The use of systemic antibiotics in the treatment of refractory periodontitis: A systematic review.

BACKGROUND: The goal in treating refractory periodontitis (RP) is to arrest or slow disease progression, which usually has included the use of systemic antibiotics adjunct to conventional mechanical debridement. The aim of this systematic review was to evaluate the evidence that the association of systemic antibiotics with conventional mechanical debridement increases the efficacy of periodontal therapy in the treatment of RP. TYPES OF STUDIES REVIEWED: The authors searched for studies in PubMed MEDLINE, Cochrane Central Register of Controlled Trials, Thomson Reuters Web of Science, Scopus, Latin American and Caribbean Center on Health Sciences Information, and Scientific Electronic Library Online electronic databases by using selected key words from the earliest records up through October 31, 2014. Only clinical intervention studies in which investigators compared the treatment of participants with RP with either mechanical debridement alone or associated with systemic antibiotics were eligible for selection. Two authors independently assessed the risk of bias of each selected study. RESULTS: The authors identified 13 articles and included 6 of them. Investigators in all studies reported greater reductions in probing depth or in loss of clinical attachment level after adjunct systemic antibiotic therapy when compared with mechanical debridement alone. Antibiotics tested included metronidazole, clindamycin, tetracycline hydrochloride, amoxicillin, and amoxicillin and potassium clavulanate. Five studies presented a high risk of bias, and 1 study presented an unclear risk. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The overall quality of the evidence does not allow the conclusion that adjunct systemic antibiotics are of additional benefit to conventional mechanical debridement alone.

In Vitro Evaluation of Antimicrobial Photodynamic Therapy Associated with Hydroalcoholic Extracts of Schinopsis brasiliensis Engl.: New Therapeutic Perspectives.

OBJECTIVE: The aim of this study was to evaluate the photodynamic potential of extracts of Schinopsis brasiliensis Engl. on bacteria involved in several human infections. BACKGROUND DATA: Photodynamic therapy (PDT) involves the interaction of light with an appropriate and photosensitizer wavelength, and the prospect of existing photosensitive compounds in herbal extracts enhanced by the application of laser diode has been promising. METHODS: The antibacterial activity against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus faecalis was obtained by the disk diffusion method on agar. The laser diode InGaAIP was used with 660 nm wavelength, 100 mW, and 4 J/cm(2), and the application was performed in a timely manner for 34 sec on each disk tested. The groups tested were: Laser and bark extract (B+L+); bark extract only (B+L-); Laser and leaf extract (F+L+); leaf extract only (F+L-); Laser and malachite green (M+L+); malachite green only (M+L-); and laser only (L+). RESULTS: There were significant differences between the B+L- and B+L+ groups (p=0.029) and between the L+F- and L+F+ groups (p=0.029) at various concentrations of the nebulized extracts of bark and leaf. Among the tested pathogens, S. aureus showed the highest zone of inhibition, 24.55±0.36 mm in group B+L+, 500 mg.mL(-1). CONCLUSIONS: PDT with malachite green was effective, and groups B+L+ and F+L+ showed excellent activity on the bacteria tested, suggesting the presence of photosensitizers in extracts of S. brasiliensis Engl.