Control of periodontal infections: A randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at treated sites

Objective To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery. Material and Methods One hundred and eighty‐seven patients were assigned to eight groups treated by SRP plus none, one, two or t...

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Published inJournal of clinical periodontology Vol. 39; no. 6; pp. 526 - 536
Main Authors Goodson, J. Max, Haffajee, Anne D., Socransky, Sigmund S., Kent, Ralph, Teles, Ricardo, Hasturk, Hatice, Bogren, Anna, Van Dyke, Thomas, Wennstrom, Jan, Lindhe, Jan
Format Journal Article
LanguageEnglish
Published Oxford Blackwell Publishing Ltd 01.06.2012
Blackwell
Subjects
Amoxicillin - therapeutic use
Analysis of Variance
Anti-Infective Agents - therapeutic use
Antibiotics
Biological and medical sciences
Cellulose - therapeutic use
Chemotherapy, Adjuvant
Chlorhexidine - therapeutic use
Clinical outcomes
Dental Scaling
Dentistry
Drug Combinations
Drug Delivery Systems
Facial bones, jaws, teeth, parodontium: diseases, semeiology
Female
Humans
Infections
Male
Maxillofacial surgery
Medical sciences
Metronidazole - therapeutic use
Middle Aged
Non tumoral diseases
Odontologi
Oral Surgical Procedures
Otorhinolaryngology. Stomatology
Periodontal Attachment Loss - therapy
periodontal disease
Periodontal Diseases - drug therapy
Periodontal Diseases - surgery
Periodontal Diseases - therapy
Periodontal Index
Periodontal Pocket - therapy
periodontal surgery
randomized controlled trial
randomized controlledtrial
Smoking - adverse effects
Tetracycline - therapeutic use
Treatment Outcome
Prognosis
Stomatology
Dentistry
randomized controlled trial
Infection
Antibiotic
Periodontal disease
Reduction
Treatment
periodontal surgery
Surgery
antibiotics
Gain
periodontal disease
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Summary:Objective To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery. Material and Methods One hundred and eighty‐seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole (SMA), local tetracycline delivery (LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level (CAL) and probing pocket depth (PPD) were statistically evaluated by ancova of main effects. Results Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24‐month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction. Conclusion Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed.
Bibliography:GCRC - No. RR00533; No. RR01032
istex:69AF8242561A4330530B102DA3AACEABAD78F83F
Table S1. Percentage (±SEM) of sites with visible plaque from American and Swedish patients averaging across all treatment groups. All differences were statistically significant.Table S2. Intent-to-treat analysis (n = 231). Factorial analysis of main effects, interactions and least squares means at 24 months of an intent-to-treat sample created by the principle of last value carried forward. Responses of periodontal surgery (SURG), systemically administered amoxicillin and metronidazole (SMA) and locally delivered tetracycline (LTC) on probe measurement change at sites with pockets >5 mm from baseline to 24 months. CAL1, PPD1 and BOP1 are baseline values of CAL, probing pocket depth and bleeding on probing respectively. Compared with the analysis of Table , the error terms are larger and the p-values of significant differences were smaller. The interpretation of results are comparable considering that 68% (30/44) of dropouts were scheduled to receive surgery, but did not.Table S3. Baseline differences of clinical parameters between subjects who dropped out of the study (n = 44) and those included in analysis (n = 187). Mean values and standard deviations are in millimetres (mm) and percentage of sites (%). No differences were statistically significant except for baseline redness which was found in 66.2% of included subjects and 84.4% of subjects that dropped out.
National Institute of Dental and Craniofacial Research - No. DE12861; No. RR025771
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ArticleID:JCPE1870
J. M. Goodson developed the tetracycline fiber used in this study between 1976 and 1994 when it was introduced. It has not been on the market since 2003. No other participants have any conflict of interest with any of the products tested in this study. This research was supported by the National Institute of Dental and Craniofacial Research grants DE12861 and RR025771, and GCRC funding from RR00533 and RR01032.
Conflict of interest and sources of funding statement
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-News-2
ObjectType-Feature-3
content type line 23
ISSN:0303-6979
1600-051X
1600-051X
DOI:10.1111/j.1600-051X.2012.01870.x