17:162-8. [PMID: 23869120 PMCID: PMC3713745 DOI: 10.4103/0972-124x.113063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 09/12/2012] [Indexed: 11/11/2022] Open
Abstract
Periodontitis is an infectious disease with marked inflammatory response, leading to destruction of underlying tissues. The aim of periodontal therapy is to eradicate the pathogens associated with the disease and attain periodontal health. This is achieved by non-surgical and surgical therapy; however, mechanical debridement and topical application of antiseptics may not be helpful in all cases. In such cases, adjunctive systemic antibiotic therapy remains the treatment of choice. It can reach micro-organisms at the base of the deep periodontal pockets and furcation areas via serum, and also affect organisms residing within gingival epithelium and connective tissue. Before advising any anti-microbial agent, it is necessary to have knowledge of that agent. The aim of this review article is to provide basic details of each systemic anti-microbial agent used in periodontal therapy. The points discussed are its mode of action, susceptible periodontal pathogens, dosage, its use in treatment of periodontal disease, and mechanism of bacterial resistance to each anti-microbial agent. It might be of some help while prescribing these drugs.
Collapse
Affiliation(s)
- Vishakha Patil
- Department of Periodontology. Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India
| | - Rohini Mali
- Department of Periodontology. Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India
| | - Amita Mali
- Department of Periodontology. Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India
| |
Collapse
|
38
|
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.
Collapse
Affiliation(s)
- Dina Zandbergen
- Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
39
|
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.
Collapse
Affiliation(s)
- Fabrizio Sgolastra
- Department of Health Sciences, School of Dentistry, University of L'Aquila, San Salvatore 1, L'Aquila, Italy.
| | | | | | | |
Collapse
|
40
|
Fernandes LA, Martins TM, Almeida JMD, Nagata MJH, Theodoro LH, Garcia VG, Bosco AF. Experimental periodontal disease treatment by subgingival irrigation with tetracycline hydrochloride in rats. J Appl Oral Sci 2011; 18:635-40. [PMID: 21308297 PMCID: PMC3881757 DOI: 10.1590/s1678-77572010000600017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 05/21/2010] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to compare subgingival irrigation with tetracycline
hydrochloride (TTC-HCL) as adjunctive treatment to scaling and root planning (SRP)
on induced periodontitis in rats. Material and methods In 60 rats, periodontal disease was ligature-induced at the mandibular left first
molar. After 7 days, the ligature was removed and all animals were submitted to
SRP, and divided into 2 groups according to the following treatment: C (n=30) -
subgingival irrigation with 1 mL of saline; T (n=30) - subgingival irrigation with
1 mL of TTC-HCL (50 mg/mL). Ten animals in each group were euthanized at 7, 15 and
30 days posttreatment. The histometric values were statistically analyzed
(p<0.05). Results In the histometric analysis, at 7, 15 and 30 days, Group T (0.72±0.05
mm2, 0.57±0.14 mm2, 0.62±0.07 mm2), showed
less bone loss (p<0.05) than Group C (1.35±0.25 mm2; 1.40±0.31
mm2; 1.29±0.27 mm2), respectively. Conclusions Subgingival irrigation with TTC-HCL was an effective adjunctive treatment for
periodontal disease induced in rats.
Collapse
Affiliation(s)
- Leandro Araújo Fernandes
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, São Paulo State Universit, Araçatuba, SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
41
|
Fernandez y Mostajo M, Zaura E, Crielaard W, Beertsen W. Does routine analysis of subgingival microbiota in periodontitis contribute to patient benefit? Eur J Oral Sci 2011; 119:259-64. [PMID: 21726285 DOI: 10.1111/j.1600-0722.2011.00828.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In clinical periodontology it is common practice to sample subgingival plaque from periodontitis patients and to search for the presence of alleged periodontal pathogens using routine laboratory techniques such as culture, DNA-DNA hybridization or real-time PCR. Usually, special attention is given to the recognition of 'red complex' microorganisms and to Aggregatibacter actinomycetemcomitans. Recently, molecular open-ended techniques have been introduced which are distinct from the more 'classical' approaches in that they do not preselect for certain species. In this study, we investigated to what extent the outcome of these techniques has changed our insight into the composition of the subgingival microbiota and whether this has consequences on clinical decision making. The open-ended approaches showed that the composition of subgingival plaque is much more complex than previously thought. Next to the 'classical' putative periodontal pathogens, several non-culturable and fastidious species are now recognized as being associated with periodontitis, thus enlarging the group of suspected periodontal pathogens. We conclude that routine analyses of subgingival plaque in the clinic are not necessarily of benefit to the patient.
Collapse
|
42
|
Novaes AB, Schwartz-Filho HO, de Oliveira RR, Feres M, Sato S, Figueiredo LC. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile. Lasers Med Sci 2011; 27:389-95. [PMID: 21399951 DOI: 10.1007/s10103-011-0901-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/15/2011] [Indexed: 11/30/2022]
Abstract
The aim of this trial was to investigate changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis, treated with antimicrobial photodynamic therapy (aPDT), in a single episode, or scaling and root planing (SRP), in a split-mouth design on -7, 0, and +90 days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer or SRP with hand instruments. Subgingival plaque samples were collected and the counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. The data were analyzed using the method of generalized estimating equations (GEE) to test the associations between treatments, evaluated parameters, and experimental times (α = .05). The results indicated that aPDT and SRP affects different bacterial species, with aPDT being effective in reducing numbers of A. actinomycetemcomitans than SRP. On the other hand, SRP was more efficient than aPDT in reducing the presence of periodontal pathogens of the Red Complex. Additionally, a recolonization in the sites treated by aPDT was observed, especially for T. forsythia and P. gingivalis. Under our experimental conditions, this trial demonstrates that aPDT and SRP affected different groups of bacteria, suggesting that their association may be beneficial for the non-surgical treatment of aggressive periodontitis.
Collapse
Affiliation(s)
- Arthur B Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
43
|
Heller D, Varela VM, Silva-Senem MXE, Torres MCB, Feres-Filho EJ, Colombo APV. Impact of systemic antimicrobials combined with anti-infective mechanical debridement on the microbiota of generalized aggressive periodontitis: a 6-month RCT. J Clin Periodontol 2011; 38:355-64. [DOI: 10.1111/j.1600-051x.2011.01707.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Mombelli A, Cionca N, Almaghlouth A. Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery? Periodontol 2000 2010; 55:205-16. [DOI: 10.1111/j.1600-0757.2010.00356.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
45
|
Heasman PA, Vernazza CR, Gaunt FL, Pennington MW. Cost-effectiveness of adjunctive antimicrobials in the treatment of periodontitis. Periodontol 2000 2010; 55:217-30. [DOI: 10.1111/j.1600-0757.2010.00341.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Griffiths GS, Ayob R, Guerrero A, Nibali L, Suvan J, Moles DR, Tonetti MS. Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re-treatment: a randomized controlled clinical trial. J Clin Periodontol 2010; 38:43-9. [DOI: 10.1111/j.1600-051x.2010.01632.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
47
|
Oteo A, Herrera D, Figuero E, O'Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis-associated periodontitis: a pilot study. J Clin Periodontol 2010; 37:1005-15. [DOI: 10.1111/j.1600-051x.2010.01607.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
48
|
Cionca N, Giannopoulou C, Ugolotti G, Mombelli A. Microbiologic Testing and Outcomes of Full-Mouth Scaling and Root Planing With or Without Amoxicillin/Metronidazole in Chronic Periodontitis. J Periodontol 2010; 81:15-23. [DOI: 10.1902/jop.2009.090390] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
49
|
|
50
|
Microbial changes in periodontitis successfully treated by mechanical plaque removal and systemic amoxicillin and metronidazole. Int J Med Microbiol 2009; 299:427-38. [DOI: 10.1016/j.ijmm.2009.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/01/2009] [Indexed: 11/24/2022] Open
|