Tetracycline in the treatment of periodontal disease: review of current literature

A role for antibiotics in the treatment of refractory periodontitis

Refractory periodontitis is considered by many investigators to be a separate disease entity that is descriptive of a particular patient who has multiple sites, rather than a few individual sites, that do not respond to conventional periodontal treatment modalities. Such patients continue to demonstrate loss of attachment and alveolar bone despite frequent periodontal treatment which includes surgical intervention, scaling and root planing, and often systemically-administered tetracycline. Controlled clinical studies have demonstrated that both clindamycin-hydrochloride and amoxicillin/clavulanate potassium (Au) are beneficial when used in conjunction with periodontal scaling. Gordon et al. found improvements in attachment levels, inflammation, suppuration, and a decrease in pocket depths for up to 2 years following a 7-day course of clindamycin given in conjunction with a full-mouth scaling. The incidence of disease activity decreased from an annual rate of 8% of all sites prior to antibiotic treatment to 0.5% after treatment. Magnusson, reporting on a similar group treated with a 14-day course of Au, found an average loss of attachment of 2.2 mm and an increase in pocket depth of 1.5 mm in sites demonstrating disease progression prior to antibiotic treatment. At 3 months post-antibiotic therapy, these sites had regained an average of 2 mm of attachment and pocket depths had decreased an equivalent amount. Both attachment levels and pocket depths remained relatively stable for up to 12 months post-therapy. In an ongoing study, 30 subjects with refractory periodontitis were treated with either clindamycin or Au in conjunction with scaling or scaling plus a placebo. Prior to antibiotic treatment, but while being scaled at 3-month intervals, sites with disease activity lost an average 2.4 mm of attachment. At 3 months post-treatment, the clindamycin-treated group showed an average gain of 2.1 mm, the Au-treated group gained 1.9 mm, and the scaling group gained 1.4 mm in attachment. The clindamycin group remained relatively stable for up to 21 months and the Au group remained stable for about 15 months without additional treatment. Five of the 6 subjects treated with scaling alone required additional treatment within 9 months. Preliminary analyses have indicated that at least two patterns or rates of attachment loss may be associated with refractory periodontitis and that each pattern may be indicative of a different microflora. The pattern associated with a relatively rapid loss of attachment was characterized by a Gram-negative flora which contained spirochetes, P. intermedia, and Fusobacterium species.(ABSTRACT TRUNCATED AT 400 WORDS)

Quality assessment and meta-analysis of systemic tetracycline use in chronic adult periodontitis

The use of systemic tetracycline in the treatment of periodontal disease has been controversial. To investigate this controversy, we performed a quality assessment and attempted to perform a meta-analysis of 13 published studies. We evaluated the quality of the study protocol and data analysis and presentation for each study. We were unable to combine data from the majority of studies due to heterogeneity of the outcomes evaluated and limitations in data reported in the individual studies. Therefore, only 2 studies were included in the quantitative meta-analysis. On a scale of 0-1, the mean score for this group of studies was 0.27 (+/- 0.19) for study protocol and 0.31 (+/- 0.11) for data analysis and presentation. Mean reduction in probing depth for the group treated with tetracycline plus scaling was 2.45 mm; for the group which received only scaling, 2.02 mm; for the group that received only tetracycline, 1.98 mm; and for the control group, 0.65 mm. We conclude that analysis of data from the published literature does not demonstrate that the use of systemic tetracycline is more beneficial than conventional treatment in the management of adult periodontal disease. More information is needed in order to perform an extensive meta-analysis of this subject.

Effect of non-surgical periodontal therapy combined with adjunctive antibiotics in subjects with "refractory" periodontal disease. (I). Clinical results

The aim of the present study was to evaluate the clinical effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects with refractory periodontitis. 10 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. Clinical registrations including gingival index, plaque index, presence of bleeding and suppuration, pocket depth, and duplicate measurements of attachment level were performed at baseline and at monthly intervals. When disease activity was detected based on the tolerance method, a bacterial sample was taken from the active site and its susceptibilities to a number of antibiotics were determined. For the selected 10 subjects, Augmentin was the antibiotic of choice. Each subject received 750 mg/day for 2 weeks, during which time a full-month scaling and root planing was performed under local anesthesia. Clinical re-evaluation was performed after 3, 6, 9 and 12 months. At the time disease activity was detected, the average loss of attachment at all active sites was 2.2 mm, and the increase in pocket depth 1.5 mm. At 3 months post-therapy, these sites had regained 2 mm of attachment which remained stable through the 12-month examination. Pocket depths decreased 2.5 mm over the first 6 months and then stabilized. The frequency of all sites that gained 1 mm or more of attachment increased by approximately 10% over the first 9 months following therapy. The frequency of all sites that decreased 1 mm or more in pocket depth increased approximately 15% over the same period.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriostatic effect of tetracycline in a temporary cement

Temporary crowns with subgingival margins can result in gingival inflammation. This inflammation is the result of plaque accumulating at the restoration-tooth interface and a change in the nature of that plaque to one associated with periodontitis. It was postulated that tetracycline incorporated in a slightly soluble cement would be released in the sulcus and decrease the amount, and improve the quality, of the subgingival microflora. The unknown was whether tetracycline is inactivated by any of the components of the temporary cement Temp Bond. To determine this concern, disks of Temp Bond cement with and without varying concentrations of tetracycline were anaerobically incubated in cultures of Bacteroides gingivalis. Results showed that tetracycline incorporated in Temp Bond at 10% by weight is highly bacteriostatic while retaining typical working properties of the cement.

Effects of short-term administration of metronidazole on the subgingival microflora

The effect of a 5-day course of systemic metronidazole was investigated in 11 recall maintenance patients over a period of 3 months. Crevicular fluid flow, bleeding on probing, pocket depth, and composition of the subgingival microbiota as observed by dark-field microscopy, were measured. The study design allowed patients to act as their own controls. At baseline 1 (day 0), each patient had a randomly assigned quadrant scaled and root-planed, and received oral hygiene instruction. Microbiological and clinical parameters were measured at baseline 1 (before treatment) and at 3, 6, and 12 weeks in both the root-planed and a designated no-treatment quadrant. At baseline 2 (12 weeks), the contralateral quadrant was scaled and root-planed, and the oral hygiene instruction was reinforced. At this appointment, each patient was given 15 metronidazole tablets (250 mg), 1 to be taken 3 times per day for 5 days. At the end of this period, patients were seen 1-2 h after taking their last tablet, and blood and crevicular fluid samples were taken to determine the concentration of metronidazole by microbiological assay in the serum and crevicular fluid. Microbiological and clinical parameters were measured at baseline 2 (before treatment) and at 13, 15, 18, and 24 weeks in both the root-planed and designated non-root-planed (metronidazole only) quadrants. Results demonstrated that in this group of recall maintenance patients, metronidazole was no more effective than root-planing alone in reducing the relative % of total motile organisms and spirochetes in 5-8 mm pockets. Crevicular fluid flow was, however, significantly reduced for 11 weeks; serum and crevicular fluid levels of metronidazole were similar 1 to 2 h after drug ingestion.

Monolithic tetracycline-containing fibers for controlled delivery to periodontal pockets

For the purpose of developing controlled delivery devices for periodontal therapy which would release over several days, six fiber types made of tetracycline-loaded biocompatible polymers were manufactured and tested. Polyethylene, polypropylene, polycaprolactone, polyurethane and cellulose acetate propionate all released their drug load within 1 day. Ethylene vinyl acetate fibers, however, provided in vitro sustained release for periods up to 9 days. A bioassay was designed to measure levels of tetracycline achieved by local delivery which used growth inhibition of Bacillus cereus as a measure of the amount of tetracycline in measured volumes of gingival sulcus fluid on filter paper strips. By this assay, fibers made from 25% loaded ethylene vinyl acetate established initial concentrations of approximately 500 micrograms/ml. The measurement of tetracycline concentration resulting from the placement of these fibers into deep periodontal pockets as a packing material provided indication that concentrations of greater than 50 micrograms/ml could be maintained for months by weekly to monthly replacement. These studies indicate that monolithic fibers made of tetracycline-loaded ethylene vinyl acetate have characteristics which could prove useful as the basis of a tetracycline delivery system for the treatment of periodontal disease.

Effect of tetracycline on gingival inflammation and alveolar bone resorption in beagles: an individual tooth by tooth analysis

The effect of systemic tetracycline on gingival inflammation and alveolar bone resorption was studied in beagle dogs. Seventeen dogs were divided into three groups receiving either no treatment, 250 mg tetracycline HCl, or 500 mg tetracycline HCl daily. The severity of gingival inflammation and activity of alveolar bone resorption during a 6-month pretreatment period was compared to a 24-month treatment period for each individual tooth studied. In the first 12 months of treatment there was a significant decrease in the severity of gingival inflammation and the activity of alveolar bone loss in the tetracycline treated dogs. By 24 months of treatment increased gingival inflammation and rate of bone loss was evident in the treated dogs. In the untreated control dogs there was a statistically significant association between the severity of gingival inflammation and activity of alveolar bone resorption about the teeth studied. In the tetracycline treated dogs, no such association existed.