Clinical, microbiological and immunological effects of 3- or 7-day systemic antibiotics adjunctive to subgingival instrumentation in patients with aggressive (stage III/IV grade C) periodontitis: a randomized placebo-controlled clinical trial

AIM

To evaluate the clinical non-inferiority of a 3-day-protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared to a 7-day-protocol in patients with stage III/IV grade C periodontitis.

METHODS

50 systemically healthy patients (32.7±4.3 years) with aggressive periodontitis (stage III/IV grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole randomly assigned to group A: (n=25) 500mg antibiotics 3-times-daily for 3 days, followed by placebo 3-times-daily for 4 days, or group B: (n=25) 500mg AB 3-times-daily for 7 days. Clinical, microbial and immunological parameters were assessed at baseline, 3 and 6 months, and patient-related outcomes after 2 weeks. The primary outcome variable was the number of residual sites with PD≥6mm at 6 months.

RESULTS

For the primary outcome variable (the number of residual sites with PD≥6mm at 6 months), the null hypothesis was rejected and demonstrated the non-inferiority of the 3d AB protocol compared to 7d AB (the upper limits of the 95%CI for ITT: [-2.572; 1.050] and PP: [-2.523; 1.318] were lower than the assumed margin of Δ=3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p>0.05). All investigated periodontopathogens and pro-inflammatory host-derived markers were statistically significantly reduced, without differences between the treatments (p>0.05).

CONCLUSION

These findings indicate that in patients with aggressive periodontitis (stage III/IV grade C periodontitis), a 3-day systemic administration of amoxicillin and metronidazole adjunctive to SI may lead to non-inferior clinical outcomes after 6-months with fewer adverse events compared to a 7-day-protocol.

Long-term results after treatment of multiple adjacent gingival recessions with the modified coronally advanced tunnel and a porcine acellular dermal matrix

<p>Objective: To evaluate the long-term clinical results after treatment of multiple adjacent recession type (RT) I and II gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with a porcine acellular dermal matrix (PADM).<br /> Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5&nbsp;±&nbsp;7.36&nbsp;years old) with a total of 41 adjacent RT I (n&nbsp;=&nbsp;23) and RT II (n&nbsp;=&nbsp;18) gingival recessions exhibiting a minimum depth of 2&nbsp;mm were treated by means of MCAT+PADM. Recession depth and width, width of attached and keratinized tissue, probing depths, and clinical attachment level were measured at baseline and at 1 and 4&nbsp;years postsurgically. The primary outcome variable was complete root coverage (ie 100% root coverage), while secondary outcomes were mean root coverage and increase in keratinized tissue and attached gingiva widths.<br /> Results: At 1 and 4&nbsp;years, statistically highly significant (P&nbsp;&lt;&nbsp;.001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05&nbsp;± 30.18% at 1&nbsp;year to 56.79&nbsp;±&nbsp;27.53% at 4&nbsp;years. Complete root coverage was obtained in 18 gingival recessions at 1&nbsp;year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4&nbsp;years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P&nbsp;=&nbsp;.003). Mean width of attached gingiva increased statistically significantly (P&nbsp;&lt;&nbsp;.05) from 2.85&nbsp;±&nbsp;1.08&nbsp;mm to 3.14&nbsp;±&nbsp;1.08&nbsp;mm at 1&nbsp;year with a statistically significant decrease at 4&nbsp;years. At 1&nbsp;year, 78.05% of gingival recessions showed a root coverage&nbsp;&gt;&nbsp;50%, and 68.29% still exhibited a root coverage&nbsp;&gt;&nbsp;50% at 4&nbsp;years.<br /> Conclusion: The use of MCAT+PADM represents a valuable treatment option for multiple adjacent maxillary and mandibular RT I and II gingival recessions on a long-term basis.</p>.

Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow

OBJECTIVES

To evaluate the role of postnatal superior mesenteric artery (SMA) flow in predicting feed intolerance and NEC in the babies who had AEDF in comparison with gestation matched SGA and AGA with normal flow.

DESIGN

This was a prospective cohort study conducted in 62 eligible babies admitted in NICU. Babies were enrolled in 3 groups. Group 1 (n = 23) was SGA and AEDF, group 2 (n = 20) was SGA and group 3 (n = 19) was AGA and both with normal UA flow. In all babies baseline SMA flow was measured before test feed (0.5 ml) and repeated every 15 minutes for 1 hour after the feed.

RESULTS

Feed intolerance was seen in 69.5% of babies in group1 (p = <0.001) as compared to 20% and 17.5% in group 2 and 3. Four (17.3%) babies developed NEC in group1 (p = 0.02) but none in other 2 groups. Baseline peak systolic velocity (PSV) and time average mean velocity (TAMV) at 60 min post feed were significantly (p = 0.01 and 0.028 respectively) lower in group1 than group3. TAMV and PSV at 60 min post feed were significantly lower (p = 0.028 and 0.03) in babies with feed intolerance as compared to no feed intolerance group. Absent end diastolic flow and hypoglycemia were independent risk factors for feed intolerance.

CONCLUSION

SGA babies with AEDF had higher incidence of feed intolerance and NEC. Serial SMA flow studies specially the 60 min post feed study may help in differentiating which babies are likely to develop feed intolerance.

Evaluation of canines for accelerant detection at fire scenes

In recent years, canines have been successfully used in fire investigations to detect accelerant residues. We set out to determine the lower limits at which canines could reliably detect potential accelerants. Measured amounts ranging from 10 to as little as 0.01 microL of gasoline, kerosene, and isopars were applied to preselected spots along a continuous sample path (25 to 40 feet long) made out of burned and unburned wood or nylon carpeting strips at the testing site. Two canines were led past this sample path at least three times and positive alerts and negative responses were recorded. Both dogs were generally able to alert on spots containing 0.01 microL or more of all three accelerants, at or beyond the purge and trap recovery and gas chromatographic detection method employed. The canines did alert occasionally on background, especially that containing traces of styrene residues, either purposely added in specific amounts or formed upon partial pyrolysis of carpeting material. The dogs alerted on sites containing 0.1 to 1.0 microL of freshly applied gasoline or kerosene placed at actual heavily damaged fire scenes, but were less successful on samples containing smaller amounts.