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PubMed2000

Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings.

BACKGROUND: Previous multi-center trials demonstrated the efficacy of a biodegradable chlorhexidine-gelatin chip (CHX) in reducing probing depth in patients with periodontitis. The present study utilized a subset of subjects from the parent study to determine if the CHX chip was effective in maintaining alveolar bone over a 9-month period. METHODS: Forty-five subjects with at least four 5 to 8 mm pockets, stratified by smoking status, were enrolled in this double-blind controlled, placebo-controlled trial. Control groups received either placebo chip plus scaling and root planing (SRP) or SRP alone. Test group subjects received active CHX chip or SRP alone (to maintain the blind). Standardized radiographs were taken for quantitative digital subtraction radiography at baseline and 9 months. RESULTS: At 9 months, 15% of SRP treated subjects experienced loss of bone in 1 or more sites, no subject treated with active chip plus SRP lost bone (P <0.01). At 9 months, significant differences in the change in probing depth and clinical attachment levels favoring the active chip over SRP alone or SRP plus CHX chip were also observed (P <0.05). CONCLUSIONS: These data indicate that the CHX chip, when used as an adjunct to scaling and root planing, significantly reduces loss of alveolar bone.

Adult↗
PubMed1989

[Microbial flora of periodontitis and monitoring of the effect of initial preparation by immunofluorescence microscopy].

The effect of initial preparation in adult periodontitis was evaluated by changes in clinical parameters and immunofluorescence microscopic counts of periodontal disease associated bacteria. Subgingival plaque samples were taken with sterilized paper points from 10 sites of 5 periodontally healthy persons and 44 sites of 23 adult periodontitis patients. Twenty-one diseased sites were periodically examined after plaque control and scaling, root planing. The direct immunofluorescence technique was used to detect Bacteroides gingivalis, Eikenella corrodens, Fusobacterium nucleatum and Treponema denticola, Bacteroides intermedius, Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Wolinella recta were counted by the indirect immunofluorescence technique. The proportions of B. gingivalis, B. forsythus, F. nucleatum, E. corrodens, T. denticola and W. recta in periodontitis lesions were significantly higher than those in healthy sites. The proportions of B. gingivalis and T. denticola were significantly related to GI, PlI, BI and PD, those of B. forsythus and W. recta to GI, PlI and BI, E. corrodens to GI and PlI, and F. nucleatum to BI. Reduced proportions of T. denticola were found in samples taken after establishment of proper plaque control. Subgingival scaling and root planing resulted in the reduction of proportions of B. gingivalis, E. corrodens, T. denticola and B. forsythus in the samples. The samples from positive bleeding sites contained higher proportions of B. gingivalis, T. denticola, B. forsythus and W. recta than did resolved sites. The present study shows that the immunofluorescence technique which detects B. gingivalis, T. denticola and B. forsythus is useful in monitoring the efficacy of initial preparation.

Adult↗
PubMed1986

The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque.

23 patients with pockets greater than or equal to 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned. For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and "others" (nonmotile rods, filaments and fusiforms). The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time-points, the benefits were not statistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels. The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subgingival plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.

Adult↗
PubMed1989

[Process of regeneration of cementum observed by various fluorescent-labeling methods].

The purpose of this study was to evaluate the effect of various fluorescent-labeling methods on longitudinal information associated with the process of regeneration of cementum after periodontal therapy. Mandibular bilateral premolars and molars in three monkeys were used. Prior to the labeling, experimental periodontitis was surgically produced at the mesial site of each tooth. In four weeks, scaling and root planing were carried out, and time marking was performed by injection of 3 kinds of fluorescent-labeling materials, tetracycline hydrochloride (30 mg/kg), calcein (8 mg/kg), and alizarin complexon (20 mg/kg), intramuscularly. The animals were sacrificed 4 days after the last injection and serial sections without decalcification were prepared. They were examined under a fluorescence microscope and further observed by contact microradiography (CMR) and staining with toluidine blue. According to the observations made by fluorescence microscopy, marked regeneration of the cementum was revealed by each of the 3 labeling agents. Also, the presence of regenerated cementum was supported by the observations by CMR and after toluidine blue staining. In addition, the regeneration of new cementum was shown to start in about 2 weeks after scaling and root planing. Judging from the results of this experiment, the various fluorescent-labeling methods seem to be effective for observing the process of regeneration of cementum.

Animals↗
PubMed1984

The influence of trauma from occlusion on the bacterial repopulation of periodontal pockets in dogs.

Pockets were surgically created in the two upper external incisors of four beagle dogs, and a copper band adapted to prevent reattachment. After 4 weeks the copper bands were removed, the teeth scaled and root-planed and crowns placed on both experimental teeth in such a way that one of them was forced bucally when the teeth occluded. An orthodontic appliance anchored in bands cemented to the cuspid teeth brought the tooth back to its original position when disclusion occurred. Experimental time was 12 weeks. Clinical indices and bacterial samples for darkfield examination were taken at baseline and weekly thereafter. The dogs were fed a diet that favored plaque accumulation and no oral hygiene was performed. Surgically created pockets initially became populated by cocci (65%-75%) and small amounts of motile bacteria (12%-15%) including 3% to 4% spirochetes. In 4 weeks the percentage of cocci declined steadily (42%-45%) and motile bacteria increased to 37% to 43% with spirochetes representing 24% to 27%. After scaling and root planing, the number of cocci increased again and motile bacteria declined although the baseline values were not reached. This decline persisted for 2 weeks after scaling. Repopulation of the pocket in traumatized and nontraumatized teeth followed the same initial pattern, taking again 5 weeks to return to prescaling levels. No difference was found between traumatized and nontraumatized teeth. Clinical measurements, however, revealed a statistically greater loss of attachment in traumatized teeth as compared with nontraumatized teeth.

Animals↗
PubMed1993

Prosol-chlorhexidine irrigation reduces the incidence of bacteremia during ultrasonic scaling with the Cavi-Med: a pilot investigation.

The purpose of this pilot investigation was to determine whether the incidence of bacteremia following subgingival ultrasonic scaling and root planing could be reduced by the use, pre- and intraoperatively, of an irrigant containing 0.12 per cent chlorhexidine (CHX); Prosol. Individuals having evidence of significant periodontal disease (minimum of seven sites per quadrant 4.0 mm and bleeding on probing) were entered into this study. By use of a random number table, patients were assigned to either the experimental or control groups. The procedures, as described below, were carried out in a double blind fashion so that neither the investigator nor the patient was aware of whether Prosol or placebo was being used. The placebo solution was flavored to make it indistinguishable from Prosol. Patients were first anesthetized. Their gingival crevices were then irrigated using the Cavi-Med ultrasonic scaler. At this point, the ultrasonic action was not activated. Ten minutes later, ultrasonic scaling and root planing with the Cavi-Med unit were begun with a continuous flow of either the placebo or control solutions. Blood samples were taken preoperatively, while postoperative samples were taken one minute after completing the scaling of each quadrant and then 10 minutes after scaling the second quadrant. Routine aerobic and anaerobic bacterial culture methods were used to identify viable blood-borne bacteria. The results show that there was no difference in the distribution or presentation of periodontal disease between the experimental and control quadrants.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease.

This study was undertaken to evaluate the microbiological and clinical effects of a subgingivally applied mixture of H2O2-NaCl and NaHCO3 followed by subgingival irrigation with 1% Betadine in the treatment of periodontal disease. 20 adults with moderate to severe periodontal disease were included in a split mouth design study. All patients were given oral hygiene instruction and were subjected to supragingival scaling in all 4 quadrants, and subgingival scaling and root planing of half the dentition. 10 patients were instructed to use the chemical antimicrobial mixture twice a day instead of dentifrice, and also received professional application of the mixture once every 14 days for 3 months in connection with reinstruction in oral hygiene procedures. The remaining 10 patients received oral hygiene instructions combined with professional tooth cleaning without use of chemicals once every 14 days during a 3-month period. The effect of treatment was evaluated by monitoring the subgingival microflora, clinical periodontal parameters, and by computer assisted subtraction analysis of serial standardized radiographs to determine changes in mass of the supporting alveolar bone. The present study revealed that subgingival debridement combined with mechanical plaque control resulted in decreased numbers of subgingival microorganisms including spirochetes and motile rods, and arrested the progressive breakdown of the periodontal tissues. Topical antimicrobial agents used in combination with subgingival scaling further reduced the subgingival microflora and substantially improved early periodontal healing including gain of probing attachment level and gain in radiographic alveolar bone mass during the 12 months of observation. No clinical improvement but a tendency to further periodontal breakdown was found in the unscaled quadrants, even in those which were subjected to a personal application of the topical antimicrobial mixture. This study indicates that professional and personal subgingival application of a mixture of H2O2-NaCl and NaHCo3 will significantly enhance the microbiological and clinical effects of periodontal scaling and root planing. These agents, and the topical mode of antimicrobial therapy seem promising in the management of human periodontal diseases.

Administration, Topical↗
PubMed1988

[Microbiological evaluation of topical application of the controlled release strips containing ofloxacin (PT-01) in the human periodontal pocket].

The recognition that destructive periodontal diseases may be caused by specific microorganisms has led to an increased interest and usage of antimicrobial agents in periodontal therapy. In this study, the effect of topical application of ofloxacin (OFLX), a synthetic antibiotic, was microbiologically evaluated. The new developed controlled release strips containing OFLX (PT-01), in which there were structurally immediate- and sustained-releasing portions, were applied to the periodontal pockets of 27 adult subjects with periodontitis. Three different sites with a deep probing pocket depth (greater than or equal to 5 mm) were randomly selected in each patient, and were divided into three groups, i.e., PT-01 applied site (T), placebo-applied site (P) and control site (C). Periodontal treatments consisted of oral hygiene instruction and supragingival scaling on day 0 and 7, and subgingival scaling and root planing on day 14. PT-01 was weekly applied on day 0 to 35, and the subgingival plaque samples from each site were collected on day 0, 14, 21 and 42. The dynamics of subgingival microflora was investigated by dark field microscopy for determination of the %s of spirochetes, motile rods and coccoid cells, and anaerobic and aerobic cultivations for the determinations of the total number of subgingival bacteria, black-pigmented Bacteroides (BPB), Fusobacterium species and Actinobacillus actinomycetemcomitans. The results showed that the significant reduction of %s of spirochetes and motile rods and significant increase of % coccoid cells were found in only PT-01 applied sites during first 14 days. In this period, the total number of cultivable bacteria, BPB and Fusobacterium species were also significantly reduced in T sites. While, after subgingival scaling and root planing were performed, significant changes in the proportions and numbers of the subgingival microflora were found in all sites. Especially, PT-01 applied site showed significant improvement in the %s of spirochetes and motile rods as well as the total number of the bacteria. Moreover, the further microbiological determinations of the each isolate revealed that no detectable amounts of A. actinomycetemcomitans could be found from any samples in this study. These results suggested that weekly application of PT-01 in the periodontal pocket could have significant effects on the qualitative and quantitative improvements in the subgingival microflora. It was also suggested that the application of PT-01 might have ameliorating effect as adjuncts of mechanical subgingival plaque control in the periodontal treatment.

Adult↗
PubMed1983

Effect of long-term tetracycline therapy on human periodontal disease.

The present investigation was performed to study the effect of long-term, low dosage tetracycline therapy on advanced periodontal disease in humans. 14 volunteers participated in the trial. Each of the participants had at least 4 pairs of diseased sites around contralateral premolars and incisors with deep pockets and advanced bone loss. The trial extended over a 50-week period and was designed as a double-blind split-mouth study. A Baseline examination included assessments of oral hygiene, gingival conditions, probing depth, attachment level and analysis of the composition of the subgingival microbiota in samples obtained from 8 selected diseased sites. All participants received oral hygiene instruction. In each patient 2 quadrants of the mouth, chosen at random, were treated by scaling and root planing. The 2 remaining quadrants were left unscaled. Following the Baseline examination the patients were randomly distributed into 2 groups of 7 members each. In one of the groups the patients received tetracycline on a daily basis during a 50-week period. The participants of the control group received placebo. Reexaminations were performed 2, 10, 20, 30 and 50 weeks after the Baseline examination. The findings demonstrated that in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling resulted in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis, probing depth and attachment loss. In fact, the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group.

Adult↗
PubMed1983

A rationale for the management of periodontal diseases: effects of tetracycline on subgingival bacteria.

Microbiologic criteria obtained with phase-contrast microscopy were used in a short-term, double-blind study to measure the effects of systemic tetracycline HCl on subgingival bacterial populations in advanced periodontal pockets refractory to local therapy (repeated scaling, root planing, and the subgingival administration of chemotherapeutic agents [H2O2, NaHCO3, NaCl, MgSO4]). Twenty-one subjects, selected for study, had at least one of the following conditions present after local therapy: spirochetes, motile rods, or crevicular leukocytes greater than or equal to 125 per phase-contrast microscopic field. Tetracycline HCl (1 gm/day for 14 days) was randomly distributed to 11 subjects and a placebo to ten subjects, so that neither the subjects nor investigators were aware of the prescription contents. Evaluations after two weeks disclosed that tetracycline HCl significantly reduced elevated levels of spirochetes, motile rods, and crevicular leukocytes to low or undetectable levels, whereas levels in the placebo subjects remained generally unchanged. The results clearly demonstrate the value of tetracycline HCl as an adjunct to periodontal therapy in reducing remaining suspected periodontopathic bacterial populations in advanced lesions after local therapy of scaling, root planing, and topically applied chemotherapy.

Adult↗
PubMed2000

Periodontal diagnostics.

Periodontitis affects a subset of the population and our current thinking is that progression of periodontal disease may be either continuous or cyclical (burst hypothesis). These features make screening and diagnostic tools desirable in the management of this disease. Although many potential markers exist, several difficulties hamper our ability to declare them diagnostic tests with proven utility. The 'gold standard' for active periodontal disease is not available and inflammation due to gingivally confined lesions (gingivitis) and periodontal inflammation which results in attachment loss is a potential confounder of any test based on assessing the host response elements of the disease. The current absence of proof for the progression of periodontal disease i.e., whether or not the burst hypothesis is correct, is a further problem. Although much is written about the need for markers of current or future disease which will prevent us from overtreating pockets, the time, effort and cost involved in testing these sites has to be balanced against the relative ease and speed of routine therapy such as root planing. In addition, we are still some way from the development and validation of reliable host or microbial testing methods. In terms of screening tests for diseases such as the early-onset forms of periodontitis, the research and development on diagnostic tools involving genetic polymorphisms, specific genes, systemic antibodies or leucocyte cell surface markers of the patients, may become a clinical reality in time. One could envisage chairside tests using blood from thumb pricks being capable of determining a young individual's risk of developing disease at a later age, and thus the need for a timely prevention programme. Before applying any test we should reconsider what treatment planning effects a positive or negative result will have, and any test which does not influence the treatment plan is redundant. Whether periodontal diagnostic tests will be developed which will indicate to the clinician the need for various treatment regimes other than root planing, is still an open question. For example, in the future, a test of specific antibody levels in patients prior to treatment might indicate their likely response to therapy and thus the need for additional therapeutic agents such as antibiotics. Periodontal diagnostic tests are still at an early stage of development and much work remains to be performed to fully validate their utility such that they become an important and cost effective aspect of clinical treatment planning, screening or patient monitoring.

Aggressive Periodontitis↗
PubMed2003

Local anti-infective therapy: mechanical and physical approaches. A systematic review.

BACKGROUND: Although mechanical non-surgical therapy (scaling and root planing) is the most common means of initial treatment of periodontal diseases, the relative clinical efficacy of various methods, including manual versus machine-driven, with or without adjunctive agents, has not been determined. RATIONALE: This systematic review analyzes the literature in an effort to identify the most effective therapies, based on both clinical and patient-centered outcomes. FOCUSED QUESTION: In patients with periodontitis, what is the effect of mechanically-driven instrumentation (e.g., power-driven) and/or subgingival irrigation with and without manual instrumentation compared to manual instrumentation alone? SEARCH PROTOCOL: Two investigators examined MEDLINE and the Cochrane Oral Health Group specialized registry for clinical trials published in English. Hand searches were performed of the International Journal of Periodontics & Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. Editors of these journals were asked to provide information on articles currently under review. In addition, an electronic discussion group on periodontal diseases and treatment was contacted, as were manufacturers of manual and mechanical instruments and of adjunctive agents. SELECTION CRITERIA INCLUSION CRITERIA: Only randomized clinical trials, cohort studies, or case-control studies at least 3 months long were included. All studies had to compare manual instrumentation (MI; scaling and root planing [SRP]) alone with some other form of non-surgical therapy. These included MI versus mechanically-driven instruments (MDI) alone; MI versus MI plus MDI; MI versus MDI plus an agent (e.g., chlorhexidine); and MI versus subgingival irrigation (SGI) delivered in conjunction with MI or MDI. EXCLUSION CRITERIA: Studies not meeting the inclusion criteria or those treating periodontal diseases as a manifestation or complication of some other disease or disorder were not included. DATA COLLECTION AND ANALYSIS: Probing depth, clinical attachment level, bleeding on probing, and gingival recession were the primary outcomes. Because of the heterogeneity of the patient populations, treatments, and outcome measures, meta-analysis was not appropriate. Only in-study data were compared. Four of the studies required extrapolating data from figures and graphs, resulting in questionable accuracy. MAIN RESULTS: 1. Nine studies, representing a study population of 129, were included in the review. 2. Five studies compared MI with MDI alone. The other 4 compared MI alone to MI plus SGI or subgingival tissue treatment. 3. There was comparable efficacy between MI and MDI when treating single-rooted teeth. 4. The use of SGI or subgingival tissue treatment as an adjunct to MI provided no additional benefit compared to MI alone. 5. Findings reported in the review must be interpreted with considerable caution, as lack of study heterogeneity made meta-analysis unfeasible and the need to extrapolate outcomes values from graphs and figures may have resulted in some inaccuracy. REVIEWERS' CONCLUSIONS: 1. Manual and mechanically-driven instrumentation appears comparable in affecting improved clinical outcomes. 2. Instrumentation time for MI and MDI were similar, except for 1 study in which MDI was significantly shorter. 3. Adjunctive SGI plus MI and subgingival tissue treatment result in similar clinical outcomes when compared to MI alone. 4. If study data are to be effectively and analytically combined to facilitate meaningful comparisons of treatment outcomes, detailed and standardized study designs must be developed and used consistently in clinical trials.

Anti-Infective Agents, Local↗
PubMed1995

Detection of peptidase activity from Treponema denticola, Porphyromonas forsythus, and Bacteroides forsythus as a means of periodontal therapy evaluation.

We have previously reported that the Periocheck test offers a rapid, simple periodontal diagnostic tool by detecting peptidase activity specifically attributed to Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus. Relationships between the peptidase activity detected by the Periocheck test and clinical measures were investigated. Fifty-seven Periocheck-positive sites selected from 27 patients with adult periodontitis were subjected to scaling and root planing. Two weeks later, a Periocheck test was undertaken in the test sites. Two groups were then determined, one composed of 40 Periocheck-positive sits, and the other consisting of 17 Periocheck-negative sites. All sites were re-examined at 6, 10, 14 and 18 weeks using both the Periocheck test and clinical measures. On week 18, the negative group displayed a significant decrease in probing pocket depth (PD) and a significant attachment level (AL) gain (2.1 and 1.2 mm, respectively), while the positive group showed a slight decrease in PD and AL gain (0.9 and 0.3 mm, respectively). The differences between negative and positive groups in PD and AL became statistically significant by the tenth week. Improvement of gingival index (GI) and bleeding on probing (BOP) was more apparent in the negative group. The detection of intrapocket microbiological status by the Periocheck test preceded the changes in PD, AL, GI, and BOP after periodontal therapy. In conclusion, the Periocheck test may provide a promising chairside monitoring tool for effectively evaluating therapies associated with scaling and root planing.

Bacterial Proteins↗
PubMed1997

Efficacy of a dentifrice and oral rinse containing sanguinaria extract in conjunction with initial periodontal therapy.

In the treatment of periodontal disease initial therapy aims at reducing marginal inflammation so allowing assessment of residual disease and further treatment options. The aim of the present study was to determine whether the use of a dentifrice and oral rinse containing sanguinaria extract led to a more rapid resolution of gingival inflammation following initial therapy. Thirty-four subjects, randomly assigned to one of two treatment groups, took part in this randomized double-blind parallel study. All subjects received initial therapy including oral hygiene instruction and scaling and root planing as required. One group also received an active dentifrice and oral rinse containing sanguinaria extract (an antiplaque agent) and zinc chloride. The other group received a placebo dentifrice and oral rinse. The gingival index (GI), plaque index (PLI) and probing pocket depths (PD) were recorded at six sites per tooth at baseline, two weeks after initial therapy and six weeks after initial therapy. There was no significant difference between the groups for any of the parameters at the baseline examination. Two weeks following initial therapy both groups showed a statistically significant increase in the number of sites with PLI of 0 or 1 (p < 0.0001) and a statistically significant increase in the number of sites with a GI of 0 or 1 (that is, no bleeding on probing), (p < 0.0001). Also there was a statistically significant increase in the number of sites with probing depths < or = 3 mm (p < 0.0001) compared with baseline. These changes were maintained through to six weeks post therapy. There was no significant advantage to the sanguinaria group. Results demonstrate that initial therapy in the form of oral hygiene instruction, scaling and root planing leads to a significant improvement in periodontal status which is maintained at least in the short term. Further, use of a dentifrice and oral rinse containing sanguinaria did not improve the efficacy of initial therapy.

Adult↗
PubMed2004

The effect of adjunctive low-dose doxycycline therapy on clinical parameters and gingival crevicular fluid matrix metalloproteinase-8 levels in chronic periodontitis.

BACKGROUND: Low-dose doxycycline (LDD) is recognized to have non-antimicrobial properties that can therapeutically modulate the host response. The aim of the present randomized, double-blind, placebo-controlled, parallel-arm study was to examine the effectiveness of LDD in combination with non-surgical periodontal therapy, compared to non-surgical periodontal therapy alone, on gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) levels and clinical parameters over a 12-month period in patients with chronic periodontitis. METHODS: GCF samples were collected, and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to a low-dose doxycycline (LDD) or placebo group. The LDD group received low-dose doxycycline (20 mg) b.i.d. for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. At each visit, all clinical measurements and GCF sampling were repeated. GCF MMP-8 levels were determined by a time-resolved immunofluorescence assay. Intragroup comparisons were tested by the Friedman test followed by Wilcoxon signed-rank test to analyze significance of changes over time. The Mann-Whitney test was used to determine differences between the LDD and placebo groups. RESULTS: Significant improvements were observed in all clinical parameters in both groups over the 12-month period (P < 0.0125). The LDD group showed a significantly greater reduction in mean PD scores at 9 and 12 months and in mean GI scores at all time points than the placebo group (P < 0.05). From baseline to 12 months, GCF MMP-8 levels were significantly reduced in both groups (P < 0.0125). The GCF MMP-8 level in the LDD group was significantly lower than that of the placebo group at 6 months (P < 0.05). CONCLUSIONS: The present results indicate that low-dose doxycycline therapy in combination with scaling and root planing can reduce GCF MMP-8 levels and improve clinical periodontal parameters in patients with chronic periodontitis. These results provide additional information about the usefulness of low-dose doxycycline therapy as an adjunct to non-surgical periodontal therapy in the long-term management of periodontal disease. The effectiveness and course of low-dose doxycycline therapy can be monitored conveniently by assessing GCF MMP-8 levels.

Adult↗
PubMed1991

Use of digital radiography to demonstrate the potential of naproxen as an adjunct in the treatment of rapidly progressive periodontitis.

The effect of the non-steroidal anti-inflammatory drug, naproxen, in reducing periodontal disease activity was assessed in 15 patients with rapidly progressive periodontitis. All patients in this double-blind study were treated with scaling and root planing. Thereafter, 7 patients receiving 500 mg naproxen b.i.d. for 3 months, and 8 patients received placebo. Disease activity was assessed in three ways. First, alveolar bone height was determined using standardized radiography. Second, alterations in alveolar bone metabolism were assessed using 99m-Tc-methylene diphosphonate uptake prior to dosing and 3 months later. Finally, bone loss or gain was detected using digital subtraction radiography. In this study, conventional subtraction images were processed to isolate the area of change and superimpose the change on the original radiograph. This allowed determination of both the direction and location of osseous changes. There was significantly less bone loss as determined by analysis of bone height during the 3-month study in the naproxen-treated patients when compared to the placebo-treated patients (p less than 0.001). Radiopharmaceutical uptake was significantly reduced in the alveolar bone in patients receiving naproxen (p less than 0.03), whereas no significant change was observed in the placebo-treated patients. Furthermore, the subtraction radiographs showed a significant increase in the proportion of teeth demonstrating bone gain in the naproxen-treated group. These findings indicate that naproxen may be a useful adjunct to scaling and root planing in patients with rapidly progressive periodontitis.

Adolescent↗
PubMed1985

Effect of subgingival scaling on systemic antibody responses to oral microorganisms.

The effects of scaling and root planing treatment on systemic antibody responses were studied in patients with periodontal disease and in normal subjects. Immunoglobulin G antibody in serum to a battery of oral microorganisms was assessed in an enzyme-linked immunosorbent assay before and after treatment in 31 individuals. The majority (96%) of the diseased patients exhibited elevated antibody to one or more of the microorganisms before the scaling regime. Significant increases in antibody levels in serum were noted in 16 of 19 patients after scaling, whereas only 2 of 12 nonscaled subjects showed similar changes during monitoring intervals of up to 3 years. The bacterial specificities of the increases were found to differ among the patients; however, a significant correlation to preexisting elevated antibody levels was observed. Peak levels of responses were noted at approximately 2 to 4 months posttreatment; antibody returned to pretreatment levels by 8 to 12 months. The predominant organisms for which changes were noted included the black-pigmented Bacteroides spp., Eikenella corrodens, Campylobacter concisus, and Actinobacillus actinomycetemcomitans. In 18 of 19 instances, the homologous microorganism was detected in the subgingival plaque when elevated antibody was present after treatment. These findings indicated that specific changes in host systemic responses accompany scaling and root planing treatment of periodontal disease patients. These alterations in the host response may provide an additional means by which successful therapy can be accomplished.

Actinobacillus↗
PubMed2004

The microbiological case for adjunctive therapy for periodontitis.

That chronic periodontitis is an infectious disease is now firmly established, and the primary role of Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola is generally accepted. Treatment by mechanical means such as scaling and root planing or surgery generally results in significant clinical improvement but may not arrest the progress or recurrence of disease. Several studies have shown that the probability of achieving lasting stability as measured by the arrest of progressive attachment loss and bone loss by primary mechanical therapy is a function, in major part, of whether pathogenic microorganisms are still present at local subgingival sites at the completion of active therapy. The infecting bacterial species are susceptible to killing by several antibiotics including, among others, tetracycline-class drugs, amoxicillin and metronidazole as well as by local exposure to chlorhexidine. Randomized clinical trials have shown that use of systemically administered antibiotics as an adjunct to mechanical therapies significantly enhances clinical outcomes and stability. Several slow-release devices that deliver anti-microbial drugs directly into periodontal pockets have been developed and are now on the market. Use of these devices permits local delivery of long-lasting, high concentrations of doxycycline (Atridox) minocycline (Arestin), and chlorhexidine (PerioChip) directly into periodontal pockets. Although these devices differ with regard to ease of use, concentration of drug delivered and length of time high drug concentrations can be maintained, randomized clinical trials have shown that their use as an adjunctive treatment to scaling and root planing results in a significantly greater reduction of periodontal pocket depth and an average increase in clinical periodontal attachment level of about 0.8 mm. Gain in clinical attachment is greater in deeper pockets than in shallower pockets. Locally delivered adjunctive anti-microbial therapy is an effective means to enhance therapeutic outcomes.

Anti-Bacterial Agents↗