ABSTRACT
AIM: To evaluate the clinical non-inferiority of a 3-day protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared with a 7-day-protocol in patients with Stage III/IV Grade C periodontitis. MATERIALS AND METHODS: Fifty systemically healthy patients (32.7 ± 4.3 years) with aggressive periodontitis (AgP; Stage III/IV Grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole and were randomly assigned to Group A: (n = 25) 500 mg antibiotics (AB) 3 times a day for 3 days, followed by placebo 3 times a day for 4 days, or Group B: (n = 25) 500 mg AB 3 times a day for 7 days. Clinical, microbial, and immunological parameters were assessed at baseline, 3 months, and 6 months, and patient-related outcomes were assessed after 2 weeks. The primary outcome variable was the number of residual sites with pocket depth (PD) ≥6 mm at 6 months. RESULTS: For the primary outcome variable (the number of residual sites with PD ≥6 mm at 6 months), the null hypothesis was rejected and non-inferiority of the 3-day AB protocol compared with the 7-day AB protocol was demonstrated (the upper limits of the 95% confidence interval for intention to treat analysis: [-2.572; 1.050] and per protocol analysis: [-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 > .05). All investigated periodontopathogens and pro-inflammatory host-derived markers were statistically significantly reduced without differences between the treatments (p > .05). CONCLUSIONS: These findings indicate that in patients with AgP (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 with a 7-day-protocol.
Subject(s)
Aggressive Periodontitis , Anti-Bacterial Agents , Aggressive Periodontitis/drug therapy , Amoxicillin/therapeutic use , Dental Scaling , Humans , Metronidazole/therapeutic useABSTRACT
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).
Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5 ± 7.36 years old) with a total of 41 adjacent RT I (n = 23) and RT II (n = 18) gingival recessions exhibiting a minimum depth of 2 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 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.
Results: At 1 and 4 years, statistically highly significant (P < .001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05 ± 30.18% at 1 year to 56.79 ± 27.53% at 4 years. Complete root coverage was obtained in 18 gingival recessions at 1 year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4 years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P = .003). Mean width of attached gingiva increased statistically significantly (P < .05) from 2.85 ± 1.08 mm to 3.14 ± 1.08 mm at 1 year with a statistically significant decrease at 4 years. At 1 year, 78.05% of gingival recessions showed a root coverage > 50%, and 68.29% still exhibited a root coverage > 50% at 4 years.
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.
