Document Detail


Microbiologic testing and outcomes of full-mouth scaling and root planing with or without amoxicillin/metronidazole in chronic periodontitis.
MedLine Citation:
PMID:  20059413     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It has been suggested that use of systemic antibiotics should be limited to patients with specific microbiologic profiles. The main purpose of the present analysis was to study whether microbiologic testing before therapy was of value in predicting which patients would specifically benefit from adjunctive amoxicillin and metronidazole, given in the context of full-mouth scaling and root planing (SRP) within 48 hours. METHODS: This was a 6-month, single-center, double-masked, placebo-controlled, randomized longitudinal study. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours; then, 25 subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days, and 26 received a placebo (control group). Pooled microbiologic samples were taken from the deepest pocket at baseline in each quadrant before and 6 months after treatment. Six periodontal pathogens were quantified by real-time polymerase chain reaction. RESULTS: Forty-seven patients were followed for 6 months. After treatment, test subjects had a substantially lower mean number of persisting sites with probing depth >4 mm and bleeding on probing than did control subjects (0.4 versus 3.0; P = 0.005; month 6). Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) could not be detected in the antibiotic group after treatment. However, in the placebo group, three of six subjects positive for A. actinomycetemcomitans continued to be positive. Lower frequencies were also noted in the test group for Porphyromonas gingivalis (P = 0.013) and Tannerella forsythia (previously T. forsythensis) (P = 0.007). However, even subjects testing negative for A. actinomycetemcomitans at baseline had a significantly better primary clinical outcome if they received the active drugs. The presence of six putative periodontal pathogens (A. actinomycetemcomitans, Fusobacterium nucleatum spp., P. gingivalis, Prevotella intermedia, Treponema denticola, and T. forsythia) quantified prior to therapy was not correlated with the outcome of full-mouth SRP with or without amoxicillin and metronidazole. CONCLUSION: Excellent clinical results in the antibiotics group were obtained regardless of the presence or absence of six classic periodontal periopathogens prior to treatment.
Authors:
Norbert Cionca; Catherine Giannopoulou; Giovanni Ugolotti; Andrea Mombelli
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of periodontology     Volume:  81     ISSN:  1943-3670     ISO Abbreviation:  J. Periodontol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-11     Completed Date:  2010-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8000345     Medline TA:  J Periodontol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  15-23     Citation Subset:  D; IM    
Affiliation:
Department of Periodontology, School of Dental Medicine, University of Geneva, Rue Barth?lemy-Menn 19, CH-1205 Geneva, Switzerland. Norbert.Cionca@unige.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Amoxicillin / therapeutic use*
Anti-Infective Agents / therapeutic use*
Antibiotic Prophylaxis / methods*
Bacteria / classification,  drug effects
Chronic Periodontitis / microbiology,  therapy*
Colony Count, Microbial
Combined Modality Therapy
Dental Scaling / methods*
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Longitudinal Studies
Male
Metronidazole / therapeutic use*
Middle Aged
Periodontal Pocket / microbiology,  therapy
Root Planing / methods
Statistics, Nonparametric
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Infective Agents; 26787-78-0/Amoxicillin; 443-48-1/Metronidazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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