Comparison of spiramycin and tetracycline used adjunctively in the treatment of advanced chronic periodontitis.

This study was designed to compare both clinical and microbiological changes during the treatment of advanced periodontal disease with mechanical debridement, with or without the adjunctive use of either spiramycin or tetracycline. The study, which included 96 patients with advanced periodontitis, was performed as a controlled double-blind parallel randomized trial. All patients received thorough scaling and root planing as well as adjunctive placebo or spiramycin or tetracycline. Probing depth measurements, attachment level changes, plaque level, gingival crevicular fluid, bleeding on probing and microbiological evaluation were carried out at baseline, 2-, 8-, 12- and 24-week visits. Seventy-nine patients (24 placebo, 27 tetracycline and 28 spiramycin) completed the study. At 24 weeks there were no intergroup differences in the improvement of any of the clinical parameters. Spiramycin was the only antibiotic which produced a significantly greater decrease in the proportion of spirochaetes than the placebo group at the 24-week visit. It was concluded that mechanical debridement alone was sufficient in decreasing the subgingival bacteria to a level which would result in the return to periodontal health. The study was not long enough to determine whether or not the difference in spirochaete level was an indication that the spiramycin group would have maintained the benefits of treatment for a longer time.

Reliability of attachment level measurements using the cementoenamel junction and a plastic stent.

Repeated measurements of attachment level appear to be important assessments in periodontal clinical trials, yet the lack of reliability for this assessment creates measurement error which in turn demands increased sample sizes or reduces the power of the test. A plastic occlusal stent has been developed as a fixed reference point to assess changes in probing depths over time and thus reflect differences in attachment levels. The advantages of this system over traditional methods have not been measured. The purpose of this study was to determine intra- and interexaminer reliability for probing depths from the stent and the CEJ. Paired measurements of attachment level using the stent produced correlation coefficients for inter- and intraexaminer readings of 0.84 and 0.76, respectively. For subgingival cementoenamel (CEJ) measurements, lower coefficients of 0.71 and 0.59 were found for inter- and intraexaminer paired readings, respectively. Thus, measurements using the stent appear to be more reliable than subgingival CEJ readings.