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Atieh MA, Shah M, Hakam A, Alghafri M, Tawse-Smith A, Alsabeeha N. Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis. Aust Dent J 2024; 69:4-17. [PMID: 37875345 DOI: 10.1111/adj.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use of AZT or AMX/MTZ for the treatment of periodontitis from current published literature. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), outcomes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analysed using a statistical software program. RESULTS Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1-3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI -0.20 to 0.22; P = 0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of ≥5 mm at 1-3 months compared to the adjunctive use of AMX/MTZ (MD -3.41; 95% CI -4.73 to -2.10; P < 0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72; P = 0.43). CONCLUSIONS Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1-3 months. AZT seem to be associated with less sites with residual probing pocket depths of ≥5 mm at 1-3 months and fewer adverse events compared with AMX/MTZ. © 2023 Australian Dental Association.
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Affiliation(s)
- M A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - M Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - M Alghafri
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nhm Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
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2
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Feres M. Anne Haffajee: An inspirational role model. Oral Dis 2023; 29 Suppl 1:907-911. [PMID: 36630194 DOI: 10.1111/odi.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
This article honors Dr. Anne Haffajee's career, her highest research standards, scholarly integrity, and inspirational mentorship. Anne-as she liked to be called-was one of the most productive clinical scientists of her time. Gifted with the unique combination of knowledge in the fields of clinical research, oral ecology, data analysis, and computer programing, her work triggered unprecedented advances in the diagnosis, progression, and treatment of periodontitis. Anne's pivotal clinical trials elucidated the effects of non-surgical and surgical periodontal therapies. In addition to her scholarly achievements, Anne played an important role in mentoring young scientists, many of whom have developed independent leadership careers in periodontal research. She always found time to help her mentees, and ultimately became a warm-hearted friend to many of them, including myself. Anne was consistently devoted to contributing to the future of clinical investigation, and more specifically concerned about the lack of interest by (1) funding agencies in supporting such studies and by (2) the new generation of investigators in pursuing a career in the area. She passed away prematurely, in 2013, at the age of 65. Undoubtedly, her work and legacy assured the continuity of high-standard clinical studies in periodontics and the survival of a whole generation of clinical researchers.
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Affiliation(s)
- Magda Feres
- Department of Periodontology, Guarulhos University (Brazil), São Paulo, Guarulhos, Brazil.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine (USA), Boston, Massachusetts, USA.,Forsyth Institute (USA), Cambridge, Massachusetts, USA
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3
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Matsubara VH, Fakhruddin KS, Ngo H, Samaranayake LP. Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review. Int Dent J 2022; 73:11-20. [PMID: 36535806 PMCID: PMC9875235 DOI: 10.1016/j.identj.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-β and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.
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Affiliation(s)
- Victor Haruo Matsubara
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia,Corresponding author. Dental School, University of Western Australia, 17 Monash Avenue, Nedlands, Perth, WA 6009, Australia.
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Hien Ngo
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman P. Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Special Administrative Region, China
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4
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Slots J. Concise evaluation and therapeutic guidelines for severe periodontitis: A public health perspective. Periodontol 2000 2022; 90:262-265. [PMID: 35913496 PMCID: PMC9804657 DOI: 10.1111/prd.12463] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The main goal of periodontology is to prevent and arrest gingivitis and periodontitis to avoid tooth loss and focal infection of periodontal origin. Periodontal scaling or flap surgery of moderate-to-severe periodontitis have shortcomings, most likely because removal of herpesviruses and bacterial pathogens in deep periodontal lesions and the adjacent inflamed gingiva requires systemic antimicrobial treatment (or gingivectomy). Valacyclovir (1000 mg twice daily on day 1, and 500 mg twice daily on day 2 and on day 3) is a potent anti-herpesvirus agent. Antibiotic combinations against bacterial pathogens include amoxicillin-metronidazole (250 mg of each, thrice daily for 4 days; for systemically healthy adults) and ciprofloxacin-metronidazole (500 mg of each, twice daily for 4 days; for immunosuppressed individuals and patients exposed to contaminated water and poor sanitation). Supportive antiseptic treatment may consist of 0.1%-0.2% sodium hypochlorite (regular household bleach) as cooling spray in ultrasonic scalers, flosser fluid in oral irrigators, and mouthrinse in patient self-care. The anti-infective treatment described here helps control cases of severe periodontitis and constitutes an exceedingly inexpensive alternative to conventional (mechanical) periodontal therapy.
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Affiliation(s)
- Jørgen Slots
- Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Zeng J, Wang Y, Yuan Q, Luan Q. The effect of (-)-epigallocatechin gallate as an adjunct to non-surgical periodontal treatment: a randomized clinical trial. Trials 2022; 23:368. [PMID: 35505441 PMCID: PMC9066833 DOI: 10.1186/s13063-022-06298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 08/29/2023] Open
Abstract
Background EGCG is proven to be of good effect to relieve periodontal inflammation, but it has not been applied as a local delivery medicine in patients with periodontitis widely. The aim of this clinical trial was to evaluate the adjunctive effect of (-)-epigallocatechin gallate (EGCG) aqueous solution as a coolant during scaling and root planing in the management of chronic periodontitis. Methods A double-blind, randomized controlled study was performed on 15 patients with moderate to severe chronic periodontitis. The bilateral maxillary teeth were randomly divided into the test side and the control side on every individual. On the control side, the periodontal therapy was routinely performed. And on the test side, in the process of periodontal therapy, the distilled water in the ultrasonic scaler was replaced with a 5-mg/mL EGCG solution. The probing depth (PPD), clinical attachment level (CAL), bleeding index (BI), gingival index (GI), and plaque index (PI) were recorded at baseline and 6 and 12 weeks after the treatment. Results PPD, CAL, BI, GI, and PI generally improved after treatment in both groups. At the sixth week and the twelfth week of review, PPD, CAL, GI, and PI had no statistical difference (p >0.05) between the two groups. At the review of the twelfth week, BI on the test side decreased significantly (p <0.05). Conclusions Using EGCG solution as the irrigant instead of water has an additional benefit on the bleeding index at the 12-week review. However, the rest clinical parameters had no additional benefit. Trial registration ClinicalTrials.gov ChiCTR2000029831, date of registration: Feb 15, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06298-6.
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Affiliation(s)
- Jiajun Zeng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Yanfeng Wang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Qiao Yuan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Qingxian Luan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
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Kang Y, Sun B, Chen Y, Lou Y, Zheng M, Li Z. Dental Plaque Microbial Resistomes of Periodontal Health and Disease and Their Changes after Scaling and Root Planing Therapy. mSphere 2021; 6:e0016221. [PMID: 34287005 PMCID: PMC8386447 DOI: 10.1128/msphere.00162-21] [Citation(s) in RCA: 8] [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: 02/21/2021] [Accepted: 05/23/2021] [Indexed: 11/20/2022] Open
Abstract
The human oral microbial community has been considered a reservoir of antibiotic resistance. Currently, the effects of periodontitis and the scaling and root planing (SRP) treatment on the performance of antibiotic-resistant genes (ARGs) and metal-resistant genes (MRGs) in the dental plaque microbiota are not well characterized. To explore this issue, we selected 48 healthy-state (HS), 40 periodontitis-state (PS; before treatment), and 24 resolved-state (RS; after SRP treatment) metagenomic data of dental plaque samples from the Sequence Read Archive (SRA) database. NetShift analysis identified Fretibacterium fastidiosum, Tannerella forsythia, and Campylobacter rectus as key drivers during dental plaque microbiota alteration in the progression of periodontitis. Periodontitis and SRP treatment resulted in an increase in the number of ARGs and MRGs in dental plaque and significantly altered the composition of ARG and MRG profiles. Bacitracin, beta-lactam, macrolide-lincosamide-streptogramin (MLS), tetracycline, and multidrug resistance genes were the main classes of ARGs with high relative abundance, whereas multimetal, iron, chromium, and copper resistance genes were the primary types of MRGs in dental plaque microbiota. The cooccurrence of ARGs, MRGs, and mobile genetic elements (MGEs) indicated that a coselection phenomenon exists in the resistomes of dental plaque microbiota. Overall, our data provide new insights into the standing of the distribution of ARGs and MRGs in oral microbiota of periodontitis patients, and it was possible to contribute to the understanding of the complicated correlations among microorganisms, resistomes, and MGEs. IMPORTANCE The emergence and development of resistance to antibiotics in periodontal pathogens have affected the success rate of treatment for periodontitis. The development of new antibacterial strategies is urgently needed to help control and treat periodontal disease, and dental plaque microbiome studies offer a promising new angle of attack. In this study, we investigated the dental plaque microbiota and resistomes in periodontal health and disease states and their changes after SRP therapy. This is the first analysis of the profile of the microbial community and antibiotic and metal resistance genes in dental plaque by the metagenomic approach, to the best of our knowledge. Monitoring the profile of these resistomes has huge potential to provide reference levels for proper antibiotics use and the development of new antimicrobial strategies in periodontitis therapy and thereby improve actual efficacy of the treatment regimens.
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Affiliation(s)
- Yutong Kang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bianjin Sun
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yiju Chen
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongliang Lou
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiqin Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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7
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Povšič K, Čuk K, Milavec S, Erčulj V, Seme K, Gašperšič R. Systemic azithromycin as an adjunct to scaling and root planing in patients with stage III/IV periodontitis: 12-month results of a randomized controlled clinical trial. Clin Oral Investig 2021; 25:5997-6006. [PMID: 33786649 DOI: 10.1007/s00784-021-03906-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/23/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine whether azithromycin (AZI) as an adjunct to scaling and root planing (SRP), when compared to placebo, decreases the number of sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 12 months post-treatment in stage III/IV periodontitis patients. MATERIALS AND METHODS In a double-blind randomized parallel-arm placebo-controlled trial, 40 stage III/IV periodontitis patients received steps 1 and 2 of periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20; AZI 500 mg/day, 3 days) or placebo (n = 20). Additional instrumentation of residual diseased sites (DS) - sites with PD ≥ 5 mm and BOP - was performed at the 3-, 6- and 9-month follow-ups. The primary outcome variable was the number of DS at the 12-month re-evaluation. Using a multivariate multilevel logistic regression model, the effects of gender, age, antibiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS The number of DS after 12 months was similar in the test (median (Me) = 4, interquartile range (IQR) = 0-6) and control (Me = 3, IQR = 1-6.5) groups. Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroup differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio (OR) for the healing of DS on molars (OR = 0.29; p < 0.001) and in smokers (OR = 0.36; p = 0.048). CONCLUSION Stage III/IV periodontitis patients showed significant but comparable improvements in periodontal parameters and the number of residual DS at the 12-month revaluation regardless of treatment type. This may have been the result of the additional instrumentation received by patients at residual DS in both treatment groups. CLINICAL RELEVANCE Treatment with AZI + SRP provided no additional benefits after 12 months in terms of periodontal parameters or the number of persisting sites with PD ≥ 5 mm + BOP as compared to SRP plus placebo. TRIAL REGISTRATION EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.
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Affiliation(s)
- Katja Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
| | - Katarina Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | | | - Vanja Erčulj
- Rho Sigma Research & Statistics, 1000, Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
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8
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Anggani HS, Perdana RG, Siregar E, Bachtiar EW. The effect of coating chitosan on Porphyromonas gingivalis biofilm formation in the surface of orthodontic mini-implant. J Adv Pharm Technol Res 2021; 12:84-88. [PMID: 33532361 PMCID: PMC7832189 DOI: 10.4103/japtr.japtr_95_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 10/03/2020] [Indexed: 12/31/2022] Open
Abstract
Infection is the main problem for the failure of orthodontic mini-implant. Modern prevention of infection is now focused on local antibacterial coatings on implant devices. Chitosan is biocompatible and has antibacterial properties. Azithromycin is a synthetic antibiotic with immunomodulatory properties in which it has an advantage over the rest of antibiotics. This study aimed to evaluate the effect coating chitosan on the orthodontic mini-implant in Porphyromonas gingivalis biofilm formation. This is an experimental study using 25 orthodontic mini-implants. Five samples were coated with chitosan, 5 samples were coated with chitosan-azithromycin, 5 samples were coated with azithromycin, 5 samples were uncoated, and 5 samples were uncoated and were not exposed to P. gingivalis. P. gingivalis biofilms on the surface of the orthodontic mini-implant were observed after 24 h of incubation. P. gingivalis biofilm mass inhibition was highest in the azithromycin-treated group, followed by chitosan + azithromycin and chitosan only. The one-way ANOVA statistic test and post hoc Bonferroni statistic test of P. gingivalis biofilm mass show a significant difference between and within groups of experiments (P < 0.05). The Pearson correlation test with a value of R = +0.88, indicated that the bacterial viability count and the biofilm mass have a strong positive correlation. In conclusion, orthodontic mini-implant coated with chitosan, chitosan with azithromycin, or azithromycin only effectively suppressed P. gingivalis biofilm formation.
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Affiliation(s)
- Haru Setyo Anggani
- Department of Orthodontic, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Renaldo Guruh Perdana
- Department of Orthodontic, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Erwin Siregar
- Department of Orthodontic, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Endang Winiati Bachtiar
- Department of Oral Biology, Oral Science Research Center, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
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9
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Sgolastra F, Petrucci A, Ciarrocchi I, Masci C, Spadaro A. Adjunctive systemic antimicrobials in the treatment of chronic periodontitis: A systematic review and network meta-analysis. J Periodontal Res 2020; 56:236-248. [PMID: 33314159 DOI: 10.1111/jre.12821] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/31/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022]
Abstract
The aim of this systematic review and network meta-analysis was to assess the efficacy of antimicrobials adjunctive to scaling and root planing (SRP) in the treatment of chronic periodontitis. The study was conducted according to the PRISMA statement. The protocol (CRD42020178621) was registered on the International Prospective Register of Systematic Reviews (PROSPERO). The MEDLINE, EMBASE, and CENTRAL databases were searched up to March 2020; furthermore, a manual search of relevant periodontal journals was conducted. Mean differences (MD) and standard deviations were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction at 6 and 12 months. A network meta-analysis was performed to assess direct and indirect comparisons and to establish a ranking of treatments. A total of 21 randomized clinical trials (RCTs) were included in the systematic review. Network meta-analysis showed that SRP + amoxicillin (AMX) + metronidazole (MTZ), as compared to SRP, reached the highest PD reduction at 6 [MD = 0.47; 95% CI (0.3; 0.64)] and 12 months [MD = 0.51; 95% CI (0.25; 0.78)], and CAL gain at 6 [MD = 0.54; 95% CI (0.27; 0.8)] and 12 months [MD = 0.37; 95% CI (0.05; 0.69)]. Network meta-analysis indicated that AMX + MTZ adjunctive to SRP provided the best improvement in clinical parameters, followed by SRP + MTZ.
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10
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Jentsch HFR, Dietrich M, Eick S. Non-Surgical Periodontal Therapy with Adjunctive Amoxicillin/Metronidazole or Metronidazole When No Aggregatibacter actinomycetemcomitans Is Detected—A Randomized Clinical Trial. Antibiotics (Basel) 2020; 9:antibiotics9100686. [PMID: 33050325 PMCID: PMC7601813 DOI: 10.3390/antibiotics9100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The aim was to compare two different systemic antibiotics regimens adjunctive to non-surgical periodontal therapy when Aggregatibacter actinomycetemcomitans was not detected in the subgingival biofilm. Methods: A total of 58 patients with periodontitis and with no A. actinomycetemcomitans in the subgingival biofilm were treated with full-mouth subgingival instrumentation and either metronidazole (MET; n = 29) or amoxicillin/metronidazole (AMX/MET; n = 29). Probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were recorded at baseline, as well as after three and six months. Subgingival biofilm and gingival crevicular fluid were collected and analyzed for major periodontopathogens and biomarkers. Results: PD, CAL and BOP improved at 3 and 6 months (each p < 0.001 vs. baseline) with no difference between the groups. Sites with initial PD ≥ 6 mm also improved in both groups after 3 and 6 months (p < 0.001) with a higher reduction of PD in the AMX/MET group (p < 0.05). T. forsythia was lower in the AMX/MET group after 3 months (p < 0.05). MMP-8 and IL-1β were without significant changes and differences between the groups. Conclusion: When A. actinomycetemcomitans was not detected in the subgingival biofilm, the adjunctive systemic use of amoxicillin/metronidazole results in better clinical and microbiological outcomes of non-surgical periodontal therapy when the application of systemic antibiotics is scheduled.
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Affiliation(s)
- Holger F. R. Jentsch
- Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Liebigstr. 12, Haus 1, D-04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-9721208; Fax: +49-341-9721259
| | - Martin Dietrich
- Private Dental Practice, Borngasse 12, D-99084 Erfurt, Germany;
| | - Sigrun Eick
- Department of Periodontology, Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Freiburgstr. 7, CH-3010 Bern, Switzerland;
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11
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Čuk K, Povšič K, Milavec S, Seme K, Gašperšič R. Influence of adjunctive azithromycin on microbiological and clinical outcomes in periodontitis patients: 6-month results of randomized controlled clinical trial. BMC Oral Health 2020; 20:241. [PMID: 32873290 PMCID: PMC7465355 DOI: 10.1186/s12903-020-01209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment. METHODS In a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS The number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0-11) and control (Me = 5, IQR = 1-22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p < 0,001). CONCLUSION Despite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP. TRIAL REGISTRATION EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.
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Affiliation(s)
- Katarina Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - Katja Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | | | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
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12
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Slots J. Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective. Periodontol 2000 2020; 83:272-276. [PMID: 32385884 DOI: 10.1111/prd.12325] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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13
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Olivieri CV, Raybaud H, Tonoyan L, Abid S, Marsault R, Chevalier M, Doglio A, Vincent-Bugnas S. Epstein-Barr virus-infected plasma cells in periodontitis lesions. Microb Pathog 2020; 143:104128. [PMID: 32165332 DOI: 10.1016/j.micpath.2020.104128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
Growing evidence supports that the Epstein-Barr virus (EBV) is a putative periodontal pathogen, but little is known regarding EBV behavior in periodontitis. Here, EBV infection was monitored in saliva and periodontal pocket (PP), at baseline and 3 months after periodontal non-surgical therapy (p-NST) in 20 patients diagnosed with periodontitis. After the treatment, the patients with the improved periodontal condition (good responders) showed a significant decrease in salivary EBV load. In contrast, in poor responders, EBV load was slightly increased. Moreover, after the therapy, most patients showed clear signs of EBV infection in a deep PP (≥5 mm) selected as a study site. To investigate how EBV can persist in a PP, we further investigate cellular sites of viral replication in PP. We identified large amounts of infiltrated EBV-infected cells, mostly overlapping with CD138+ plasma cells (PC). EBV-infected PCs formed high-density clusters within the infiltrate and along the periodontal epithelium which were commonly associated with CD3+ T-cells and CD20+ B-cells to evoke diffuse ectopic lymphoid-like structures. Taking together, this study provides new insights to support a model where the periodontal condition may play a major role in oral EBV shedding. Since PC harbors the late productive phases of EBV replication, the periodontal condition may favor B-cell differentiation with possible amplification of periodontal EBV infection and viral spreading. PCs have long been recognized as pathogenic markers in inflammatory lesions. Our finding sheds new light on the role of EBV infection and PC in periodontitis.
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Affiliation(s)
- Charles V Olivieri
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France
| | - Hélène Raybaud
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France; Pôle Odontologie, Centre Hospitalier Universitaire de Nice, 06000, Nice, France
| | - Lilit Tonoyan
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France
| | - Sarah Abid
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France
| | - Robert Marsault
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France
| | - Marlène Chevalier
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France
| | - Alain Doglio
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France; Unité de Thérapie Cellulaire et Génique (UTCG), Centre Hospitalier Universitaire de Nice, 06101, Nice, France.
| | - Séverine Vincent-Bugnas
- MICORALIS, Faculté de Chirurgie Dentaire, Université Côte D'Azur, 5 Rue Du 22ième BCA, 06353, Nice, France; Pôle Odontologie, Centre Hospitalier Universitaire de Nice, 06000, Nice, France.
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Rams TE, Sautter JD, van Winkelhoff AJ. Comparative In Vitro Resistance of Human Periodontal Bacterial Pathogens to Tinidazole and Four Other Antibiotics. Antibiotics (Basel) 2020; 9:antibiotics9020068. [PMID: 32046045 PMCID: PMC7168304 DOI: 10.3390/antibiotics9020068] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
The in vitro resistance of selected red/orange complex periodontal pathogens to tinidazole was compared with four other antibiotics. Subgingival biofilm samples from 88 adults with severe periodontitis were anaerobically incubated on enriched Brucella blood agar with and without supplementation with tinidazole (16 mg/L), metronidazole (16 mg/L), amoxicillin (8 mg/L), doxycycline (4 mg/L), or clindamycin (4 mg/L). Growth of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Fusobacterium nucleatum, Streptococcus constellatus, or Campylobacter rectus on antibiotic-supplemented plates indicated their in vitro antibiotic resistance. Tinidazole inhibited all test species, except P. intermedia/nigrescens, P. micra, and S. constellatus in 3.8%, 10.2%, and 88.9% of species-positive patients, respectively. Significantly fewer patients yielded tinidazole-resistant test species, and had significantly lower subgingival proportions of tinidazole-resistant organisms, than patients with amoxicillin, doxycycline, or clindamycin-resistant species, but not those with metronidazole-resistant strains. Joint in vitro species resistance to tinidazole and amoxicillin, or metronidazole and amoxicillin, was rare. Tinidazole performed in vitro similar to metronidazole, and markedly better than amoxicillin, doxycycline, or clindamycin, against fresh clinical isolates of red/orange complex periodontal pathogens. As a result of its similar antimicrobial spectrum, and more convenient once-a-day oral dosing, tinidazole should be considered in place of metronidazole for systemic periodontitis drug therapy.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA 19140, USA
- Correspondence:
| | - Jacqueline D. Sautter
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA
| | - Arie J. van Winkelhoff
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Department of Periodontology, University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, 9713 GZ Groningen, The Netherlands
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15
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Abstract
Four billion individuals worldwide have a history of periodontitis, with the poorest people in society most affected. Periodontitis can lead to unsightly drifting of teeth and tooth loss that may interfere with the wellbeing of daily living and has also been linked to at least 57 medical diseases and disabilities. The etiology of severe periodontitis includes active herpesviruses, specific bacterial pathogens, and destructive immune responses, but herpesviruses seem to be the major pathogenic determinant. Periodontal herpesviruses that disseminate via the systemic circulation to nonoral sites may represent a major link between periodontitis and systemic diseases. Current treatment of periodontitis focuses almost exclusively on bacterial biofilm and will require revision. Periodontal therapy that targets both herpesviruses and bacterial pathogens can provide long-term clinical improvement and potentially reduces the risk of systemic diseases. Molecular diagnostic tests for periodontal pathogens may enable early microbial identification and preemptive therapy. This review details an efficient and reliable anti-infective treatment of severe periodontitis that can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- School of Dentistry, University of Southern California, Los Angeles, California
| | - Henrik Slots
- University of Nevada at Reno School of Medicine, Reno, Nevada.,St. George's School of Medicine, St. George, Grenada.,Renown Medical Center, Reno, Nevada
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16
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Jagannathan N, Acharya A, Yi Farn O, Li KY, Nibali L, Pelekos G. Disease severity, debridement approach and timing of drug modify outcomes of adjunctive azithromycin in non-surgical management of chronic periodontitis: a multivariate meta-analysis. BMC Oral Health 2019; 19:65. [PMID: 31029129 PMCID: PMC6486979 DOI: 10.1186/s12903-019-0754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background Past meta-analyses have shown adjunctive systemic Azithromycin (AZI) to provide minor clinical benefits in scaling and root surface debridement (S/RSD). However, these have not considered the covariance of key outcome parameters; probing pocket depth (PPD) and Clinical Attachment Level (CAL) or systematically examined some potential sources of heterogeneity. Aim To jointly synthesize 6-month outcomes of systemic AZI as adjunctive to S/RSD in chronic periodontitis and investigate 3 potential sources of heterogeneity. Methods Four databases were searched for suitable randomized controlled clinical trials (RCTs). Standardized mean differences (SMD) in PPD and CAL between AZI + S/RSD and S/RSD alone, at 6-month follow-up were computed. Within-study covariances of PPD and CAL were derived from reported multiple time-point data. A multivariate meta-analysis with random effects jointly modelled PPD and CAL, factoring in their covariance. This model included 3 moderators with interaction effects; timing of AZI initiation (pre-therapy/post-therapy), type of S/RSD [full-mouth debridement (FMD)/partial-mouth debridement (PMD)], and baseline study-level mean values of PPD/CAL. Results Among 276 abstracts, 11 observations from 9 RCTs qualified for meta-analysis. Within-study correlation-coefficients of PPD with CAL significantly increased with increasing study-level baseline mean values (Spearman’s r = 0.79, p < 0.01). The full multivariate meta-analysis model showed significant effects for the 3 moderators (Q statistic = 150.03, p < 0.01), retained significant residual heterogeneity (Q statistic = 88.50, p < 0.01) but outperformed (Likelihood- ratio statistic = 102.95, p < 0.01,) a null-model with no moderators (Q statistic = 201.5, p < 0.01). A significant effect was seen only on the SMD for PPD (estimate = 1.16 mm, 95% CI: 0.27 mm–2.07 mm mm, p = 0.01) but not CAL (estimate = 0.17 mm, 95% CI: -0.92 mm-1.26 mm, p = 0.76). SMD in PPD positively interacted with study baseline value (estimate = 0.11, 95% CI: 0.08–0.15, p < 0.01). Significant negative interactions of SMD in PPD with PMD (estimate = − 1.25 mm, 95% CI: -1.73 mm- -0.78 mm, p < 0.01) and pre-therapy drug initiation (estimate = − 1.18 mm, 95% CI: -1.48 mm--0.87 mm, p < 0.01) were evident. Conclusion Joint synthesis of PPD and CAL showed, at 6-months, AZI + S/RSD provided a benefit over S/RSD alone for PPD alone when correlation with CAL was accounted for. Deeper study-level baseline PPD, FMD type of S/RSD, and post-therapy drug initiation associated with greater PPD reduction. Electronic supplementary material The online version of this article (10.1186/s12903-019-0754-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nithya Jagannathan
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Aneesha Acharya
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong.,Dr D Y Patil Dental College and Hospital, Pimpri, Pune, India
| | - Ong Yi Farn
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Kar Yan Li
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong
| | - Luigi Nibali
- Centre for Oral Immunobiology & Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, England
| | - George Pelekos
- Periodontology, Faculty of Dentistry, The University of Hong Kong, 3F, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Yin Pun, Hong Kong.
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17
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Liaw A, Miller C, Nimmo A. Comparing the periodontal tissue response to non-surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate-to-severe periodontitis: a preliminary randomized controlled trial. Aust Dent J 2019; 64:145-152. [PMID: 30628088 DOI: 10.1111/adj.12674] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The usefulness of administrating adjunctive systemic antibiotics to expedite healing of periodontal tissues is a topic of interest given the lack of clear guidelines. AIM To compare clinical outcomes in patients given adjunctive azithromycin (AZ), adjunctive amoxicillin plus metronidazole (AMX + MTZ), or scaling and root planing (SRP) alone in the treatment of moderate-to-severe chronic periodontitis. METHODS Thirty-eight patients were randomly assigned into: SRP alone; 500 mg AMX plus 400 mg MTZ three times per day for 7 days; or 500 mg AZ for 3 days. Antibiotics were administered after the first SRP session and clinical parameters for full-mouth and baseline probing pocket depth (PPD) categories were reviewed 2-months post-treatment. RESULTS Thirty-four of 38 patients completed the study. All groups experienced significant improvements in full-mouth clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing. AZ exhibited greater reductions in PPD than SRP alone for baseline severe sites, whilst AMX+MTZ showed significant improvements in PPD and CAL than SRP alone for baseline moderate and severe sites. Of the two antibiotic therapies, AMX+MTZ showed greater reductions in PPD compared with AZ in baseline moderate sites only. CONCLUSIONS For patients with moderate-to-severe periodontitis, adjunctive systemic antibiotics might result in greater clinical benefits.
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Affiliation(s)
- A Liaw
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
| | - C Miller
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Smithfield, Queensland, Australia
| | - A Nimmo
- College of Medicine and Dentistry, James Cook University, Smithfield, Queensland, Australia
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18
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Kan P, Sasaki H, Inaba K, Watanabe K, Hamada N, Minabe M. Inhibitory effects of azithromycin on the adherence ability of Porphyromonas gingivalis. J Periodontol 2019; 90:903-910. [PMID: 30690740 DOI: 10.1002/jper.18-0559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/07/2018] [Accepted: 12/24/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Porphyromonas gingivalis is a major pathogen and has a high detection rate in periodontal disease. Fimbriae and hemagglutinin are expressed by P. gingivalis, and these play an important role in the adherence of the bacteria to periodontal tissue and biofilm formation. The aim of this study was to investigate the effects of sub-minimal inhibitory concentrations (sub-MICs) of azithromycin on the adherence of P. gingivalis, focusing on the inhibition of fimbriae expression and hemagglutinin activity. METHODS P. gingivalis ATCC 33277 were incubated anaerobically with sub-MICs of azithromycin at 37°C by gentle shaking for 18 hours. The bacterial cells were harvested, washed twice with phosphate-buffered saline (PBS), and the proteins analyzed by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blotting. Adherence assay and hemagglutinin activity tests were done with the same culture. RESULTS The results of SDS-PAGE indicated that the sub-MICs of azithromycin inhibited 41-kDa fimbrial protein expression and hemagglutinin activities. The disappearance of 41-kDa fimbrial protein expression and long fimbriae in 0.4 µg/mL, 0.2 µg/mL, and 0.1 µg/mL of azithromycin was confirmed by western blotting and transmission electron microscopy. The adherence of P. gingivalis to human gingival epithelial cells was reduced by sub-MICs of azithromycin compared with the adherence levels without antibiotic. CONCLUSIONS These results suggest that sub-MICs of azithromycin may reduce the adherence of P. gingivalis to host cells, by inhibiting production of fimbriae and hemagglutinin activities. Therefore, azithromycin can be used as a biofilm treatment of periodontal disease caused by P. gingivalis.
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Affiliation(s)
- Powen Kan
- Division of Periodontology, Department of Oral Interdisciplinary Medicine, Kanagawa Dental University, Yokosuka, Japan
| | - Haruka Sasaki
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, Yokosuka, Japan
| | - Keitaro Inaba
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, Yokosuka, Japan
| | - Kiyoko Watanabe
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, Yokosuka, Japan
| | - Nobushiro Hamada
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, Yokosuka, Japan
| | - Masato Minabe
- Division of Periodontology, Department of Oral Interdisciplinary Medicine, Kanagawa Dental University, Yokosuka, Japan
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19
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Gartenmann SJ, Weydlich YV, Steppacher SL, Heumann C, Attin T, Schmidlin PR. The effect of green tea as an adjunct to scaling and root planing in non-surgical periodontitis therapy: a systematic review. Clin Oral Investig 2018; 23:1-20. [PMID: 30382412 DOI: 10.1007/s00784-018-2684-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide a systematic overview on the efficacy of green tea catechin as an adjunct to scaling and root planing (SRP) in terms of probing pocket depth (PPD). MATERIALS AND METHODS A systematic literature search was performed using electronic databases in PubMed, Scopus, Medline, Cochrane, CINAHL, and Web of Science on randomized clinical trials up to January 2017. The research question was posed in accordance with PRISMA guidelines. RESULTS The search provided 234 studies. After analyzing the full texts, five studies were included, with four studies qualifying for meta-analysis. Mean PPD reduction was significantly higher (α = 0.05) when green tea catechin was used as an adjunct to SRP (test group) than with SRP alone (control group). The difference in the reduction was 0.74 mm [0.35-1.13; 95% CI]. CONCLUSION The local application of green tea catechin as an adjunct to SRP may result in a beneficial reduction in PPD. Due to the highly heterogeneous data and some risk of bias, however, this data still needs to be interpreted with caution. CLINICAL RELEVANCE The finding suggests that green tea catechin may be a topical adjunct to SRP without negative side effects.
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Affiliation(s)
- S J Gartenmann
- Clinic for Preventive Dentistry, Periodontology and Cardiology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Y V Weydlich
- Private practice, Wallisellen and St. Gallen, Switzerland
| | - S L Steppacher
- Private practice, Wallisellen and St. Gallen, Switzerland
| | - C Heumann
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - T Attin
- Clinic for Preventive Dentistry, Periodontology and Cardiology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Patrick R Schmidlin
- Clinic for Preventive Dentistry, Periodontology and Cardiology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
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Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000 2018; 78:59-97. [DOI: 10.1111/prd.12235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Jörgen König
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor Michigan
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Peter Meisel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
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21
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Marchetti G, Fraiz FC, Nascimento WMD, Soares GMS, Assunção LRDS. Improving adolescents' periodontal health: evaluation of a mobile oral health App associated with conventional educational methods: a cluster randomized trial. Int J Paediatr Dent 2018; 28:410-419. [PMID: 29756308 DOI: 10.1111/ipd.12371] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adolescence is a decisive period in the construction of new conduits. OBJECTIVE The influence of an App associated with conventional educational methods in adolescents' oral health. STUDY DESIGN Randomized controlled trial including 291 participants (mean age = 16.1 years) in baseline. The study consisted of four phases. Interventions were evaluated through the knowledge score (KS) and oral indexes (OHI-S/GBI). KS was obtained through five affirmations about periodontal diseases applied in different moments (pre-test, post-test, and follow-up test). Phase I included pre-test and oral clinical examination. Sample was randomly divided into two groups: oral (OG) and video orientation (VG) and post-test (phase II). Phase III characterized the formation of groups: OG + App/OG without App/VG + App/VG without App. App consisted of reinforcement messages which was sent during 30 days. Phase IV comprised follow-up test and clinical evaluation. RESULTS There was no significant difference in KS between OG/VG. Overall, App improved KS (P < 0.001). VG + App showed a significant increase in KS in the follow-up test compared to the post-test (P = 0.046). There was a significant reduction in oral indexes for all methods. CONCLUSION App was effective in increasing knowledge, especially associated with video. The different methods were equally effective for a better standard in oral hygiene.
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Affiliation(s)
- Gisele Marchetti
- Pediatric Dentistry, Department of Stomatology, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Fabian Calixto Fraiz
- Pediatric Dentistry, Department of Stomatology, Universidade Federal do Paraná, Curitiba, PR, Brazil
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22
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Theodoro LH, Assem NZ, Longo M, Alves MLF, Duque C, Stipp RN, Vizoto NL, Garcia VG. Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial. Photodiagnosis Photodyn Ther 2018; 22:217-222. [DOI: 10.1016/j.pdpdt.2018.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
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Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontol 2000 2018; 72:153-75. [PMID: 27501498 DOI: 10.1111/prd.12129] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 12/12/2022]
Abstract
Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.
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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.
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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
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Preus HR, Gjermo P, Baelum V. A double-masked Randomized Clinical Trial (RCT) comparing four periodontitis treatment strategies: 5-year clinical results. J Clin Periodontol 2017; 44:1029-1038. [DOI: 10.1111/jcpe.12793] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Hans R. Preus
- Department of Periodontology; Institute of Clinical Odontology; Faculty of Dentistry; University of Oslo; Oslo Norway
| | - Per Gjermo
- Department of Periodontology; Institute of Clinical Odontology; Faculty of Dentistry; University of Oslo; Oslo Norway
| | - Vibeke Baelum
- Department of Dentistry and Oral Health; Aarhus University; Aarhus Denmark
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Ong HS, Oettinger-Barak O, Dashper SG, Darby IB, Tan KH, Reynolds EC. Effect of azithromycin on a red complex polymicrobial biofilm. J Oral Microbiol 2017; 9:1339579. [PMID: 28748041 PMCID: PMC5508370 DOI: 10.1080/20002297.2017.1339579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/05/2017] [Indexed: 01/09/2023] Open
Abstract
Azithromycin has recently gained popularity for the treatment of periodontal disease, despite sparse literature supporting efficiency in treating periodontal bacterial biofilms. The aim of this study was to evaluate the effect of azithromycin on biofilms comprised of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in comparison to an amoxicillin and metronidazole combination. P. gingivalis W50, T. denticola ATCC35405, and T. forsythia ATCC43037 grown under anaerobic conditions at 37°C were aliquoted into 96-well flat-bottom plates in different combinations with addition of azithromycin or amoxicillin + metronidazole at various concentrations. For the biofilm assay, the plates were incubated at 37°C anaerobically for 48 h, after which the biofilms were stained with crystal violet and measured for absorbance at AU620. In this model, polymicrobial biofilms of P. gingivalis + T. denticola, P. gingivalis + T. forsythia, and T. denticola + T. forsythia were cultured. Combination of all three bacteria enhanced biofilm biomass. Azithromycin demonstrated a minimal biofilm inhibitory concentration (MBIC) of 10.6 mg/L, while the amoxicillin + metronidazole combination was more effective in inhibiting biofilm formation with a MBIC of 1.63 mg/L. Polymicrobial biofilm formation was demonstrated by combination of all three red complex bacteria. Azithromycin was ineffective in preventing biofilm formation within a clinically achievable concentration, whereas the combination of amoxicillin and metronidazole was more effective for this purpose.
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Affiliation(s)
- Hwei Sze Ong
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
| | - Orit Oettinger-Barak
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
| | - Stuart G Dashper
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
| | - Ivan B Darby
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
| | - Kheng H Tan
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
| | - Eric C Reynolds
- Melbourne Dental School, Oral Health Cooperative Research Centre, Bio21 Institute, The University of Melbourne, Carlton, Australia
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Feres M, Figueiredo LC, Soares GMS, Faveri M. Systemic antibiotics in the treatment of periodontitis. Periodontol 2000 2017; 67:131-86. [PMID: 25494600 DOI: 10.1111/prd.12075] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 12/12/2022]
Abstract
Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.
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O'Rourke VJ. Azithromycin as an adjunct to non-surgical periodontal therapy: a systematic review. Aust Dent J 2017; 62:14-22. [PMID: 27492140 DOI: 10.1111/adj.12448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate the current published work relating to the clinical benefits of the use of systemic azithromycin as an adjunct to non-surgical periodontal therapy. A published work search of PubMed, EMBASE and Cochrane Register of Controlled Trials up to 27 April 2016 was undertaken. The large degree of heterogeneity in the types of studies, treatment protocols, test subjects, sample size and exclusion criteria indicated that the use of narrative synthesis of all relevant studies was a valid method of review. Of the 194 eligible studies, 15 were found to be of relevance. The majority of studies demonstrated an additional clinical benefit when azithromycin is used as an adjunct to non-surgical periodontal therapy, particularly in deeper pockets (≥6 mm). In conclusion, the current body of research on the adjunctive use of systemic azithromycin in non-surgical periodontal therapy suggests there is a clinical benefit and that this benefit is greatest in deeper initial pockets (≥6 mm). The findings also suggest that future studies need to be more careful in subject selection to identify susceptible patients or at risk sites, both the immunoregulatory effects and antibiotic resistance of azithromycin needs to be reported, and that study populations need to be more homogeneous.
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Affiliation(s)
- V J O'Rourke
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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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.
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ASSEM NZ, ALVES MLF, LOPES AB, GUALBERTO JUNIOR EC, GARCIA VG, THEODORO LH. Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis. Braz Oral Res 2017; 31:e67. [DOI: 10.1590/1807-3107bor-2017.vol31.0067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 06/02/2017] [Indexed: 02/19/2023] Open
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Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review. J Am Dent Assoc 2016; 146:150-63. [PMID: 25726342 DOI: 10.1016/j.adaj.2014.12.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/19/2014] [Accepted: 12/04/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP). METHODS The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects). RESULTS After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP. CONCLUSION Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP. PRACTICAL IMPLICATIONS Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient.
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Renatus A, Herrmann J, Schönfelder A, Schwarzenberger F, Jentsch H. Clinical Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis. J Clin Diagn Res 2016; 10:ZE01-7. [PMID: 27630968 DOI: 10.7860/jcdr/2016/20176.8115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/27/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Over the years, numerous trials have sufficiently documented benefits of adjuvant administration of antibiotics in combination to Scaling and Root Planing (SRP) in treatment of periodontitis. Nevertheless there are justified doubts in respect to antibiotics administration with regard to increasing development of resistances. AIM The aim of this review study and meta-analysis was to verify a possible benefit of Azithromycin (AZM) as an alternative adjuvant antibiotic in combination with SRP. MATERIALS AND METHODS Electronic databases (Pubmed) were searched from the earliest point of record until May 2015. A hand search was also conducted. The variables considered in this respect were Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and SRP. A meta-analysis containing trials comparing SRP as a sole therapy with SRP and administration of AZM was produced once all of the data obtained had been reviewed. RESULTS Six randomised clinical trials were accepted into the review and the meta-analysis following the process of trial selection. Meta-analysis revealed larger overall effects by the systemic administration of AZM compared with SRP on their own in terms of PD, CAL, BOP, Plaque-Index and total bacterial load reduction after three and six months. CONCLUSION The data used in this study revealed that the systemic administration of AZM is beneficial compared with SRP on its own for the treatment of chronic periodontitis.
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Affiliation(s)
- Antonio Renatus
- Faculty, Department of Cariology, Endodontology and Periodontology, Centre for Periodontology, University Hospital of Leipzig , Leipzig, Germany
| | - Jörg Herrmann
- Student, Department of Cariology, Endodontology and Periodontology, Centre for Periodontology, University Hospital of Leipzig , Leipzig, Germany
| | - Antje Schönfelder
- Student, Department of Psychology, Clinical Research Organization , Leipzig, Germany
| | - Fabian Schwarzenberger
- Professor, Faculty of Informatics/Mathematics, University of Applied Sciences , Dresden, Germany
| | - Holger Jentsch
- Professor, Department of Cariology, Endodontology and Periodontology, Centre for Periodontology, University Hospital of Leipzig , Leipzig, Germany
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Harris SA, Harris EA. Herpes Simplex Virus Type 1 and Other Pathogens are Key Causative Factors in Sporadic Alzheimer's Disease. J Alzheimers Dis 2016; 48:319-53. [PMID: 26401998 PMCID: PMC4923765 DOI: 10.3233/jad-142853] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review focuses on research in epidemiology, neuropathology, molecular biology, and genetics regarding the hypothesis that pathogens interact with susceptibility genes and are causative in sporadic Alzheimer's disease (AD). Sporadic AD is a complex multifactorial neurodegenerative disease with evidence indicating coexisting multi-pathogen and inflammatory etiologies. There are significant associations between AD and various pathogens, including Herpes simplex virus type 1 (HSV-1), Cytomegalovirus, and other Herpesviridae, Chlamydophila pneumoniae, spirochetes, Helicobacter pylori, and various periodontal pathogens. These pathogens are able to evade destruction by the host immune system, leading to persistent infection. Bacterial and viral DNA and RNA and bacterial ligands increase the expression of pro-inflammatory molecules and activate the innate and adaptive immune systems. Evidence demonstrates that pathogens directly and indirectly induce AD pathology, including amyloid-β (Aβ) accumulation, phosphorylation of tau protein, neuronal injury, and apoptosis. Chronic brain infection with HSV-1, Chlamydophila pneumoniae, and spirochetes results in complex processes that interact to cause a vicious cycle of uncontrolled neuroinflammation and neurodegeneration. Infections such as Cytomegalovirus, Helicobacter pylori, and periodontal pathogens induce production of systemic pro-inflammatory cytokines that may cross the blood-brain barrier to promote neurodegeneration. Pathogen-induced inflammation and central nervous system accumulation of Aβ damages the blood-brain barrier, which contributes to the pathophysiology of AD. Apolipoprotein E4 (ApoE4) enhances brain infiltration by pathogens including HSV-1 and Chlamydophila pneumoniae. ApoE4 is also associated with an increased pro-inflammatory response by the immune system. Potential antimicrobial treatments for AD are discussed, including the rationale for antiviral and antibiotic clinical trials.
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Affiliation(s)
- Steven A Harris
- St. Vincent Medical Group, Northside Internal Medicine, Indianapolis, IN, USA
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Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. J Am Dent Assoc 2016; 145:1227-39. [PMID: 25429036 DOI: 10.14219/jada.2014.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a growing health problem worldwide. People with T2DM are at risk of experiencing periodontitis and likely require treatment. Using data from the national multicenter Diabetes and Periodontal Therapy Trial (DPTT), the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy. METHODS The DPTT investigators randomly assigned adults with T2DM (hemoglobin A1c [HbA1c] ≥ 7 percent and < 9 percent) and moderate to advanced periodontitis to receive immediate or delayed therapy (scaling and root planing, oral hygiene instruction, chlorhexidine rinse). The investigators assessed probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and medical conditions at baseline, three months and six months. Six-month changes in mean PD, CAL and BOP defined the treatment response. Complete data were available for 473 of 514 DPTT participants. The authors used multiple regression models to evaluate participant-level factors associated with the response. RESULTS More severe baseline PD, CAL and BOP were associated with greater improvements in these same measurements (P < .0001). Hispanic participants experienced greater improvements in PD and CAL than did non-Hispanic participants (P < .0001). Obese participants (those with a body mass index > 30 kilograms per square meter) experienced greater reductions in PD and BOP than did participants who were not obese (P < .001). Age, sex, HbA1c values, diabetes duration, and smoking were not associated with change in any outcome (P > .1). CONCLUSIONS In patients with T2DM, baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy. Body mass index and Hispanic ethnicity-but not glycemic control, diabetes duration or smoking-also may be useful in predicting clinical changes in this population.
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Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy. Antimicrob Agents Chemother 2016; 60:1779-87. [PMID: 26729495 DOI: 10.1128/aac.02575-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/28/2015] [Indexed: 11/20/2022] Open
Abstract
Sitafloxacin (STFX) is a newly developed quinolone that has robust antimicrobial activity against periodontopathic bacteria. We previously reported that oral administration of STFX during supportive periodontal therapy was as effective as conventional mechanical debridement under local anesthesia microbiologically and clinically for 3 months. The aim of the present study was to examine the short-term and long-term microbiological and clinical effects of systemic STFX and azithromycin (AZM) on active periodontal pockets during supportive periodontal therapy. Fifty-one patients receiving supportive periodontal therapy were randomly allocated to the STFX group (200 mg/day of STFX for 5 days) or the AZM group (500 mg/day of AZM for 3 days). The microbiological and clinical parameters were examined until 12 months after the systemic administration of each drug. The concentration of each drug in periodontal pockets and the antimicrobial susceptibility of clinical isolates were also analyzed. The proportions of red complex bacteria, i.e., Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are the representative periodontopathic bacteria, were significantly reduced at 1 month and remained lower at 12 months than those at baseline in both the STFX and AZM groups. Clinical parameters were significantly improved over the 12-month period in both groups. An increase in the MIC of AZM against clinical isolates was observed in the AZM group. These results indicate that monotherapy with systemic STFX and AZM might be an alternative treatment during supportive periodontal therapy in patients for whom invasive mechanical treatment is inappropriate. (This study has been registered with the University Hospital Medical Information Network-Clinical Trials Registry [UMIN-CTR] under registration number UMIN000007834.).
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Jentsch HFR, Buchmann A, Friedrich A, Eick S. Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole. Clin Oral Investig 2015; 20:1765-73. [PMID: 26685849 DOI: 10.1007/s00784-015-1683-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.
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Affiliation(s)
- Holger F R Jentsch
- Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Liebigstr. 12, Haus 1, 04103, Leipzig, Germany.
| | | | | | - Sigrun Eick
- Department of Periodontology, Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Zhang Z, Zheng Y, Bian X. Clinical effect of azithromycin as an adjunct to non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled clinical trials. J Periodontal Res 2015; 51:275-83. [PMID: 26362529 DOI: 10.1111/jre.12319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 12/11/2022]
Abstract
The results of recent published studies focusing on the effect of azithromycin as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis are inconsistent. We conducted a meta-analysis of randomized controlled clinical trials to examine the effect of azithromycin combined with SRP on periodontal clinical parameters as compared to SRP alone. An electronic search was carried out on Pubmed, Embase and the Cochrane Central Register of Controlled Trials from their earliest records through December 28, 2014 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Data were extracted independently by two authors. Either a fixed- or random-effects model was used to calculate the overall effect sizes of azithromycin on probing depth, attachment level (AL) and bleeding on probing (BOP). Heterogeneity was evaluated using the Q test and I(2) statistic. Publication bias was evaluated by Begg's test and Egger's test. A total of 14 trials were included in the meta-analysis. Compared with SRP alone, locally delivered azithromycin plus SRP statistically significantly reduced probing depth by 0.99 mm (95% CI 0.42-1.57) and increased AL by 1.12 mm (95% CI 0.31-1.92). In addition, systemically administered azithromycin plus SRP statistically significantly reduced probing depth by 0.21 mm (95% CI 0.12-0.29), BOP by 4.50% (95% CI 1.45-7.56) and increased AL by 0.23 mm (95% CI 0.07-0.39). Sensitivity analysis yielded similar results. No evidence of publication bias was observed. The additional benefit of systemic azithromycin was shown at the initially deep probing depth sites, but not at shallow or moderate sites. The overall effect sizes of systemic azithromycin showed a tendency to decrease with time, and meta-regression analysis suggested a negative relation between the length of follow-up and net change in probing depth (r = -0.05, p = 0.02). This meta-analysis provides further evidence that azithromycin used as an adjunct to SRP significantly improves the efficacy of non-surgical periodontal therapy on reducing probing depth, BOP and improving AL, particularly at the initially deep probing depth sites.
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Affiliation(s)
- Z Zhang
- Department of Periodontology, Tianjin Stomatological Hospital, Nankai University, Tianjin, China
| | - Y Zheng
- Department of General Dentistry, Stomatological Hospital, Tianjin Medical University, Tianjin, China
| | - X Bian
- Department of Periodontology, Stomatological Hospital, Tianjin Medical University, Tianjin, China
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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]
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Buset SL, Zitzmann NU, Weiger R, Walter C. Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs. Clin Oral Investig 2015; 19:1763-75. [PMID: 26063646 DOI: 10.1007/s00784-015-1499-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/24/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. OBJECTIVE This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin. MATERIALS AND METHODS A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion. RESULTS Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant (p < 0.05) beneficial effects of azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes. CONCLUSION In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients. CLINICAL RELEVANCE When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis.
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Affiliation(s)
- Sabrina L Buset
- Department of Periodontology, Endodontology and Cariology, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Periodontology, Endodontology and Cariology, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland.
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Faveri M, Figueiredo LC, Feres M. Considerations About Designing and Reporting Randomized Clinical Trials--Response to the Letter to the Editor From Preus et al. J Evid Based Dent Pract 2015; 15:87-8. [PMID: 25987394 DOI: 10.1016/j.jebdp.2015.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
| | | | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Effects of azithromycin, metronidazole, amoxicillin, and metronidazole plus amoxicillin on an in vitro polymicrobial subgingival biofilm model. Antimicrob Agents Chemother 2015; 59:2791-8. [PMID: 25733510 DOI: 10.1128/aac.04974-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/24/2015] [Indexed: 01/30/2023] Open
Abstract
Chronic periodontitis is one of the most prevalent human diseases and is caused by dysbiosis of the subgingival microbiota. Treatment involves primarily mechanical disruption of subgingival biofilms and, in certain cases, adjunctive use of systemic antibiotic therapy. In vitro biofilm models have been developed to study antimicrobial agents targeting subgingival species. However, these models accommodate a limited number of taxa, lack reproducibility, and have low throughput. We aimed to develop an in vitro multispecies biofilm model that mimics subgingival plaque, to test antimicrobial agents. Biofilms were cultivated using the Calgary Biofilm Device and were exposed to amoxicillin (AMX), metronidazole (MTZ), azithromycin (AZM), and AMX-MTZ at four different concentrations for 12, 24, or 36 h. Chlorhexidine (CHX) (0.12%) was used as the positive control. The compositions of the biofilms were analyzed by checkerboard DNA-DNA hybridization, and the percent reduction in biofilm metabolic activity was determined using 2,3,5-triphenyltetrazolium chloride and spectrophotometry. Thirty-five of the 40 species used in the inoculum were consistently recovered from the resulting in vitro biofilms. After 36 h of exposure at the 1:27 dilution, AMX-MTZ reduced metabolic activity 11% less than CHX (q = 0.0207) but 54% more than AMX (q = 0.0031), 72% more than MTZ (q = 0.0031), and 67% more than AZM (q = 0.0008). Preliminary evidence of a synergistic interaction between AMX and MTZ was also observed. In summary, we developed reproducible biofilms with 35 subgingival bacterial species, and our results suggested that the combination of AMX and MTZ had greater antimicrobial effects on these in vitro multispecies biofilms than expected on the basis of the independent effects of the drugs.
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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.
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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.
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:689-706. [DOI: 10.1111/jre.12252] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 12/24/2022]
Affiliation(s)
- J. A. J. Keestra
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - I. Grosjean
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Coucke
- Department of Clinical Biology; Scientific Institute of Public Health; Brussels Belgium
| | - M. Quirynen
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
| | - W. Teughels
- Department of Oral Health Sciences, Periodontology; KU Leuven & University of Leuven; Leuven Belgium
- Department of Periodontology; University Hospitals Leuven; Leuven Belgium
- Fund for Scientific Research Flanders (FWO), Egermontstraat; Brussels Belgium
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Soares GMS, Mendes JAV, Silva MP, Faveri M, Teles R, Socransky SS, Wang X, Figueiredo LC, Feres M. Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial. J Clin Periodontol 2014; 41:366-76. [PMID: 24834504 DOI: 10.1111/jcpe.12217] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies. METHODS One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy. RESULTS At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites. CONCLUSION The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone.
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Tsalikis L, Sakellari D, Dagalis P, Boura P, Konstantinidis A. Effects of doxycycline on clinical, microbiological and immunological parameters in well-controlled diabetes type-2 patients with periodontal disease: a randomized, controlled clinical trial. J Clin Periodontol 2014; 41:972-80. [PMID: 25041182 DOI: 10.1111/jcpe.12287] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the clinical, microbiological and immunological effects of systemic doxycycline as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with well-controlled type 2 diabetes. MATERIALS AND METHODS Sixty-six patients compliant to oral hygiene (Hygiene Index <20%) allocated to either a test (systemic doxycycline for 21 days) or a control (placebo) group participated in the present randomized controlled trial (RCT). Clinical assessments were recorded at baseline, 3 and 6 months after therapy and included clinical attachment level (CAL), set as the primary outcome of the study, probing pocket depth (PPD), recession (RE) and bleeding on probing (BOP). At the same time points, counts of 15 subgingival species were evaluated by "checkerboard" DNA-DNA hybridization, gingival crevicular fluid samples were analysed for matrix metalloproteinase-8 (MMP-8) by ELISA and HbA1c levels were determined. Comparisons between and within groups were performed by non-parametric tests (Mann-Whitney, Wilcoxon signed-ranks and z-test for proportions with Bonferroni corrections) at the 0.05 level. RESULTS No major differences were noticed in clinical and microbiological parameters of periodontal disease or levels of MMP-8 between the two groups. CONCLUSIONS Adjunctive systemic doxycycline does not seem to significantly enhance the effects of SRP in well-controlled diabetes type 2 patients.
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Affiliation(s)
- Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Keestra JAJ, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2014; 50:294-314. [PMID: 25142259 DOI: 10.1111/jre.12221] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. BACKGROUND Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. MATERIAL AND METHODS The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent. CONCLUSION Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).
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Affiliation(s)
- J A J Keestra
- Department of Oral Health Sciences, Periodontology, KU Leuven & University of Leuven, Leuven, Belgium; Department of Periodontology, University Hospitals Leuven, Leuven, Belgium
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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.
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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
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Faveri M, Figueiredo LC, Feres M. Treatment of Chronic Periodontitis May Be Improved by the Adjunctive Use of Systemic Metronidazole. J Evid Based Dent Pract 2014; 14:70-2. [DOI: 10.1016/j.jebdp.2014.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bartold PM, Van Dyke TE. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000 2014; 62:203-17. [PMID: 23574467 DOI: 10.1111/j.1600-0757.2012.00450.x] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
New concepts evolve when existing ones fail to address known factors adequately or are invalidated by new evidence. For decades periodontitis has been considered to be caused by specific bacteria or groups of bacteria and, accordingly, treatment protocols have largely been based on anti-infective therapies. However, close inspection of current data leads one to question whether these bacteria are the cause or the result of periodontitis. Good evidence is emerging to suggest that it is indeed the host response to oral bacteria that leads to the tissue changes noted in gingivitis. These changes lead to an altered subgingival environment that favors the emergence of 'periodontal pathogens' and the subsequent development of periodontitis if the genetic and external environmental conditions are favorable for disease development. Thus, it seems that it is indeed the initial early host-inflammatory and immune responses occurring during the development of gingivitis, and not specific bacteria or their so-called virulence factors, which determine whether periodontitis develops and progresses. In this review we consider these concepts and their potential to change the way in which we view and manage the inflammatory periodontal diseases.
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Pradeep AR, Singh SP, Martande SS, Naik SB, N P, Kalra N, Suke DK. Clinical and microbiological effects of levofloxacin in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial. ACTA ACUST UNITED AC 2014; 6:170-8. [DOI: 10.1111/jicd.12091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 11/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Avani R. Pradeep
- Department of Periodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Sonender P. Singh
- Department of Periodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Santosh S. Martande
- Department of Periodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Savitha B. Naik
- Department of Conservative Dentistry and Endodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Priyanka N
- Department of Conservative Dentistry and Endodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Nitish Kalra
- Department of Periodontics; Government Dental College and Research Institute; Bangalore Karnataka India
| | - Deepak K. Suke
- Department of Periodontics; Government Dental College and Research Institute; Bangalore Karnataka India
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